Narcolepsy is a sleep disorder. The exact cause of this disease is yet to be known. It is a very rare disease. The main complaint is that there is extreme sleepiness in the daytime in this disease. The patient also complains of difficulty falling sleep at night. Such people find it difficult to cope with daily activities. They find it difficult to focus in school, at home, at work, and at social events or gatherings because they suffer from tiredness due to improper sleep at night. There is no cure for narcolepsy, but few lifestyle changes and medications can make it easier to reduce the symptoms.(1)
Does Narcolepsy Make It Hard To Wake Up?
Narcolepsy is a chronic condition that mainly interferes with the ability of the brain to control the sleep and wake cycle. The main symptom of such patients is extreme daytime sleepiness. The patient does not have a problem in waking up but has a problem to stay awake throughout the day. During the night also, the patient has trouble staying asleep and wakes up a lot of times in the middle of the night. In the daytime, the patient may fall asleep unknowingly while working or driving or talking or eating.
Along with daytime sleepiness, the patient also experiences loss of muscle tone suddenly and this leads to a feeling of weakness and the person is unable to use muscles voluntarily. This is called cataplexy. Cataplexy is sometimes triggered by certain strong emotions like anger, stress, fear, laughter, etc. Cataplexy may take weeks or even years to show up after narcolepsy is diagnosed. The frequency of occurrence of cataplexy attacks is not stagnant. Some people might experience two to three attacks in their lifetime while others might experience many attacks of cataplexy in one single day. Cataplexy attack occurs in certain muscles only but not in all muscles. The attack lasts for some time and it is usually mild in nature. In cataplexy, the patient does not lose consciousness, while in other disorders like convulsions, seizure disorders, etc. the patient loses consciousness. This is the differentiating feature between cataplexy and other seizure disorders. The attacks of cataplexy are not very harmful as they go away instantaneously on their own after lasting for a few minutes. The attack may be mild and may cause very minor symptoms like drooping of eyelids are a few minutes.
Sometimes the attack may be severe and the patient may not be able to move his/her body or perform any function for a few minutes. When this happens the patient cannot speak, move or even open eyes. But the patient retains consciousness during this attack.(2)
Pathophysiology Of Narcolepsy
Hypocretin, which is also known as orexin, is a neuropeptide that functions in the brain. Neuropeptides are small protein-like molecules that are used by neurons to communicate amongst each other. This neuropeptide hypocretin works for the regulation of wakefulness. There are more than billions of cells in the brain but amongst them only around ten to twenty thousand neurons are able to secrete hypocretin. When there is loss or deficiency of these neurons that produce hypocretin, it results in narcolepsy. It has been found that people with narcolepsy have less number of these hypocretin-producing neurons in their brain. In narcolepsy, the patient goes into REM sleep straight away after being awake and there might be little non-REM sleep in between. In the REM sleep, the skeletal muscles go into total atonia due to hyperpolarization of alpha motor neurons in the spinal cord and brainstem. It has been seen that acetylcholine (a neurotransmitter) has been involved in this pathway to cause atonia of muscles. The reason why these hypocretin-producing neurons die is not known yet but some studies suggest it may be due to abnormalities in the immune system. It has also been seen that narcolepsy occurs in a seasonal pattern too. It is seen more in the summer and spring seasons because these are the seasons when people get sick the most.(2), (3)
Narcolepsy does not make it difficult to wake up but the patient faces more problems after waking up because of daytime sleepiness. The patient feels very sleepy throughout the day and may also suffer from sleep attacks where the patient falls asleep involuntarily anytime and anywhere. The only problem while getting up is that the patient may suffer from sleep paralysis and may be unable to move for a few minutes after waking up.