- The overwhelming feeling of wellness right before a
- The Symptoms and Early Signs of Narcolepsy — and How to Spot Them
- Excessive Daytime Sleepiness Is a Hallmark Sign of Narcolepsy, But It Often Goes Unrecognized
- Narcolepsy Signs and Symptoms
- Are there Different Types of Narcolepsy?
- Narcolepsy with Cataplexy
- Narcolepsy without Cataplexy
- Subtle Symptoms of Narcolepsy
- Major Sleep Disorders
- 4 Signs You Might Have Sleep Apnea
- 3. You’re Always Tired
- 4. You Fit the Profile
- Sleep and Driving
The overwhelming feeling of wellness right before a
149.On a peaceful evening, Samantha sits upright on a chair in her lawn with her eyes closed. Then, she starts breathing repeatedly and recites “happy” several times. Samantha is practicing: Getting Started with Meditation APA Learning Outcome: 1.1 Blooms Level: Apply Difficulty: Low King – Chapter 05 #149 Topic: Health 150. Which of the following statements is true of meditation? A . Meditation is an altered state of consciousness or a psychological state of altered attention and expectation in which the individual is unusually receptive to suggestions. B. As a physiological state, meditation shows qualities of sleep and wakefulness, yet it is distinct from both. C. The meditator is ignorant of his or her thoughts and feelings and is, therefore, not consumed by them. D. A meditative state is exactly similar to the hypnotic state. The Meditative State of Mind APA Learning Outcome: 1.1 Blooms Level: Understand Difficulty: Medium King – Chapter 05 #150 Topic: Health 151. Explain the concept of executive function in the context of cognitive control. Executive function is a key aspect of controlled processing. It refers to higher-order, complex cognitive processes, including thinking, planning, and problem solving. These cognitive processes are linked to the functioning of the brain’s prefrontal cortex. Executive function is the person’s capacity to harness consciousness, to focus in on specific thoughts while ignoring others. This aspect of executive function is called cognitive control; it is the capacity to maintain attention by reducing interfering thoughts and being cognitively flexible. Feedback: Levels of Awareness APA Learning Outcome: 1.1 Blooms Level: Understand Difficulty: Medium King – Chapter 05 #151 Topic: Higher-Level Consciousness 152. Explain the concept of automatic processes. Automatic processes are states of consciousness that require little attention and do not interfere with other ongoing activities. They require less conscious effort than controlled processes. When a person is awake, his or her automatic behaviors occur at a lower level of awareness than controlled processes, but they are still conscious behaviors. Feedback: Levels of Awareness APA Learning Outcome: 1.1 Blooms Level: Understand Difficulty: Medium King – Chapter 05 #152 Topic: Lower-Level Consciousness
The Symptoms and Early Signs of Narcolepsy — and How to Spot Them
Excessive Daytime Sleepiness Is a Hallmark Sign of Narcolepsy, But It Often Goes Unrecognized
One feature that does distinguish excessive daytime sleepiness due to narcolepsy is a “sleep attack,” when people fall asleep suddenly, unintentionally, and in a way that is out of their control. Such episodes can occur multiple times throughout a day and last for varying amounts of time. People will usually wake up feeling refreshed but then have another sleep attack episode after a very short period of time.
In some cases, these sudden sleep episodes can happen right in the middle of engaging in an activity such as eating, talking, being in a meeting, or attending class. (3,4,5)
People with narcolepsy experience sleep attacks because the brain is not able to properly regulate its sleep and wake cycles. People with the condition may go right into REM (rapid eye movement) sleep without first entering NREM sleep (nonrapid eye movement), and this can happen both during the night and in the daytime. The disruption of normal sleep-wake cycles leads to poor sleep at night, too. (6,7)
RELATED: What You Need to Know About the Different Stages of Sleep
While excessive daytime sleepiness (persistent sleepiness during waking hours regardless of how much sleep you get the night before) is a key early symptom of narcolepsy, many people who have extreme fatigue during the day may not initially suspect that they have the condition. Several reasons may account for this:
- People are used to feeling tired on a routine basis. “Daytime sleepiness could be a symptom of many things, even just not getting enough sleep,” says Shelley Hershner, MD, an assistant professor of neurology and the director of the Collegiate Sleep Clinic at the University of Michigan in Ann Arbor who has worked on narcolepsy quality metrics for the American Academy of Sleep Medicine (AASM). Thus, the common symptoms many people with narcolepsy have that are related to inadequate sleep — mental fogginess, memory problems, trouble focusing or paying attention, or lack of energy — can look like the typical signs of the sleep deprivation that can come with having a packed schedule or being stressed. (8)
- Other symptoms usually show up later. Particularly in the early stages of the illness, more unique narcolepsy symptoms (such as cataplexy, which means experiencing sudden episodes of muscle weakness) often don’t appear until later, anywhere from weeks to years after someone gets the disorder. Or if they are present, they may be very subtle (a barely noticeable drooping of the eyelids, for example).
