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Is narcolepsy an autoimmune disease


Narcolepsy confirmed as autoimmune disease

Results also partly explain why the 2009 swine flu virus, and a vaccine against it, led to spikes in the sleep disorder.

Nerve cells (red) that act as receptors for hypocretins, hormones that regulate the sleep cycle, are attacked by the immune system in narcolepsy patients. Credit: C.J.Guerin, MRC Toxicology Unit/ Science Photo Library

As the h2N1 swine flu pandemic swept the world in 2009, China saw a spike in cases of narcolepsy — a mysterious disorder that involves sudden, uncontrollable sleepiness. Meanwhile, in Europe, around 1 in 15,000 children who were given Pandemrix — a now-defunct flu vaccine that contained fragments of the pandemic virus — also developed narcolepsy, a chronic disease.

Immunologist Elizabeth Mellins and narcolepsy researcher Emmanuel Mignot at Stanford University School of Medicine in California and their collaborators have now partly solved the mystery behind these events, while also confirming a longstanding hypothesis that narcolepsy is an autoimmune disease, in which the immune system attacks healthy cells.

Narcolepsy is mostly caused by the gradual loss of neurons that produce hypocretin, a hormone that keeps us awake. Many scientists had suspected that the immune system was responsible, but the Stanford team has found the first direct evidence: a special group of CD4+ T cells (a type of immune cell) that targets hypocretin and is found only in people with narcolepsy.

“Up till now, the idea that narcolepsy was an autoimmune disorder was a very compelling hypothesis, but this is the first direct evidence of autoimmunity,” says Mellins. “I think these cells are a smoking gun.” The study is published today in Science Translational Medicine1.

Thomas Scammell, a neurologist at Harvard Medical School in Boston, Massachusetts, says that the results are welcome after “years of modest disappointment”, marked by many failures to find antibodies made by a person's body against their own hypocretin. “It’s one of the biggest things to happen in the narcolepsy field for some time. ”

Loose ends

It is not clear why some people make these T cells and others do not, but genetics may play a part. In earlier work2, Mignot showed that 98% of people with narcolepsy have a variant of the gene HLA that is found in only 25% of the general population.

Environmental factors, such as infections, probably matter too. Mellins’ working model is that narcolepsy happens when people with a genetic predisposition, which involves having several narcolepsy-related gene variants, encounter an environmental factor that mimics hypocretin, triggering a response from the immune system. The 2009 h2N1 virus was one such trigger: the team found that these same special CD4+ T cells also recognize a protein from the pandemic h2N1 virus.

Narcolepsy of course was around long before the 2009 pandemic. And since new cases of the disease tend to arise right after winter — following the seasonal peak in flu — it's possible that other strains or even other viruses are involved, too.

But the results do not fully explain the Pandemrix mystery, because other flu vaccines contained the same proteins but did not lead to a spike in narcolepsy cases. Regardless, Mellins says that it should be possible to avoid repeating the same mistake by ensuring that future flu vaccines do not contain components that resemble hypocretin.

Another loose end is that “they don’t show how these T cells are actually killing the hypocretin neurons”, adds Scammell. “It’s like a murder mystery and we don’t know who the real killer is.” He thinks that it is unlikely that the T cells are the true culprits; instead, they could be acting through an intermediary, or might merely be a symptom of some other destructive event.

“The results are very important, but they need to do a replication study in a large group of patients and controls,” says Gert Lammers, a neurologist at Leiden University Medical Center in the Netherlands and president of the European Narcolepsy Network. “If the findings are confirmed, the first important spin-off might be the development of a new diagnostic test. ”

Autoimmunity in narcolepsy - PMC

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The information provided on this page should not be used for self-treatment or self-diagnosis. If you suspect a disease, you should seek help from a qualified specialist. Only your doctor can diagnose and prescribe treatment.

Article content:

  • Causes
  • Symptoms of narcolepsy
  • Diagnostics
  • Narcolepsy treatment
  • Prognosis and prevention

What is narcolepsy?

