Epworth Sleepiness Scale

People who experience excessive daytime sleepiness should try to see a physician. Although physicians have the capability of diagnosing narcolepsy, anyone can actually measure their general level and quality of daytime sleepiness before they run to a doctor.

A questionnaire uses the Epworth Sleepiness Scale in order to measure quality of daytime sleepiness. Narcolepsynetwork.org explains that “each item describes a routine daytime situation.”  Their directions state to “use the scale to rate the likelihood that you would doze off or fall asleep (in contrast to just feeling tired) during that activity. If you haven’t done some of these things recently, consider how you think they would affect you. “

One important aspect to consider after taking the questionnaire is to never make your own diagnosis. The purpose of the scale is to help you determine the degree to which you experience sleepiness during the day. If the total score turns out to be ten or higher, you may be a victim of narcolepsy but it isn’t always accurate.  Therefore, the best thing to do is ask a doctor to make sure.

To access the questionnaire go to:  Epworth Sleepiness Scale Form.

Source: http://www.narcolepsynetwork.org/about-narcolepsy/do-i-have-narcolepsy/epworth-sleepiness-scale/

The Medication

The following is a list of different medications that may be prescribed to narcoleptic patients. After each medication is listed, I provide further information about its uses, side effects, etc.

Amphetamines: 

Amphetamines are used to stimulate the central nervous system. Examples of Amphetamines with their common names include Dexedrine, methamphetamine, Dextrostat, Adderall, and Ritalin.  generalized central nervous system stimulants. They help narcoleptic patients by enhancing their alertness and reducing the urge to sleep. Despite these benefits, Amphetamines have side effects such as anxiety, elevated blood pressure, and drug addiction.

Pemoline or commonly known as Cylert:

This medication may help narcoleptics. However, it isn’t as effective as Amphetamines. It can cause liver problems due to its potential rise of toxicity.  As a result, doctors recommend frequent liver blood tests

Modafinil  or commonly known as Provigil:

This medication is similar to amphetamines even though it is not a central nervous system stimulant. Common side effects are temporary and mild headache and nausea. Although a another common side effect includes high blood pressure, the risk is much lower than in amphetamines. The risk for mental side effects such as mood changes, euphoria, or addiction is lower as well. Doctors prescribe patients with a single daily dose of Modafinil. Interestingly, Modafinil may not be able to treat cataplexy. If a patient is switched from amphetamines to Modafinil, cataplexy may result.

Armodafinil or commonly known as Nuvigil: 

This drug It is similar to modafinil and enhances alertness and wakefulness by acting as a brain stimulant,. Although it is not known how Nuvigil really stimulates the brain,  researchers believe that it may increase the amount of dopamine. Side effects of Nuvigil include, headache, anxiety, diarrhea, dizziness, insomnia, nausea, and fatigue.

Monoamine oxidase inhibitors (MAOIs): 

MAOIs are antidepressants which also include common medications such as Nardil and Eldepryl. These drugs reduce excessive daytime sleepiness.

Anticataplectic medication:

These drugs are useful because they are able to treat cataplexy. For example, Tricyclic antidepressants (TCAs) reduce cataplexy by acting on neurotransmitters and suppressing REM sleep. The main side effects include dry mouth, dry eyes, blurred vision, constipation, increase in appetite, anxiety, headache, and confusion. Another serious side effect that may increase disturbances in nighttime sleep is periodic limb movements. Also, cataplexy may get worse if medication is stopped.

Selective serotonin reuptake inhibitors (SSRIs) 

Selective serotonin reuptake inhibitors help treat cataplexy The most common SSRIs are are fluoxetine (Prozac), paroxetine (Paxil), sertraline(Zoloft), citalopram (Celexa), and venlafaxine (Effexor). SSRIs cause  lower risks of side effects than TCAs, even though they aren’t as effective. Common side effects are, nausea, diarrhea, and mild tremor

Sodium oxybate or commonly known as Xyrem:

These drugs are also called gamma-hydroxybutyrate (GHB). They are used to treat cataplexy and excessive daytime sleepiness. It is usually taken at night before bedtime, and four hours later. As a result, it reduces disturbed night time sleepiness which in turn decreases drowsiness during the day.  If Xyrem is taken during the day, drowsiness increases. 

Dogs and the Cure for Narcolepsy

As I posted more and more blogs, I became curious about one detail regarding medication for narcolepsy. I asked myself how were the first medications for narcolepsy tested? I knew that before medication for any disease is found and prescribed to patients, numerous researchers, scientists, and pharmacists have to test different drugs in labs. But how are they determining whether or not it works?