- People aren’t as aware of narcolepsy. Even though narcolepsy isn’t extremely rare — it affects about 1 in 2,000 people, according to the AASM and the National Institutes of Health — it’s a condition that often flies under the radar and is frequently overshadowed by other more well-known sleep disorders, like insomnia and sleep apnea. (9,10)
- Extreme sleepiness during the day is often a symptom of other illnesses. Severe daytime drowsiness is a common symptom of sleep disorders such as obstructive sleep apnea and insomnia, and it could also be a sign of diabetes, an underactive thyroid, or depression, among many other health conditions. (11,12)
Signs and Symptoms
The hallmark symptom of narcolepsy is an excessive daytime sleepiness (EDS), in which a person falls asleep at times when they want to be awake. EDS may include daytime sleep attacks that occur with or without warning, persistent drowsiness and fleeting moments of sleep that occur in between a person’s waking state.
Other symptoms may include:
- Cataplexy Most people with narcolepsy experience some degree of cataplexy, which is defined as a sudden loss of voluntary muscle control. An attack may involve only a slight feeling of weakness and limp muscles — such as sagging facial muscles, nodding head, buckling knees, loss of arm strength and garbled speech — or also may cause immediate total body collapse. These attacks are usually triggered by intense emotions, such as laughter, surprise, anger, stress and fear, and can last anywhere from a few seconds to thirty minutes.
- Sleep Paralysis For a brief period when falling asleep or waking up, a person with narcolepsy may be unable to talk or move.
- Hypnagogic Hallucinations These are defined as vivid, realistic and typically frightening dreams that occur when a person is falling asleep.
- Automatic Behavior This occurs when familiar or routine tasks, such as making coffee in the morning, getting the paper and taking a shower, are performed without full memory or awareness of them.
- Fragmented Nighttime Sleep In addition to having trouble with sleep during the day, people with narcolepsy also tend to sleep poorly at night, waking up often.
Are there Different Types of Narcolepsy?
Narcolepsy symptoms can vary from person to person, with some cases more severe than others. There are two main types of narcolepsy:
Narcolepsy with Cataplexy
In addition to the other narcolepsy symptoms, people who have narcolepsy with cataplexy experience sudden muscle weakness and lose control of the muscles in their face, arms, legs, or torso. This causes the person to slur words, have a sagging jaw, collapse, or slump over and be unable to move. During cataplexy, the person is awake. An episode can last for seconds or up to one or two minutes and is often triggered by a strong emotion, such as excitement or laughter.
Narcolepsy without Cataplexy
A person with narcolepsy without cataplexy has all the symptoms of narcolepsy extreme sleepiness, sleep attacks, dream-like hallucinations and paralysis while falling asleep or waking up, and disrupted nighttime sleep), but without episodes of sudden muscle weakness triggered by strong emotions. This type of narcolepsy can be less severe than narcolepsy with cataplexy.
Subtle Symptoms of Narcolepsy
And even EDS presents some subtle symptoms and often needs additional questions put to patients by healthcare providers to be properly diagnosed. Instead of specifically mentioning EDS, patients may report feeling tired, fatigued, irritable, or subject to other mood changes. They may also note being unable to carry out usual daily activities without substantial effort, poor attention, concentration lapses, and memory difficulties.5
Narcolepsy experts say asking patients to explain what is happening to them, rather than leading the patient with specific questions, is often the best way to get helpful information.
“Patients rarely present in ‘textbook’ fashion,” says University of Washington professor of neurology Nathaniel Watson. “Keeping an awareness that narcolepsy does not necessarily have to include every element of the classic tetrad is helpful. Automatic behavior is pretty consistently present in my patients. So when I am not hearing a patient describe cataplexy, hypnagogic or hypnapompic hallucinations (HH), or sleep paralysis, but I think they may have narcolepsy, I often ask about behaviors such as putting dishes in the freezer or getting in their car and forgetting where they were intending to go.”
Most sleep physicians would have little difficulty recognizing full-blown cataplexy, especially if there are clear emotional triggers, Scammell says. “However, cataplexy is often more subtle and may involve mild weakness of the face, neck, or voice. Thus, it is helpful to ask specifically about mild, transient weakness affecting just parts of the body.”
Patients sometimes have difficulty describing everything leading up to their cataplexy events. Physicians can elicit helpful information by asking specific questions such as whether patients experience weakness when feeling a strong emotion such as when laughing at or telling a joke, Scammell says. “If cataplexy is suspected, it is important to inquire about other triggers with open-ended questions since it is essential to determine whether it is true muscle weakness with a functional impact (eg, can’t hold head up or speech is slurred) rather than feelings of fatigue. Sometimes cataplexy begins with intermittent weakness resembling asterixis,” he says.
And regarding the three lesser known symptoms (per the AWAKEN survey) of hypnagogic hallucination, sleep paralysis, and sleep disruption:
- Hypnagogic hallucination presents as vivid, dream-like experiences occurring during transitions between wake and sleep. They may be misdiagnosed as a psychotic disorder, Scammell says. “But the HH can be clearly identified when one establishes that they occur only around the beginning or end of sleep or when drowsy,” he says.
- Sleep paralysis is the temporary inability to move voluntary muscles while falling asleep or waking up. The experience may be extremely distressing.6 These episodes typically end spontaneously within 1 to 10 minutes, or disappear when another person touches the patient.5 These symptoms often occur together.
- Sleep disruption is the interruption of sleep by frequent arousals and awakenings5 and may be present in about half of narcolepsy patients. While sleep onset is rarely a problem, an inability to maintain continuous sleep is very common.6 To identify sleep disruption, healthcare professionals should ask patients to rate sleep quality overall during the past month. Additional items to ask about may include: how long it usually takes to fall asleep at night; how much total time the patient spends in bed each night; how many hours of sleep the patient usually gets each night; how many times the patient wakes up during the night; whether poor sleep ever interferes with the patient’s activities the next day.7
Narcolepsy often first appears between the ages of 10 and 25.6 The median time frame between symptom onset and diagnosis is 10.5 years, but better awareness of the symptoms—both the subtle and the more obvious—can decrease the amount of suffering patients endure.8
Peter Blais, RPSGT, is a registered sleep technologist with the Center for Sleep Disorders at St. Mary’s Regional Health System in Auburn, Me. He estimates about 1% of patients at the center are tested for narcolepsy. CONTACT [email protected]
The symptoms of narcolepsy can appear all at once or they can develop slowly over many years. The four most common symptoms are: excessive daytime sleepiness, cataplexy, sleep paralysis, and hypnagogic hallucinations. In some cases, excessive daytime sleepiness is the only symptom.
Excessive daytime sleepiness (EDS)
EDS is usually the first symptom of narcolepsy. People with narcolepsy often report feeling easily tired or tired all the time. They tend to fall asleep not only in situations in which many normal people feel sleepy (after meals or during a dull lecture), but also when most people would remain awake (while watching a movie or writing a letter). People with narcolepsy may also have a “sleep attack” at a very unusual and sometimes dangerous time (while in the middle of a conversation or driving a car).
Cataplexy is sometimes the first symptom of narcolepsy, but usually it develops several years after EDS. Attacks of cataplexy are sudden, brief losses of muscle control. Cataplexy may be mild such as a brief feeling of weakness in the knees, or it may cause complete physical collapse, resulting in a fall. A person having such an attack is fully awake and knows what is happening. Cataplexy is triggered by stress or a strong emotion such as laughter, anger or surprise. In some individuals, attacks can be caused by simply remembering or anticipating an emotional or anxiety-producing situation.
Sleep paralysis also causes a brief loss of muscle control. Sleep paralysis occurs upon waking up or falling asleep. It is the feeling of being unable to move or speak, even though totally aware of the surroundings. Unlike cataplexy, touching the person usually causes the paralysis to disappear.
Hypnagogic hallucinations are vivid dreamlike experiences that are difficult to distinguish from reality. The dream is often like a nightmare, involving images or sounds of strange animals or prowlers. These dreams are particularly frightening because the person is awake but has no control over the action. The dreams are also disturbing because they can be mistaken for the hallucinations or the delusions of mental illness. A person with narcolepsy may also have other symptoms.
Automatic behavior is the performance of routine tasks by a person who is not consciously controlling the activity. Sometimes a person may actually fall asleep and continue an activity, but not recall having done it when awakened. Automatic behavior can be very dangerous if a person is involved in a potentially dangerous activity such as driving or cooking.