Narcolepsy is a pathological condition characterized by an inability to control sleep and wakefulness. Sudden onset of excessive daytime sleepiness and other symptoms of narcolepsy can occur at any time, even in situations that require extreme concentration, such as driving. The risk group for the development of narcolepsy is men, the frequency of cases is 1 in 2 thousand people. But there is an opinion that the prevalence is higher due to the fact that not all patients do not seek medical help and treatment. Narcolepsy Source:
description of the clinical observation. Remizevich R.S., Kurasov E.S. Bulletin of the National Medical and Surgical Center. N. I. Pirogova, Volume 8, No. 4, 2013. pp. 141-145 - not a fatal pathology, but accidents still happen during attacks.

Causes

The exact causes of narcolepsy are unknown, although it has been established that heredity plays a role, as well as a lack of the neurotransmitter orexin, which is responsible for wakefulness.

REM sleep literally invades the periods of wakefulness and the transition to sleep. Symptoms of narcolepsy are associated with a sharp loss of muscle tone, the appearance of vivid visions, which are just characteristic of the phase of REM sleep.

It was not possible to establish the exact reasons for the decrease in the production of the neurotransmitter, but the predisposing factors for the development of the pathology were identified:

  • serious craniocerebral injuries and their consequences;
  • infectious diseases affecting the nervous system Source:
    Autonomic disorders in narcolepsy (review of foreign literature). Golokov V.A., Nikolaeva T.Ya., Schneider N.A., Kantimirova E.A. Medical Almanac No. 5(45), 2016. pp. 165-168;
  • pronounced hormonal changes;
  • autoimmune diseases;
  • chronic stress and severe emotional upheaval;
  • nervous and physical exhaustion.

As a rule, the development of a disease requires the combined action of several factors at once. Great importance in the mechanism of the development of the state is given to the work of immunity. An immune response is triggered, as a result of which its own cells are mistakenly destroyed, which leads to the onset of symptoms.

Symptoms of narcolepsy

The most common symptom is excessive daytime sleepiness, as well as persistent sleep disturbances at night. This creates inconvenience, spoils the quality of life, affects success in work and social relations.

Over time, the clinical picture changes, other signs join:

  • The first and most common symptom is sudden falling asleep during the day. Drowsiness is severe, patients fall asleep against their will, even in unsuitable surroundings. But after waking up, they feel a surge of strength, there is no drowsiness. This state can be deceptive - after a short time they fall asleep again. At the same time, waking up the patient is no more difficult than during normal sleep.
  • Cataplexy Source:
    Narcolepsy with prepubertal onset cataplexy. Gromova D.O., Zinovieva O.E., Rogovina E. G., Poluektov M.G. Neurological journal No. 4, 2012. pp. 22-27 - sudden muscle weakness after strong emotional outbursts. The resulting weakness can be explained by a sharp loss of muscle tone, which often ends in injuries associated with a fall. The duration of the attack varies and lasts up to several minutes, followed by falling asleep.
  • Hallucinations on falling asleep and waking up. They are characterized as vivid acoustic or visual visions that correspond to REM sleep. This state is sometimes called "waking sleep", and the patient himself does not realize that he is sleeping and dreaming. This is a dangerous condition that creates confusion between reality and dream.
  • Sleep paralysis is a condition characterized by the inability to move after waking up, but the ability to breathe and blink remains. The patient is conscious, understands where he is. Most often, sleep paralysis is formed in the morning, less often in the evening and at night. Sleep paralysis is aggravated by hallucinations without the ability to move. The condition goes away after a few minutes.

Only 10% of patients present with all symptoms at once. Usually first appear in young people, with no previous diseases. Although they can be associated with strong emotional upheavals or chronic stress. After the first onset of symptoms, narcolepsy is permanent, but does not affect life expectancy.

In clinical practice, it is customary to distinguish 2 types of narcolepsy:

  • the first occurs due to orexin deficiency, the appearance of cataplexy is characteristic Source:
    Narcolepsy-cataplexy. Vasilchenko T.S., Gabdrakipova A.A. Bulletin of Science and Education No. 24(78), 2020. pp. 53-55;
  • the second is characterized by a normal level of the neurotransmitter and cataplexy does not occur.

Diagnostics

The main thing is to detect the pathology in time to prevent risks to the patient's physical health and harm to others. The patient cannot control narcolepsy, attacks occur even at the time of hard work and maximum concentration of attention, as well as performing tasks that involve risks to health and even life.

When visiting a doctor, the symptoms that characterize the diagnosis are studied in detail. The doctor is interested in:

  • the patient's complaints, when the attack first occurred and how long it lasted, what symptoms are present;
  • neurological examination data, some tests;
  • results of additional examination methods to confirm the diagnosis.

These include polysomnography. Source:
Problems in the differential diagnosis of epileptic seizures and narcolepsy (clinical observation). Dmitrenko D.V., Alekseeva O.V., Sapronova M.R., Usoltseva A.A., Areshkina I.G. Bulletin of the North-Eastern Federal University. M. K. Ammosova. Series: Medical Sciences No. 4(13), 2018. pp. 44-51 with EEG data. This method of examination allows you to objectively assess the activity of the brain and sleep phases. The survey continues throughout the night. Electrodes are placed on the patient's head, which fix the indicators and give them out in the form of curves - the doctor analyzes the data.

Additionally, CT and MRI are recommended to assess brain function and condition. In some cases, it may be necessary to analyze the cerebrospinal fluid, which is aimed at determining the concentration of orexin.

Treatment tactics are determined by the data obtained during the examination. This takes into account the severity of concomitant pathology, acquired diseases.

Treatment of narcolepsy

Drug treatment prescribed by specialists is constant, but the number of drugs depends on the clinical picture and the characteristics of the manifestation of the disease. Doctors usually prescribe:

  • stimulants;
  • sleeping pills to help normalize night sleep;
  • antidepressants;
  • means to combat daytime sleepiness.

Other recommendations are added to medications - lifestyle changes that help control symptoms. Patients with narcolepsy are recommended to:

  • strictly follow the daily routine: go to bed and get up at the same time, regardless of holidays and weekends;
  • give up alcohol completely and stop smoking;
  • Minimize your intake of coffee, sugary sodas, energy drinks, and junk food;
  • introduce a short daytime nap into your schedule;
  • lead an active lifestyle, play sports, for example, exercise therapy, yoga.

Prognosis and prevention

Unfortunately, there is no cure for narcolepsy. All treatment is aimed at controlling and maximizing symptom relief. After the course of treatment, the patient returns to his usual way of life, although there are still some restrictions.

There are some prohibitions for all narcolepsy patients. They are forbidden to drive a car, as well as to occupy positions related to hazardous industries, for example, to work with machine tools, in large factories, etc. After all, an attack can happen at any moment, regardless of what a person is doing.

  • Narcolepsy-cataplexy. Vasilchenko T.S., Gabdrakipova A.A. Bulletin of Science and Education No. 24(78), 2020. p.53-55
  • Narcolepsy with cataplexy with onset in prepubertal age. Gromova D.O., Zinovieva O.E., Rogovina E.G., Poluektov M.G. Neurological journal №4, 2012. pp.22-27
  • Modern concepts of narcolepsy with a description of clinical observation. Remizevich R.S., Kurasov E.S. Bulletin of the National Medical and Surgical Center. N. I. Pirogova, Volume 8, No. 4, 2013. p.141-145
  • Autonomic disorders in narcolepsy (review of foreign literature). Golokov V.A., Nikolaeva T.Ya., Schneider N.A., Kantimirova E.A. Medical Almanac No. 5(45), 2016. p.165-168
  • Problems of differential diagnosis of epileptic seizures and narcolepsy (clinical observation). Dmitrenko D.V., Alekseeva O.V., Sapronova M.R., Usoltseva A.A., Areshkina I.G. Bulletin of the North-Eastern Federal University. M. K. Ammosova. Series: Medical Sciences No. 4(13), 2018. p.44-51

Article published : 31/05/2017
Last updated : 30/11/2022

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what are symptoms, treatment, causes

Narcolepsy - what is it?

Narcolepsy is a rare chronic brain disorder in which a person suddenly falls asleep at the wrong time.

