Narcolepsy is a chronic disorder that presents as a disruption of sleep-wake cycles in individuals who are asleep. People with narcolepsy experience issues with daytime and nighttime sleeping that are associated with disturbances in REM sleep (rapid eye movement). The most common symptoms of narcolepsy include:
It is not unusual for individuals with narcolepsy to experience weight gain once the disorder develops.
In most cases, the symptoms of narcolepsy will typically appear between childhood and young adulthood (most often between the ages of 7 and 25).
Some genetic associations have been made; however, it appears that the majority of cases of narcolepsy have little or no family history, which would suggest that genetic associations do not play a major role in the development of these cases. There have been cases where brain injuries have resulted in the development of narcolepsy in some individuals; however, most cases of narcolepsy do not have a history of traumatic brain injury.
Narcolepsy can only be diagnosed by a physician. None of the above major symptoms are diagnostic of narcolepsy, although cataplexy is often used to diagnose narcolepsy or at least to warrant further investigation. Typically, the diagnostic process consists of:
Although narcolepsy is considered a neurological disorder, it is also assessed and treated by psychiatrists, and it has numerous psychological features associated with it. There is no cure for narcolepsy, but the United States Food and Drug Administration has approved several medications for the treatment of narcolepsy:
Certain antidepressant medications also appear to be effective in controlling excessive daytime sleepiness and cataplexy, particularly tricyclic antidepressants (e.g., desipramine) and certain selective serotonin reuptake inhibitors (e.g., Prozac and Effexor). Antidepressants often have less severe side effects than stimulants; however, they do have their own side effect profile that can include weight gain, issues with sexuality, and high blood pressure. Certain behavioral interventions can also be helpful, such as avoiding caffeine or alcohol, maintaining a regular sleep schedule, and engaging in stress reduction and relaxation techniques. Of course, there are ongoing clinical trials investigating the uses of other medications in the treatment of narcolepsy.
Because of the severe stress that individuals with narcolepsy experience, there is also the potential for development of other psychological issues, such as depression, anxiety, issues of adjustment, etc. In addition, individuals with sleep disorders do appear at risk to develop substance use disorders.
There has been quite a bit of research that has investigated the association between sleep disorders such as narcolepsy and substance abuse. A number of studies have looked at different associations between symptoms of narcolepsy and impulsiveness, which suggest an increased probability to engage in risk-taking behavior, such as substance abuse.
For instance, one study published in the Journal of Clinical Sleep Medicine found that individuals who are diagnosed with narcolepsy and had cataplexy were significantly more impulsive than individuals who did not have cataplexy. A study reported in the journal Psychiatry found that a significant number of a small sample of individuals with sleep disorders also reported having substance use disorders, particularly alcohol use disorders, polysubstance abuse, and narcotic use disorders. About half of the sample reported using drugs to induce sleep or to assist with sleep issues.
A few of the drugs used to treat narcolepsy, such as Provigil, antidepressant medications, and Nuvigil, are considered to be low-risk drugs for abuse; however, other amphetamines, methylphenidate, and sodium oxybate are known to have higher potentials for abuse. Nonetheless, individuals who take these medications under the supervision of a physician and within the confines of a prescription appear to avoid developing significant issues with substance abuse; however, individuals who get them illegally or doctor shop for more medications are more prone to develop issues with substance use disorders.
At this time, there does not appear to be a large body of reliable research specifically investigating the rates of co-occurring narcolepsy in substance use disorders despite the connection between sleep disorders and substance abuse; however, it is certain that individuals who are not formally involved in treatment for narcolepsy are at risk to develop a substance use disorder based on the aforementioned studies.
Individuals with these co-occurring diagnoses require integrated treatment, which involves a multidisciplinary team approach to treatment that includes the following: