July 07, 2007

Narcolepsy, Restless Legs Syndrome (RLS


Narcolepsy is a chronic, neurological sleep disorder with no known cause. It involves the body's central nervous system. Narcolepsy is a genetic disorder, but what causes narcolepsy is not yet known.

The main characteristic of narcolepsy is excessive and overwhelming daytime sleepiness, even after adequate nighttime sleep. A person with narcolepsy is likely to become drowsy or to fall asleep at inappropriate times and places, and sleep attacks may occur with or without warning.

Attacks can occur repeatedly in a single day, drowsiness may persist for long periods of time, and nighttime sleep may be fragmented with frequent awakenings.

What are the symptoms of narcolepsy?
excessive daytime sleepiness (EDS) - an overwhelming desire to sleep at inappropriate times

cataplexy - a sudden loss of muscle control ranging from slight weakness to total collapse

sleep paralysis - being unable to talk or move for about one minute when falling asleep or waking up

hypnagogic hallucinations - vivid and often scary dreams and sounds reported when falling asleep

Secondary or auxiliary symptoms include:

automatic behavior - performing routine tasks without conscious awareness of doing it and often without memory of it
disrupted nighttime sleep, including multiple arousals
Other difficulties that may be caused by primary symptoms side effects of medication or result from one's continuing struggle to cope, including:

feelings of intense fatigue and continual lack of energy
difficulty in concentrating and memorizing
vision (focusing) problems
eating binges
weak limbs
difficulties in handling alcohol

How is narcolepsy diagnosed?
In addition to a complete medical history and physical examination, diagnostic procedures may include:

combination of excessive daytime sleepiness (EDS) and cataplexy provide preliminary clinical diagnosis

laboratory tests - to confirm diagnosis and plan treatment, including:
overnight polysomnogram (PSG) - to determine the presence of excessive daytime sleepiness ( EDS) and perhaps other underlying causes of this symptom

Multiple Sleep Latency Test (MSLT) - to measure sleep onset and how quickly rapid eye movement (REM) sleep occurs

genetic blood test - to measure certain antigens often found in people who have a predisposition to narcolepsy

How is narcolepsy treated?
Specific treatment will be determined by your doctor(s) based on:

your age, overall health and medical history
extent of the disease
your tolerance for specific medications, procedures or therapies
expectations for the course of the disease
your opinion or preference

The goal of treatment of narcolepsy is for the patient to remain as alert as possible during the day and to minimize any recurring episodes of cataplexy while using a minimal amount of medication.

medications - excessive daytime sleepiness and cataplexy are treated separately, with central nervous system stimulants usually prescribed for excessive daytime sleepiness ( EDS) and tricyclic antidepressants for cataplexy

nap therapy - two or three short naps during the day to help control sleepiness and maintain alertness
proper diet
regular exercise

Restless Legs Syndrome (RLS)

Restless legs syndrome (RLS) is a sleep disorder in which a person experiences unpleasant sensations in the legs, which are described as:


These sensations usually occur in the calf area, but may be felt anywhere from the thigh to the ankle. One or both legs may be affected; for some people, the sensations are also felt in the arms. People with RLS have an irresistible urge to move the the affected limb when the sensations occur.

Some patients, however, have no definite sensation except for the need to move. Sleep problems are common with RLS because of the difficulty it causes in getting to sleep.

What causes RLS?
The cause of RLS is still unknown. Some cases are believed to be inherited, some cases have been associated with nerve damage in the legs due to diabetes, kidney problems or alcoholism. RLS can also be a side effect of a pinched nerve root in the lower back.

What are the symptoms of RLS?
Sensations occur when the person with RLS lies down or sits for prolonged periods of time, causing:

the need to move the legs for temporary relief of symptoms by:
stretching or bending
rubbing the legs
tossing or turning in bed
getting up and pacing
a definite worsening of the discomfort when lying down, especially when trying to fall asleep at night, or during other forms of inactivity, including sitting
a tendency to experience the most discomfort late in the day and at night

Adapted from: University of Maryland Medical Center (UMMC)