The brain cannot properly regulate sleep and wake patterns, which can lead to the following symptoms:

  • excessive daytime sleepiness (hypersomnia) Feeling very sleepy during the day, difficulty concentrating and staying awake
  • Sleep attacks Falling asleep suddenly and without warning
  • Cataplexy Temporary loss of muscle control leading to weakness and eventual collapse, often in response to such emotions like laughter and anger
  • sleep paralysis - temporary inability to move or speak when waking up or falling asleep
  • frequent dreams and wakefulness at night - dreams often come when you fall asleep (hypnogogic hallucinations) or just before or during awakening (hypnopompic hallucinations) and difficult to deal with emotionally.

    Symptoms of narcolepsy

    Excessive daytime sleepiness

    Excessive daytime sleepiness is usually the first sign of narcolepsy. This can significantly affect daily life.

    Feeling sleepy during the day and trying to stay awake makes it difficult to concentrate on work or school.

    People with narcolepsy can be mistaken for being lazy or rude.

    Sleep attacks

    Sleep attacks, where you fall asleep suddenly and without warning, are also common in people with narcolepsy. They can happen at any moment.

    The duration of a sleep attack depends on the individual. For some people, the "microsleep" lasts only a few seconds, while others may fall asleep for several minutes.

    If narcolepsy is poorly controlled, sleep attacks may occur several times a day.

    Cataplexy

    Most people with narcolepsy also experience cataplexy, which is a sudden temporary weakness or loss of muscle control.

    Typical symptoms of cataplexy:

    • drooping jaw
    • head drops down
    • legs clench uncontrollably
    • slurred speech
    • double vision or difficulty focusing

    Cataplexy attacks are usually triggered by an emotion such as excitement, laughter, anger or surprise.

    Seizures may last from a few seconds to several minutes.

    Some people with narcolepsy have cataplexy attacks once or twice a year, others several times a day.

    In trying to avoid seizures, some people may become emotionally withdrawn and socially isolated.

    Sleep paralysis

    Some people with narcolepsy have episodes of sleep paralysis. This is a temporary inability to move or speak that occurs when waking up or falling asleep.

    Episodes can last from a few seconds to several minutes. While sleep paralysis does no harm, being unable to move can be frightening.

    Other symptoms

    Narcolepsy can also cause a number of other symptoms, including:

    • hallucinations - seeing or hearing unreal things, especially when going to bed or waking up; presence in the bedroom - most common hallucination
    • memory problems
    • headaches
    • restless sleep - such as hot flashes, frequent awakenings, vivid nightmares, or physical manifestation of dreams
    • automatic behavior - continuation of an activity without any recollection of it afterwards
    • depression

    Talk to a therapist if you have narcolepsy and feel depressed.

    Your doctor can advise you on how to minimize the impact of narcolepsy on your daily life.

    He can also put you in touch with narcolepsy organizations or support groups.

    What Causes Narcolepsy: Causes

    Narcolepsy is often caused by a deficiency in the brain chemical hypocretin (also known as orexin), which regulates wakefulness.

    Hypocretin deficiency is thought to be caused by the immune system mistakenly attacking the cells that make it or the receptors that allow it to work.

    But this does not explain all cases of narcolepsy, and the exact cause of the problem is often unclear.

    Possible causes of narcolepsy include:

    • hormonal changes that may occur during puberty or menopause
    • severe psychological stress
    • an infection, such as swine flu, or a medicine used to vaccinate against it (Pandemrix)

    Immune system problem

    Antibodies are normally produced by the body to destroy pathogens and toxins.

    When antibodies mistakenly attack healthy cells and tissues, this is called an autoimmune response.

    In 2010, scientists in Switzerland discovered that some people with narcolepsy develop antibodies against a protein called trib 2.

    Trib 2 is produced by an area of ​​the brain that also produces hypocretin. This results in a lack of hypocretin, which means the brain is less able to regulate sleep cycles.

    These study results may help explain the cause of narcolepsy in many cases, but they do not explain why some people with the condition still produce near-normal levels of hypocretin.

