The American Psychiatric Association (APA) Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-5) 9 also outlines diagnostic criteria, particularly for clinicians who are not experts in sleep medicine. The diagnostic criteria for narcolepsy are outlined in the AASM International Classification of Sleep Disorders – Third Edition (ICSD-3) 5. A surprising, yet common symptom of narcolepsy is substantial fragmentation in nocturnal sleep, which reduces the quality of sleep thus increasing the severity of daytime symptoms. Sleep paralysis is described as "the disturbing temporary inability to move voluntary muscles at sleep-wake transitions," usually occurring at the point of waking and less often at the point of falling asleep (p. Sleep paralysis and interrupted nighttime sleep are also very common, whereas hallucinations and automatic behaviors have been reported with less frequency 8. EDS is regularly accompanied by sleep attacks, which are abrupt involuntary sleep episodes lasting anywhere from a few seconds to several minutes 7. The severity of cataplexy episodes can range from mild weakness of facial muscles (e.g., drooping of eyelid) to a complete loss of tone in voluntary muscles 7.Įxcessive daytime sleepiness, the cardinal feature of narcolepsy, is also typically the first presenting symptom 3. Episodes of cataplexy develop over several seconds and individuals remain entirely conscious-a feature that differentiates them from seizures-regardless of the varying duration and intensity that have been reported. The National Institute of Neurological Disorders and Stroke termed cataplexy as a "sudden loss of muscle tone while the person is awake that leads to feelings of weakness and a loss of voluntary muscle control" (p. Na-1 results from a loss of cerebrospinal fluid (CSF) hypocretin-1 concentration and is accompanied by cataplexy, whereas Na-2 does not involve cataplexy or low levels of CSF hypocretin-1 5,6. CDH are largely characterized by excessive daytime sleepiness (EDS), which is a hallmark symptom of both Na-1 and Na-2. The two major forms of narcolepsy, as identified by the American Academy of Sleep Medicine (AASM)-Narcolepsy type 1 (Na-1) and Narcolepsy type 2 (Na-2)-are central disorders of hypersomnolence (CDH) 5,6. Prevalence rates are also consistent across countries, yet some studies conducted in Japan have indicated higher rates 3,4. There are no differences in rates of narcolepsy among men and women. For most individuals, symptoms present in the first two decades of life, typically prior to age 25 3. population, and 1 out of 2,000 persons worldwide, are living with narcolepsy 2. Narcolepsy is a lifelong neurological sleep disorder with potentially disabling symptoms that are developmental in nature 1. Narcolepsy Therapeutics Pharmacologic actions Behavioral medicine Psychosocial impact. The American Academy of Sleep Medicine's (AASM) Quality Measure Drivers and potential future treatment options are also discussed. Psychosocial factors, although frequently acknowledged, deserve further attention and awareness from researchers and providers. This article outlines evidence-based pharmacologic therapies, behavioral techniques, and psychosocial costs related to narcolepsy. Recent advances related to the neurobiological basis of narcolepsy have led to newer pharmacological treatment options and adjunctive behavioral techniques that support symptom management. Narcolepsy is a chronic neurological sleep disorder with potentially disabling symptoms ranging from occupational concerns to mental health difficulties.
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