A specialist sleep physician is a doctor who specialises in sleep medicine and is the best choice for diagnosing and treating Narcolepsy. When it comes to managing Narcolepsy, finding the right kind of doctor is of utmost importance. The expertise and experience of a knowledgeable physician can make all the difference in accurately diagnosing and effectively treating this complex sleep disorder.
At Manse Medical, we specialise in providing accurate diagnosis and personalised treatment for Narcolepsy. In this article, we’ll discuss the condition of Narcolepsy, as well as why our sleep experts are qualified to help you manage it.
What is Narcolepsy?
Narcolepsy is a neurological disorder characterised by excessive daytime sleepiness and a disruption in the sleep-wake cycle. People with Narcolepsy often experience an overwhelming sleepiness which can lead to sudden and uncontrollable episodes of falling asleep during the day, even in inappropriate or potentially dangerous situations.
What are its symptoms?
Narcolepsy manifests with a variety of symptoms that can significantly impact an individual’s daily life. Here is a list of common symptoms associated with Narcolepsy:
- Individuals with Narcolepsy experience persistent and overwhelming daytime sleepiness, often leading to an irresistible urge to sleep during the day.
- Narcolepsy is characterised by sudden and uncontrollable episodes of falling asleep, known as sleep attacks. These episodes can occur at any time, regardless of the person’s activity level.
- Cataplexy is a sudden loss of muscle tone triggered by intense emotions such as laughter, surprise, or anger. It can result in muscle weakness, slurred speech, drooping facial muscles, or even complete collapse.
- Narcolepsy can cause temporary paralysis upon waking up or falling asleep. During these episodes, individuals are unable to move or speak for a brief period, which can be distressing.
- Hallucinations that occur during the transition between wakefulness and sleep. They may involve vivid, dream-like experiences, visual disturbances, or auditory hallucinations.
- Many individuals with Narcolepsy experience fragmented and disrupted sleep at night, often waking up frequently or having difficulty maintaining continuous sleep.
- Some people with Narcolepsy may engage in automatic behaviours, where they continue with routine activities or tasks without conscious awareness during a sleep attack.
- Narcolepsy can affect cognitive function, leading to difficulties with concentration, memory recall, and overall mental alertness.
- Narcolepsy can sometimes lead to mental health concerns such as depression or anxiety. Collaborating with a psychiatrist can provide comprehensive care for both physical and mental well-being.
- In some cases, Narcolepsy may be associated with other sleep-related breathing disorders.
What are its risk factors?
While the exact cause of Narcolepsy remains unknown, several risk factors have been identified that may increase the likelihood of developing the condition. These risk factors include:
- Genetic Predisposition, with certain genes being associated with an increased susceptibility to the disorder. Having a family history of Narcolepsy can elevate the risk.
- Autoimmune Factors; as, in some cases, the immune system mistakenly attacks the cells responsible for regulating sleep and wakefulness.
- Narcolepsy with cataplexy, the most common form of Narcolepsy, is often associated with a deficiency of hypocretin, a chemical in the brain that helps regulate sleep. The exact cause of this deficiency is not fully understood.
- Narcolepsy typically starts during adolescence or early adulthood, although it can develop at any age. The condition often becomes apparent in the late teenage years or early twenties.
- Hormonal changes, such as those occurring during puberty or pregnancy, may trigger or exacerbate Narcolepsy symptoms in susceptible individuals.
- Certain infections have been linked to an increased risk of developing narcolepsy. It is believed that these infections may trigger an autoimmune response that leads to the destruction of hypocretin-producing cells.
What kind of doctor is best for Narcolepsy?
When it comes to Narcolepsy, the ideal doctor to consult is a specialist sleep physician. These healthcare professionals possess in-depth knowledge and experience in diagnosing and managing Narcolepsy. As narcolepsy is a neurological sleep disorder, it can also be helpful to work with a neurologist who is experienced in assessment of this condition, particularly if there are unusual clinical features that may suggest epilepsy or another neurological diagnosis. A sleep physician will often work with a neurologist in those situations.
How do these doctors diagnose Narcolepsy?
Sleep medicine specialists use a combination of clinical evaluations, sleep studies, and other diagnostic tests to diagnose Narcolepsy. The diagnostic process typically involves the following steps:
Medical History and Symptom Evaluation
The doctor will begin by conducting a detailed medical history interview, discussing the patient’s symptoms, their frequency, and their impact on daily life. They may ask about excessive daytime sleepiness, sudden loss of muscle tone (cataplexy), sleep paralysis, hallucinations, and disrupted nighttime sleep.
Epworth Sleepiness Scale
The Epworth Sleepiness Scale is a questionnaire that assesses daytime sleepiness. Patients rate their likelihood of dozing off or falling asleep in various situations, providing a numerical score that helps gauge the severity of excessive daytime sleepiness.
Polysomnography (PSG)
Polysomnography is an overnight sleep study that monitors brain activity, eye movements, muscle tone, heart rate, and other physiological parameters while the patient sleeps. PSG helps identify disruptions in sleep architecture and may reveal underlying sleep disorders that contribute to excessive daytime sleepiness.
Multiple Sleep Latency Test (MSLT)
The MSLT is conducted during the day following a PSG. It measures the patient’s tendency to fall asleep and assesses their sleep onset REM periods (SOREMPs). Multiple nap opportunities are provided, and the time it takes to fall asleep and enter REM sleep is recorded. Frequent SOREMPs and shorter sleep latency durations can be indicative of Narcolepsy.