    Possible causes

    A number of factors can increase the risk of narcolepsy or cause an autoimmune problem.

    List of causes of narcolepsy:

    • hereditary genetic error
    • hormonal changes, including those that occur during puberty or menopause
    • severe psychological stress
    • sudden change in sleep pattern
    • or infection such as swine flu streptococcal infection
    • Pandemrix influenza vaccine

    Studies have not yet confirmed whether all of these can lead to narcolepsy.

    Pandemrix vaccine

    A 2013 study found an association between the Pandemrix flu vaccine used during the 2009-10 swine flu epidemic and narcolepsy in children.

    The risk is very low: the chance of developing narcolepsy after a dose of vaccine is estimated at about 1 in 52,000 shots.

    But Pandemrix is ​​no longer used in the UK for influenza vaccination.

    Effects of narcolepsy on sleep

    The total amount of time a person with narcolepsy sleeps is not necessarily different from the time spent by people who do not have the condition.

    But narcolepsy can significantly affect sleep cycles and reduce sleep quality.

    Sleep consists of cycles of different brain activity known as non-rapid eye movement (NREM) and rapid eye movement (REM).

    During REM sleep, your brain activity increases and you may dream. Normal sleep begins with three stages of non-REM sleep, followed by a short period of REM sleep.

    Then REM and REM sleep alternate during the night. In the second half of the night, REM sleep is more noticeable.

    If you have narcolepsy, this picture is much more fragmented and you may wake up several times a night.

    You may also experience REM sleep much earlier than usual after falling asleep, as well as the effects of REM sleep such as dreaming and paralysis while you are still conscious.

    Secondary narcolepsy

    Narcolepsy can sometimes be the result of an underlying disorder that damages areas of the brain that produce hypocretin.

    For example, narcolepsy can develop after such diseases:

    • Head injury
    • The brain tumor
    • Dispersed sclerosis (MS)
    • Encephalitis
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    Narzlepsy, which occurred as a result of the identified underlying disease, is called secondary narcolence.

    Who gets narcolepsy?

    Narcolepsy is a fairly rare disease. It is difficult to determine exactly how many people have narcolepsy because many cases go unnoticed.

    But it is estimated to affect around 30,000 people in the UK.

    Narcolepsy is thought to affect men and women equally, although some studies have shown that the condition is more common in men.

    Symptoms of narcolepsy often begin during adolescence, although it is usually diagnosed between the ages of 20 and 40.

    Diagnosis of narcolepsy

    See your doctor if you suspect you have narcolepsy. He may ask about your sleep habits and any other symptoms.

    He may also do tests to rule out other conditions that may be causing your excessive daytime sleepiness, such as sleep apnea, restless leg syndrome in bed and jerky movements during sleep, or an underactive thyroid gland (hypothyroidism).

    If necessary, you will be referred to a sleep specialist, a sleep doctor, who will analyze your sleep pattern.

    This usually involves an overnight stay at a specialized sleep centre, a sleep laboratory, so that various aspects of your sleep can be monitored.

    The exclusion of other factors

    Narcolepsy can be difficult to diagnose, because the symptoms can be similar to symptoms of other conditions, such as:

    • APNOE
    • Epilepsy
    • Depression of thyroid gland (Hypotiresis)
    • previous head injury

    Excessive daytime sleepiness can also sometimes be caused by the side effects of certain medications.

    Your GP may do some tests to rule out other conditions that may be causing your symptoms.

    For example, you may have a physical exam, blood pressure tests, and blood tests.

    Sleep study

    If your therapist thinks you may have narcolepsy, they will refer you to a sleep disorder specialist, a somnologist, who will evaluate your sleep patterns.

    There are many different ways to analyze your sleep.

    Epworth Sleepiness Scale

    The Epworth Sleepiness Scale is a questionnaire used to assess the likelihood that you will fall asleep while performing various activities.

    Your therapist will use the results to decide if you should be referred to a sleep specialist.

    When completing the questionnaire, you will be asked to rate your likelihood of falling asleep in situations such as sitting and reading, watching TV, and traveling as a passenger in a car.

    A score of 10 or less means you have the same level of daytime sleepiness as the general population. If you score 11 or higher, you have an increased level of daytime sleepiness.

    In this case, your therapist will likely refer you to a sleep specialist for further investigation.

    Polysomnography

    Polysomnography is a study of your sleep that is done at a specialist sleep centre.

    This usually involves spending the night at a sleep center so your sleep patterns can be analyzed.

    During the night, several different parts of your body will be monitored with electrodes and bandages placed over your body while you sleep.

    The sensors will also be placed on your feet and the oxygen sensor will be attached to your finger.

    A number of different tests will be performed during the polysomnography, including:

    • electroencephalography (EEG), which tracks brain waves
    • electrooculography, which tracks eye movements
    • Electromyography (EMG), which monitors muscle tone
    • Recordings of movements in the chest and abdomen (belly)
    • Recordings of airflow through the mouth and nose
    • Pulse oximetry, which measures heart rate and blood oxygen levels
    • Electrocardiography (ECG) ) that controls your heart

    Audio and video equipment can also be used to record sound and images.

    After you get enough sleep, a specialist will review your test results to determine if you have normal brain activity, breathing patterns, muscle and eye movements.

    Multiple Sleep Latency Test

    The Multiple Sleep Latency Test measures how long it takes you to fall asleep during the day. You can have this test after a polysomnogram.

    You will be asked to take several naps during the day and the specialist will analyze how quickly and easily you fall asleep.

    If you have narcolepsy, you usually fall asleep easily and enter REM sleep very quickly.

    You can also get a blood test to see if you have a genetic marker known as HLA DQB*0602 associated with narcolepsy.

    A positive result confirms the diagnosis, but does not make it 100% - 30% of people without narcolepsy also have the genetic marker.

    Measuring hypocretin (orexin)

    Narcolepsy is often associated with a deficiency in the sleep-regulating brain chemical hypocretin, also known as orexin.

    Research has shown that measuring hypocretin levels in the cerebrospinal fluid surrounding the brain and spinal cord can be helpful in diagnosing narcolepsy.

    To measure hypocretin levels, a sample of cerebrospinal fluid is taken with a needle during a procedure called a lumbar puncture.

    Sleep specialists are increasingly using this test to make a diagnosis.

    Treatment for narcolepsy

    There is currently no cure for narcolepsy, but making changes to improve sleep and taking medication can help minimize the impact of this condition on your daily life.

    Frequent and short naps evenly distributed throughout the day are one of the best ways to deal with excessive daytime sleepiness.

    This can be difficult when you're at work or school, but a therapist or specialist can create a sleep schedule to help you get used to daytime naps.

    Keeping a strict sleep schedule can also help, so you should go to bed at the same time whenever possible.

    If your symptoms are particularly bothersome, you may be given medication to help reduce daytime sleepiness, prevent cataplexy attacks, and improve your sleep at night.

    These medicines are usually taken as tablets, capsules or drinking solutions.

    Good Sleep Habits

    Here's what you can do to reduce excessive daytime sleepiness and make it easier to sleep at night:

    • frequent, short naps—spread sleep periods evenly throughout the day; a therapist or sleep specialist can help you plan a schedule that fits in with your other activities.
    • stick to a strict sleep schedule - try to go to bed and wake up at the same time each day whenever possible.
    • relax before bed - for example, take a warm bath
    • provide a good sleeping environment - for example, keeping the bedroom temperature comfortable, quiet and free of distractions
    • avoid caffeine (found in coffee, tea, and some carbonated drinks), alcohol, smoking before bed
    • do not exercise before bed - leave at least 2 hours between the end of exercise and going to bed
    • do not eat a lot, do not eat heavy meals before bed

    Some medicines you buy at the pharmacy, such as cold and allergy medicines, can cause drowsiness as a side effect.

    You should avoid taking these medicines during the day if you have narcolepsy as they can make your daytime sleepiness worse.

    Talk to your doctor or pharmacist if you don't know which medicines make you sleepy. They may recommend alternatives that do not cause drowsiness.

