Sleep Disorders

Narcolepsy

Narcolepsy is a chronic neurological disorder that affects the region of the central nervous system that regulates sleep and wakefulness. It is characterized by a sudden recurrent uncontrollable compulsion to sleep. Other names for narcolepsy include hypnolepsy, sleeping disease, paroxysmal sleep, and Gelineau syndrome. The disorder affects an estimated 200,000 Americans and symptoms generally appear in a person’s teens or early twenties.

Narcolepsy is characterized by the following signs and symptoms:

Sudden, uncontrollable episodes of sleep at inappropriate times, such as while having dinner, talking, driving or working;
Sudden episodes of loss of muscle tone, ranging from slight weakness (such as limpness at the neck or knees, sagging facial muscles, or inability to speak clearly) to complete body collapse (This can be precipitated by intense emotion, such as laughter or anger.);
Inability to talk or move when falling asleep or waking up;
Vivid, often unpleasant, dream-like experiences that occur while dozing or falling asleep;
Disrupted nighttime sleep with frequent awakenings;
Performance of routine tasks without memory of the action; and
Learning and memory difficulties

The disease can vary in severity. Some persons with it have mild sleepiness or rare cataplexy (less than one episode per week). Other persons may have moderate sleepiness or infrequent cataplexy (less than one episode a day). Still other persons with narcolepsy may experience severe sleepiness or have severe cataplexy (with one or more episodes of cataplexy per day).

Some experts feel that diagnosis rates are as low as 50% of the total population of patients. The diagnosis may be delayed as much as 10 years after disease onset due to inadequate patient-physician communication and/or misdiagnosis.

The causes of narcolepsy are unknown. It is not a fatal disorder in itself but it can lead to fatalities. For example, a narcoleptic may fall asleep while driving.

Download Narcolepsy, a four-page PDF file from the National Heart, Lung, and Blood Institute.

Treatments for narcolepsy include medications that improve alertness and antidepressants to help control cataplexy. Narcolepsy has typically been treated with amphetamine or amphetamine-like stimulants, most commonly methylphenidate (Riatlin), pemoline (Cylert), methamphetamine (Desoxyn), and dextroamphetamine (Dexedrine). Provigil is taking over much of the market. With good toleration by the body and fewer sympathomimetic and side effects, Provigil is not a domaminiergic, yet still has a lower potency than the amphetamine-like stimulants. Provigil is approved by FDA for sleepiness associated with narcolepsy.

Excerpts from the Stanford School of Medicine's FAQ on Narcolepy.

Causes of excessive daytime sleepiness

Stimulants were first used in 1931 for the treatment of narcolepsy. Since then, John Dynes and Knox Findley applied the EEG to the diagnosis of the disorder in 1941 and later in 1978, Richardson used the MSLT to diagnose narcolepsy.

Obstructive sleep apnea/hypopnea syndrome (OSAHS)

OSAHS is a serious, potentially life threatening breathing disorder which affects 6 million adult Americans. Some studies indicate that it is associated with an increased risk of heart attack and stroke. More common in men than women, OSAHS is experienced by sufferers as a lack of airflow throughout the night. This leads to frequent brief arousals. It occurs in 4 percent of middle-aged men and 2 percent of middle-aged women. Over age 65, the prevalence rises to 28 percent and 24 percent for men and women respectively. OSAHS has been the focus of extensive research because of its association with neurocognitive and cardiovascular complications

OSAHS is characterized by the following symptoms:

Brief interruptions of air flow during sleep and loss of oxygen;
Repetitive arousals, often unnoticed, during sleep;
Falling asleep at inappropriate times during the day, such as while driving, working or talking;
Early morning headaches;
Depression, irritability and sexual dysfunction; and
Learning and memory difficulties

Provigil should only be used as a supplementary treatment for OSAHS. It should not be used as a substitute for the most common treatment for sleep apnea: continuous positive air pressure (CPAP), a device that keeps air passages open during sleep and prevents the breathing pauses associated with the condition.

NEW: Provigil found to improve wakefullness and memory in patients with OSAHS

Shift work sleep disorder (SWSD)

SWSD is a sleep disorder that affects people who frequently rotate shifts or work at night, such as doctors, police, emergency personnel, and construction and factory workers. The body’s natural circadian rhythms make it difficult for those who don’t work the traditional 9 to 5 hours adjust to their schedule. The human body naturally follows a 24-hour period of wakefulness and sleepiness that is regulated by an internal circadian clock that regulates cycles in body temperature, hormones, heart rate and other body functions. For humans, the desire to sleep is strongest between midnight and 6 am. Many people are alert in the morning with a natural dip in alertness in the mid-afternoon. It is very difficult to reset the internal circadian clock to make those who work at night feel sleepy during the day and alert at night. An estimated 10 to 20 percent of night shift workers fall asleep on the job, which not only hinders their work and makes them more prone to accidents, but makes it difficult for them to sleep during the day, even though they are tired.

SWSD consists of a constant or recurrent pattern of sleep interruption that results in insomnia or excessive sleepiness. Shift work sleep disorder is common in people who work nontraditional hours, usually between 10:00 pm and 6:00 am.

SWSD is primarily experienced by people working at night or individuals on schedules that require them to work and sleep at irregular times. For instance, a health care worker on a schedule such as 8 am to 4 pm Monday and Tuesday and 12 to 8 am Thursday and Friday would be prone to SWSD. More on SWSD

Is Provigil ever prescribed for conditions other than the ones the drug is FDA-approved for?

Yes. While Provigil is FDA-approved only for narcolepsy, OSAHS and SWSD, many physicians are prescribing it for patients who do not suffer from one of these conditions but exhibit similar symptoms.

Provigil is being subscribed to millions of people for "off-label" or “lifestyle” uses, including:

Age-related memory decline
Attention deficit disorder
Depression
Fatigue caused by high-pressure jobs requiring long hours
Fatigue caused by chemotherapy treatment for cancer patients
Fatigue experienced by persons suffering from diseases such as multiple sclerosis
Fatigue experienced by people who need to be awake and alert for extended amounts of times such as soldiers, truckers or students cramming for finals
Jet lag
Memory problems associated with Alzheimer’s disease
Post-anesthesia grogginess
Sleepiness caused by other prescription medications
Treatment for cocaine addiction

Currently, many clinical trials are taking place to assess the effectiveness in using Provigil to treat other conditions than EDS associated with narcolepsy, OSAHS and SWSD.

What are some of the reasons why Provigil should not be prescribed solely to relieve fatigue?

Some doctors worry that people taking Provigil to combat fatigue might go undiagnosed for underlying diseases such as diabetes or sleep apnea that cause fatigue.

(See article - Narcolepsy more common in men)

(Does Provigil improve memory?)

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