Other Diagnostic Tests
In some cases, additional tests may be performed to rule out other possible causes of symptoms or to gather further information. These may include genetic testing, and occasionally, specialised imaging studies like a brain MRI. Cerebrospinal fluid (CSF) testing is done in some centres overseas and may occasionally be requested as part of the assessment of narcolepsy in Australia.
How do these doctors treat Narcolepsy?
Sleep medicine specialists employ a multifaceted approach to treat Narcolepsy, aiming to alleviate symptoms and improve overall quality of life. The treatment plan is typically tailored to the specific needs and symptoms of each patient. Here are some common strategies used in Narcolepsy management:
Medication
Various medications are prescribed to address the different symptoms of narcolepsy.
- Stimulants, such as Modafinil, armodafinil, dexamfetamine or methylphenidate, are commonly used to combat excessive daytime sleepiness.
- Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) or norepinephrine reuptake inhibitors (NRIs), may be prescribed to help manage cataplexy and regulate REM sleep.
- Sodium oxybate is another medication used to improve nighttime sleep and reduce cataplexy, but access to this medication is very difficult and expensive in Australia.
- Other medications that are available overseas, including pitolisant and solriamfetol, are not currently available in Australia.
Lifestyle modifications
Making certain lifestyle changes can greatly support Narcolepsy management. Sleep hygiene practices, including maintaining a consistent sleep schedule, creating a sleep-friendly environment, and avoiding stimulants before bedtime, can help improve sleep quality. Regular exercise, a balanced diet, and stress management techniques can also contribute to overall well-being.
Behavioural therapies
Counselling and cognitive-behavioural therapy (CBT) techniques can be beneficial for individuals with narcolepsy, but it is important to make sure that the therapist is familiar with the condition. CBT for insomnia (CBT-I) can help address sleep difficulties where these are present. These therapies can assist individuals in developing effective sleep routines, managing stress, and adapting their behaviours to better accommodate Narcolepsy symptoms.
Education and support
Providing education about Narcolepsy and its management is crucial. Doctors may offer guidance on understanding triggers, recognising early warning signs of sleep attacks, and implementing strategies to minimise risks associated with excessive daytime sleepiness. Support groups such as ‘Narcolepsy Connect’ can also play a significant role in offering emotional support and connecting individuals with Narcolepsy to a community of people facing similar challenges. Click here to learn more about the program.
Regular follow-up and monitoring
Narcolepsy is a chronic condition that requires ongoing care. Doctors will schedule regular follow-up appointments to assess treatment effectiveness, monitor symptoms, and make any necessary adjustments to the treatment plan. This ensures that the management approach remains optimised and aligned with the individual’s changing needs.
Why is it important to seek diagnosis and treatment for Narcolepsy?
Seeking timely diagnosis and treatment for Narcolepsy is crucial for several reasons:
Improved quality of life
Narcolepsy symptoms, such as excessive daytime sleepiness, cataplexy, and disrupted nighttime sleep, can significantly impair daily functioning and overall quality of life. With proper diagnosis and treatment, symptoms can be effectively managed, allowing individuals to experience improved wakefulness, better sleep, and enhanced cognitive function.
Safety and accident prevention
Excessive daytime sleepiness associated with Narcolepsy increases the risk of accidents, particularly while driving or operating machinery. Prompt diagnosis and appropriate treatment can help mitigate this risk, ensuring the safety of both the individual with Narcolepsy and others around them. Individuals with narcolepsy must report this diagnosis to the motor vehicle licensing authority in their state, and will need confirmation from their sleep physician that they meet national standards for fitness to drive.
Academic and professional success
Narcolepsy symptoms can interfere with academic performance, professional productivity, and career advancement. With proper treatment, individuals with narcolepsy can better manage their symptoms, improving concentration, alertness, and overall performance in educational and professional settings.
Prevention of complications
People with narcolepsy have higher rates of diabetes, obesity, heart disease and mental health issues. Timely diagnosis and treatment can help minimise the risk and impact of these complications, promoting better long-term health outcomes.
Emotional well-being and social life
Narcolepsy can have a profound impact on an individual’s emotional well-being and social interactions. Feelings of embarrassment, anxiety, and isolation may arise due to unpredictable sleep attacks, cataplexy episodes, and the challenges of managing the condition. By seeking appropriate diagnosis and treatment, individuals can receive the support needed to cope with these emotional challenges and maintain satisfying relationships and social connections.
Understanding and coping strategies
Diagnosis provides individuals with Narcolepsy the opportunity to gain a better understanding of their condition. It allows them to learn about Narcolepsy, its symptoms, triggers, and management strategies. Through proper treatment, healthcare providers can guide patients in developing effective coping mechanisms, lifestyle adjustments, and self-care practices tailored to their specific needs.
Where can I go for effective Narcolepsy treatment?
At Manse Medical, we provide both high quality diagnosis and treatment for sleep disorders such as Narcolepsy. We take a personalised approach that focuses on your medical history and background, in order to provide you with a complete treatment plan that addresses your concerns and helps you effectively manage your symptoms. Book your appointment online by selecting your preferred clinic and choose from the list of our available specialists. We also offer support services for those recently diagnosed and this program is called Narcolepsy Connect. Click here to learn more.
