narkolepsian

Narkolepsian is an adjective used to describe aspects related to narcolepsy, a chronic neurological sleep disorder characterized by excessive daytime sleepiness and abnormal REM sleep phenomena. Narcolepsy is typically categorized into two main types: type 1, with cataplexy and often low orexin (hypocretin) levels; and type 2, without cataplexy and without confirmed orexin deficiency.

Core symptoms include persistent daytime sleepiness with sudden sleep attacks, cataplexy (loss of muscle tone triggered by emotion), sleep paralysis around sleep onset or awakening, and hypnagogic or hypnopompic hallucinations. Nighttime sleep is frequently fragmented.

Pathophysiology usually involves loss of orexin-producing neurons in the lateral hypothalamus, leading to instability of wakefulness and REM sleep. The condition has genetic associations, notably HLA-DQB1*06:02, and is thought to have autoimmune contributions in some individuals, with possible environmental triggers.

Diagnosis relies on history and sleep testing. Polysomnography followed by the multiple sleep latency test shows reduced mean sleep latency and often sleep-onset REM periods; low CSF orexin confirms type 1 when available.

Treatment is symptomatic and multidisciplinary. There is no cure. Management includes scheduled daytime naps, wake-promoting medications (modafinil or armodafinil; methylphenidate or amphetamines as needed), and sodium oxybate for symptoms and cataplexy. Antidepressants can help with cataplexy. Emphasis is on sleep hygiene, regular schedules, and safety considerations such as driving precautions.

Epidemiology and prognosis: Narcolepsy affects a small fraction of the population, usually beginning in adolescence or early adulthood. With treatment, many individuals experience improved functioning, though symptoms often persist.