PrevalenceĪbout 200,000 Americans are diagnosed with narcolepsy. The typical onset of narcolepsy is between ages seven and 25. Moderate: Cataplexy once a day or every several days, disturbed nocturnal sleep, and need for daily naps Severe: medication resistant cataplexy with multiple daily episodes, persistent somnolesence and disturbed nocturnal sleep (e.g, excessive movements, insomnia, and vivid dreams).(American Psychiatric Association, 2013). Mild: Infrequent cataplexy (< once per week), need for naps once or twice a day, and less disturbed nocturnal sleep. The clinician can also specify the severity of narcolepsy: 347.00 (G47.419) Autosomal dominant narcolepsy, obesity, and type 2 diabetes: Narcolepsy, obesity, and type 2 diabetes and low CSF hypocretin-1 levelsģ47.10 (G47.429) “ Narcolepsy can also be secondary to another medical condition: This subtype is for narcolepsy that has developed secondary to infectious, traumatic, or neoplasmic destruction of hypocretinergic neurons (American Psychiatric Association, 2013). 347.00 (G47.419) Autosomal dominant cerebellar ataxia, deafness, and narcolepsy: (with low or intermediate CSF hypocretin-1 levels), deafness, cerebellar ataxia, and eventually dementia. The clinician can include several additional specifiers to the narcolepsy diagnosis : “ 347.00 (G47.419) Narcolepsy without cataplexy, but with hypocretin deficiency, low CSF hypocretin-1 levels and positive polysomnography/multiple sleep latency test without cataplexy, 347.01 (G47.411) Narcolepsy with cataplexy but without low hypocretin levels. Individuals with narcolepsy will plunge into REM sleep upon onset of sleep (Psychologist World, 2014). Nocturnal sleep polysomnography study revealing abnormally low Rapid Eye Movement (REM) sleep duration ( two REM sleep episodes upon onset of sleep (American Psychiatric Association, 2013).REM sleep typically does not occur until an individual has gone through sleep stages One through Three. Objective measure of hypocretin deficiency in the cerebrospinal fluid (CSF) as defined by “less than or equal to 110 pg/mL”, excluding CSF levels of hypocretin-1 in the context of recent TBI. In children or in individuals “within six months of narcolepsy onset, involuntary grimacing or jaw-opening with tongue thrusting, or hypotonia”, in the absence of clear emotional triggers.3. Episodes of cataplexy, or loss of muscle tonus, occurring several times a month, episodes lasting seconds to minutes of sudden full body loss of skeletal muscle tone without LOC (Loss Of Consciousness) that are precipitated by an episode of strong emotion. These episodes must occur at least three times per week over the past three months, accompanied by at least one of the following symptoms:ġ. Symptoms of NarcolepsyĪccording to the DSM-5, (Diagnostic and Statistical Manual of Mental Disorders, fifth edition), narcolepsy is a disorder in which the individual will experience recurrent periods of an irresistible need to sleep, or will fall asleep, or nap within the same day, regardless of whether or not the time and place are appropriate. Hypnogogic hallucinations (vivid dreams upon onset of sleep) hypnopompic hallucination (vivid dreams upon waking) and sleep paralysis (inability to move upon waking) can be part of the clinical presentation (Simon, 2012). Their should be an objective laboratory finding of abnormally low levels of hypocretin, a neuropeptide associated with sleep/wake and arousal levels, (Tsujino & Sakurai, 2009), and according to a polysomnography study, unusually low amounts of REM sleep during nocturnal sleep. The sleep episodes will typically be triggered by a strong emotional response in the individual (Psychologist world, 2014), or a heavy meal, or general psychosocial stressors (Simon, 2012). Narcolepsy is accompanied by unusually rapid onset of REM sleep (American Psychiatric Association, 2013). Despite adequate nocturnal sleep, the individual will experience daytime fatigue, or EDS (Excessive Daytime Sleepiness) (Psychologist World, 2014), and (University of Tennessee, 2014).The individual will experience sudden loss of muscle tonus ranging from isolated muscle weakness to bilateral, full body loss of muscle tonus, and will fall asleep in inappropriate times and places, which may place themselves or others in danger, if they are driving or doing another potentially hazardous activity. Narcolepsy is a neurologically based, chronic, hypersomnic type of sleep disorder, which typically appears in childhood, adolescence or young adulthood. DSM-5 Category: Sleep-Wake Disorders Introduction
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