    Connect with others

    Narcolepsy is not just a condition that is difficult to live with, it can be difficult for others to understand.

    Some of the symptoms, such as sudden loss of muscle control (cataplexy), can be frightening for people who are unaware of the condition.

    You may find it helpful to talk to friends and family about your condition.

    Tell your child's teachers if your child has been diagnosed with narcolepsy. It is important that teachers are aware of your child's condition so that they do not mistake his behavior for laziness or for staying up too late.

    If you have narcolepsy, there is no reason why you should not be able to work if your employer is aware of your condition and agrees to accommodate it, such as letting you work flexible hours or scheduling naps. But some jobs are not for you.

    Your general practitioner or sleep specialist/sleep specialist can arrange for you to speak with a social worker if they think it might help.

    A social worker can offer counseling and support, including advice about a career, any changes that may be made at school or work, and any financial or relationship problems you may have.

    You may also find it helpful to contact your local or national narcolepsy support group.

    They can give you advice on how to live with narcolepsy and connect you with others who are in a similar situation.

    Drugs for narcolepsy

    A number of different drugs are used to treat the symptoms of narcolepsy, but not all are licensed to treat narcolepsy, and the evidence for their effectiveness in treating this condition is not always conclusive.

    The availability of some of these drugs may vary depending on the policy of your local drug regulator.

    Stimulants

    If necessary, a medicine known as a stimulant, such as modafinil, dexamphetamine, methylphenidate, or pitolisant, may be prescribed by a physician or specialist.

    These medicines stimulate your central nervous system, which helps you stay awake during the day. They are usually taken in tablets every morning.

    The total side effects of stimulants are as follows:

    • Headaches
    • Nausea
    • Nervousness
    • Problems of sleep at night (insomnia)
    • Implicability
    • Loss
    9000 9000 if you experience persistent or unpleasant side effects from stimulants. He can prescribe alternative medicine.

    Modafinil

    Modafinil has been linked to irregular heartbeats (arrhythmias) and high blood pressure, so you will need to be monitored regularly for these problems during treatment.

    Modafinil should not be taken during pregnancy as it may harm the unborn baby.

    For this reason, it is not safe to get pregnant while taking modafinil. You must use effective birth control while taking it and for at least 2 months after you stop taking it.

    If you are taking birth control pills, modafinil may make them less effective. So consider switching to a different type of contraception or using a different contraceptive along with the pill. A therapist or specialist can help you.

    Sodium oxybate

    Sodium oxybate is a medicine that can improve sudden loss of muscle control and help you sleep at night and reduce daytime sleepiness.

    Sodium oxybate is a liquid medicine you take at night in 2 doses: the first dose when you go to bed and the second dose 2.5 to 4 hours later.

    You may need an alarm clock so that you can take your medicine at the right time.

    You will need to take sodium oxybate 2 to 3 hours after eating, as food can affect how much of the medicine is absorbed into your body.

    Do not drink alcohol while taking sodium oxybate. You should also avoid mentally demanding activities, such as driving or operating heavy machinery, for at least 6 hours after ingestion.

    Although there is some uncertainty about how effective antidepressants are in treating narcolepsy, they are sometimes used to treat symptoms such as sudden loss of muscle control, hallucinations, and sleep paralysis.

    Many different types of antidepressants have been used to treat people with narcolepsy, including:

    • selective serotonin reuptake inhibitors (SSRIs), such as femoxetine, fluoxetine, and citalopram
    • serotonin-norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine
    • tricyclic antidepressants (TCAs) such as imipramine and clomipramine

    These medicines are thought to work by changing the levels of certain chemicals in your brain and reducing the number of dreams (REM) that are responsible for many of the symptoms of narcolepsy.

    The side effects you may experience will depend on the specific medication you are taking, but common antidepressant side effects may include:

    • Feelings of excitement, shakiness or anxiety
    • Poor well -being
    • Dry mouth
    • Small clouding of vision
    • SUBSTANCE
    • DOISTRICTION
    • Difficulty problems or Summary
    • Sexy dysfunction, such with orgasm

    Most side effects go away within a few weeks.

    Learn more