Narcolepsy is a relatively common but unknown sleep disorder that has many symptoms, including excessive sleepiness and

automatic sleep attacks. Afflicted may have strange sleep schedules and intruding feelings of drowsiness throughout the day, even after an adequate amount of sleep. These individuals are also typically able to fall into the REM stage of sleep much quicker than the average population. Many individuals that suffer from narcolepsy also have another disease called cataplexy. Cataplexy is defined as the sudden loss of muscle tone. This sudden loss is often triggered by strong emotions like laughing or crying. The weakness of muscle ranges anywhere from a small loosening of the facial muscles to a full collapse. While those with cataplexy could potentially fall asleep during these attacks, those episodes of sleep are not related to narcoleptic ones. There are many tests to see if one has narcolepsy. The most used test is the Multiple Sleep Latency Test (MSLT). In this test, the patient sleeps in increments of 20 minutes with two hours between each sleep event. Data is monitored during this test, including brain waves, eye movements, and brain activity. Periodically, it is difficult to discern if a patient has narcolepsy or not from the MSLT. In this case, it is more wise to do a repeat (or repeats, if needed) than to attempt other tests, as they are not nearly as accurate. In a study by the University of Toronto, Canada, it was discovered that just a single repeat MSLT would confirm a diagnosis of narcolepsy that a first test had not completely confirmed. Another common test is the polysomnogram, which is a recording of brain waves as well as muscle and nerve functions taken while the patient is asleep. It can quickly confirm if a patient has entered REM, which, depending on how long it takes to get to the REM stage, can be a good indicator on whether or not the patient has narcolepsy. Recent studies have uncovered a link between narcolepsy and to a produced protein called hypocretin. Hypocretin, also called orexin, is responsible for managing sleep patterns. Sufferers are usually found to have less of the neurons that produce this protein. When hypocretin levels are low, sleep balance is hard to maintain and people may face irregular sleep patterns. This is simply because there are too little hypocretin proteins to properly keep the schedule intact. Another, more recent, study suggests that there may be a link with the influenza virus, specifically H1N1. There was a large increase in the number of narcoleptic children in Finland following the H1N1 scare of 2009. In 2010, 54 children were diagnosed with narcolepsy. Out of these 54, 50 of them had been vaccinated up to 242 days before symptoms began showing. They had been vaccinated by a popular H1N1 vaccination at the time. In China, also at the same time, was a growth of the number of narcoleptics. This group is different from the Finland group in that only a few had gone in for a vaccination. Out of 142 patients that had developed narcolepsy, only eight had received an H1N1 vaccination. This is explained by the fact that many of these Chinese had been victims of H1N1 previously. The onset of narcolepsy had positively correlated with the H1N1 infection (as well as other, lesser known upper airway infections). The other large link between H1N1 and narcolepsy is one of the respiratory system. Any upper airway infection, which includes H1N1, has been shown to lead to a immune response that will cause the brain to lose hypocretin-producing neurons. Following this, it is also believed that breathing problems that narcoleptics have are linked to a hypocretin deficiency. Narcolepsy can not only introduce, but also tend to, other sleep-related problems. Narcoleptics commonly suffer from sleep paralysis, which is when the body is asleep but the mind is awake. Typically, sufferers are fully aware of their surroundings and are conscious, but their bodies are unable to move. These episodes can last anywhere from seconds to hours and can be extremely frightening to those that experience them. Narcoleptics are also able to have more believable dreams. For many, hallucinations are a normal part of life simply because dreams and the real world are difficult to distinguish. Many narcoleptics can use all of their senses in dreams similar to how they could be used in real life. For example, smelling a flower would not just evoke a similar smell and emotion like it

would to a normal person. Smelling a flower would be the full experience of doing so in real life to a narcoleptic, complete with the smell and physical feelings that smelling something would introduce. Physically, there are other problems that can be serious to narcoleptics. There is a large correlation between having narcolepsy and having some sort of sleep-disordered breathing problem. Since there are studies that show a link between upper airway problems and narcolepsy, it is easy to see the parallel between two of these disorders. Out of 102 narcoleptics, 29 were sufferers of an obstructive sleep breathing disorder. This disease is one that, if not properly attended to, can lead to serious problems, not only physically, but mentally as well. Narcolepsy typically appears during adolescence, which is a difficult time for many people. Common side effects to narcoleptics include seemingly uncontrollable weight gain, social difficulties, irritability, frustration, and overall difficulties in concentration. Due to these problems, many afflicted adolescents turn to substance use. Many use illegal substances just to keep them awake, unaware of the problems associated with them. Recently, though, there has been evidence to support that nicotine may somehow lower the incidence of sleep attacks or other narcoleptic episodes. Recent work has introduced the role of hypocretin in drug addiction. Hypocretin could have a link to quite a few aspects of addiction, including reinstatement and dependence. Hypocretin could quite possibly influence the states that influence addiction, which could help explain why so many narcoleptics turn to drugs in the first place. Even so, it is difficult to tell exactly how much of an influence hypocretin has on drug addiction to a narcoleptic, especially with the amount of hypocretin being so small compared to a healthy person. Narcoleptic social difficulties can be destructive to a personality, since they, on average, face a harsher world than the unaffected. Narcoleptics have higher health-related costs (including doctor visits and insurance costs), a higher chance of dabbling in medications, and an overall higher cost of living. They also have to deal with lower employment rates, lower income, and less actual on-the-job hours. These problems can exist long before a narcoleptic is actually ever diagnosed. According to one study, these consequences had been found 11 years prior to the first diagnosis. The situations only worsened or became more prevalent as time went on. There are only a limited number of treatments available, and the majority of these do not target the problem directly. Most are just stimulants that activate the transmission of dopamine in the brain. Anti-depressant medication and therapies are also effective in the treatment of symptoms, as the constant transmission of adrenaline keeps users awake and alert to the point where sleep attacks and drowsiness episodes are much less likely to happen. Behavioral and schedule therapies are also common approaches to helping the problem, and, much of the time, are paired together. Trying to do studies in aversive conditioning showed disheartening results. Unmedicated narcolepsy patients had no response in the amygdala to the conditioned stimuli. More recently, studies in using GHB (Gamma-hydroxybutyrate) to treat symptoms have happened. These studies show that using GHB is a decent treatment for sleep attacks, but not for other symptoms. Daytime sleepiness and sleep attacks were removed for many sufferers, but overall sleep times, length of night sleeping, and length of sleep cycles had no changes. A barrier to treatment is the fact adult and child research does not have much in common. Since children are still developing, brains are tougher to gauge in their possible potential. As far as the future holds, hypocretin replacement is a very popular therapy idea that could have the potential to cure most, if not all, problems related to this disease. Works Cited DiLeone, R., Sarhan, M., and Sharf, R. 2011. Orexin/Hypocretin, Drug Addiction, and Narcolepsy.

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