Emmanuel Mignot determined that dogs experience narcolepsy as well. At Stanford University, he used narcoleptic canines to test medication. His goal was to find a treatment for narcolepsy in dogs and ultimately apply his findings to treat humans.

He determined, “that some medications that were not available for human use, were very, very effective and much better treatment than the old medications that were used in human narcolepsy".

Mignot gave a narcoleptic teenager, Lindsey Watson, a novel medication that allows her to stay awake throughout the day. The treatment included the well known Xyrem, and Stratera. Both of these medications were tested on narcoleptic dogs.

Although there is still no cure for narcolepsy, treatment is constantly progressing As a result, Mignot believes that he one step closer to finding the cure. Since medications both help dogs and humans, there may be some important biological link. He took some time to study genes in dogs and found that they are missing hypocretin, a chemical that functions in wakefulness in the brain. He later found the same chemical is missing in humans. He believed that replacing hypocretin can mean a cure for narcolepsy. But one must ask one simple question: How? More research is being done to get to the bottom of this.

Here is a video of a dog with narcolepsy. As you watch, observe the similarities in narcoleptic symptoms between dogs and humans.

Is Diagonsis of Narcolepsy Measurable?

Mignot’s goal in his study was to define the hypocretin deficiency syndrome and determine whether or not measurement of the number of hypocretin cells can be used to diagnose narcolepsy. They determined the amount of hypocretin cells in narcoleptic subjects and people with normal levels of hypocretin by the Multiple Sleep Latency Test and signal detection analysis.

Their results show that people with narcolepsy as well as cataplexy had an HLA frequency of about 93% while narcoleptics without cataplexy had a frequency of 56%. They also found that hypocretin levels above 200 pg/mL was normal, while hypocretin levels of 110 pg/mL signified narcolepsy.

Because of these results, Mignot determined that measureing CSF hypocretin-1 is a valid test to determine whether a person has narcolepsy. Measurements would also work better with narcoleptics who experience  cataplexy. 

For further details of the study, click the following link:

http://med.stanford.edu/school/Psychiatry/narcolepsy/articles/Role_of_Cerebrospinal_Fluid_Hypocretin.pdf

Documentary: My Day Out with Narcolepsy

Here is a mini documentary that follows a person who is a victim of narcolepsy. I found these videos very interesting and wanted to share them with you. 

Behavioral Strategies for a Better Life

 A normal and full state of alertness requires more than the usual medication for people with narcolepsy. Different behavioral strategies  for a narcoleptic can greatly assist his or her state of alertness and quality of life. 

Here is a list of the different behavioral strategies recommended:

1.) It is important for narcoleptics to take short naps that are regularly scheduled throughout the day. 

2.) A Narcoleptic should improve quality of nighttime sleep so that he or she can eliminate constant fatigue during the day. The way to do this is by:

• avoiding taking drugs, alcohol, caffeine before bedtime, and smoking at night
• making sure that he/she has a regular sleep schedule
• keeping the bedroom environment warm, peaceful, and comfortable
• making time for relaxation before bedtime. For example, warm baths or showers are both soothing and relaxing.

3.) A healthy body is tremendously essential to better a narcoleptic's state of alertness. He or she should try to exercise a few hours before bedtime. This technique not only improves the quality of sleep, but it also prevents the person from gaining excessive weight (a common symptom of narcolepsy).

4.) Maintaining and improving emotional health is very important, especially for a narcoleptic who faces anxiety and frustration. Support groups are useful so that narcoleptics can have emotional support and also can express their feelings.

Even though  these behavioral techniques along with medication cannot fully cure narcolepsy, they allow a narcoleptic to be one step closer in controlling his or her life.

Narcolepsy and Weight Gain

Sheela Philomena, a writer for medindia.net, has recently written an article about the latest news in narcolepsy research. According to a study, there is a relationship between narcolepsy and weight gain. Narcoleptics may gain weight even though if they substantially very little. Why are these symptoms occurring?

According Cell Metabolism, researchers have determined that there is deficiency of orexin, a neuropeptide hormone that enhances hunger and wakefulness. As a result, narcoleptics lack energy and cannot burn fat as well as an average person. Specifically. they are unable to burn brown fat. For background information, white fat stores calories while brown fat is used for burning them. The burning of calories from brown fat generates heat. With adequate amounts of orexin, people are able to indulge or eat more. Simultaneously, they can lose more weight.

Studies have found that orexins in mice are important for forming brown fat. As the number of orexin decreases, the amount of brown fat and energy decreases. When the mice are injected with orexin, they ultimately lose fat.

These findings are important because weight loss therapies can be created that base their programs on increasing orexin in the body.