Narcolepsy: awakening to an underestimated reality
DOI:
https://doi.org/10.25118/2236-918X-7-3-4Keywords:
Narcolepsy, cataplexy, hypersomnolence, hypocretin (orexin), hallucination, sleep paralysisAbstract
Narcolepsy is an underestimated disease that takes about 10 years to be diagnosed. The objective of the present study was to raise the awareness of physicians in general, and psychiatrists in particular, about the importance of considering narcolepsy in their patients in daily clinical practice. The negative impact of narcolepsy on quality of life is significant and comparable to that of epilepsy or schizophrenia. Diagnosis is characterized by the presence of five cardinal symptoms: excessive daytime sleepiness; cataplexy; sleep paralysis; hallucinations; and fragmentation of nocturnal sleep. The multiple sleep latency test is used after a baseline polysomnography to confirm diagnosis. Associated depression, bipolar and anxiety disorders are highly prevalent in patients with narcolepsy. Patients with narcolepsy are treated with stimulants and low doses of antidepressants. Interestingly, the abrupt withdrawal of antidepressants can cause a transient syndrome similar to cataplexy. Another common finding in patients with narcolepsy is REM sleep behavior disorder after the use of antidepressants. The use of psychostimulants, employed in narcolepsy for excessive daytime sleepiness control, can be accompanied by paranoid psychosis, similar to schizophrenia. The diagnosis, treatment, and management of narcolepsy associated with comorbidities are a challenge and should be given due consideration.
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