Disturbed nighttime sleep
Disturbed nighttime sleep frequently occurs in people with narcolepsy. Although they have difficulty staying awake during the day, they may also have difficulty staying asleep at night. The many nighttime awakenings further increase the problem of sleepiness during the day.
Other symptoms of narcolepsy
Other symptoms reported by people with narcolepsy include lethargy, low motivation, inability to concentrate, and memory loss. Children are often unable to keep up with their friends or school work and adults are unable to fulfill normal obligations relating to work or family. Some people also experience blurred or double vision, headaches, dizziness, snoring and excess weight.
Major Sleep Disorders
Many sleep disorders are rare. For example, in 15 years of practice, Davila has treated only a few cases of recurrent hypersomnia, in which people have periods of extreme sleepiness that come and go. During an attack, a person may sleep up to 16-18 hours, rousing only to eat or use the bathroom. Episodes can last a few days or many weeks.
But a few sleep disorders, such as sleep apnea or restless legs syndrome, are common. Major sleep disorders include:
Insomnia: Insomnia may be a symptom of a sleep disorder, so people with this complaint may need a thorough evaluation, Shives says. But it can also be a sleep disorder by itself. Insomnia makes it difficult to fall asleep or stay asleep. Sleep quality may be poor, leaving people feeling unrefreshed when they awake.
Sleep apnea: This sleep disorder causes loud snoring, gasping, choking, pauses in breathing, and sudden awakenings. The person repeatedly stops breathing long enough to interfere with sleep; these pauses also temporarily decrease a person’s oxygen supply. During the day, people with sleep apnea often feel very sleepy. Sleep apnea can raise the risk of high blood pressure, stroke, and heart attack.
Restless legs syndrome (RLS): RLS causes irresistible urges to move the legs while a person is lying down. The person may also feel creeping, crawling, burning, or painful sensations in the legs. In a related sleep disorder called “periodic limb movement disorder,” repetitive jerking movements or twitching of the legs or arms during slumber lead to fragmented, unrefreshing sleep.
Parasomnias: Parasomnias, or abnormal behaviors during sleep, include sleepwalking, sleep-talking, head-banging, and night terrors that cause people to sit up, flail, and scream. In one type of parasomnia called “rapid eye movement behavior disorder,” people may kick, punch, or wave their arms unintentionally (usually in response to a dream) while they’re in REM sleep. This sleep disorder usually afflicts older men, according to Shives. It has also been linked to an increased risk of Parkinson’s disease, she adds.
Narcolepsy: Narcolepsy’s main symptoms are excessive sleepiness during the day or recurring “sleep attacks” that cause people to fall asleep uncontrollably during normal waking hours. Some people also have sudden spells of muscle weakness following emotional excitement and may fall to the ground. Some people with narcolepsy experience sleep paralysis, where they can’t move when falling asleep or just waking up. Other symptoms include vivid dreams or hallucinations while falling asleep or waking up.
4 Signs You Might Have Sleep Apnea
3. You’re Always Tired
4. You Fit the Profile
Sleep and Driving
Asleep at the wheel
When it comes to alarm bells, statistics on drowsy driving paint a very concerning picture of road safety. An astounding 69% of adult drivers report driving while drowsy at least once a month in the previous year according to The National Sleep Foundation’s 2009 Sleep in America Poll. The prevalence of drowsy driving is higher among respondents reporting a sleep problem (41%) versus those without a problem (28%). The results indicate that sleepiness is a major safety hazard with potentially devastating consequences. The U.S. Department of Transportation estimates that at least 100,000 traffic accidents, and as many as 1,550 deaths a year are caused by sleepy drivers or falling asleep at the wheel. Nodding off for just three seconds or less while driving can prove fatal. Drowsy driving slows reaction times, reduces vigilance and impairs information processing.
What causes drowsy driving?
Sleepiness and the need to fall asleep while driving can be attributed to several causes:
- Sleep loss. Most Americans do not get the 7 to 9 hours of sleep recommended per night and suffer from chronic sleep deprivation. Lifestyle choices and personal demands such as balancing work, family or other responsibilities restrict sleep.
- Untreated or unrecognized sleep disorders, such as sleep apnea, narcolepsy or restless legs syndrome lead to excessive daytime sleepiness. Sleep disorders can cause sleep fragmentation or sleep disruption, which prevents quality or restorative sleep and results in an accumulated sleep debt.
- Job-related sleep restriction. Shift workers, as well as those working long hours, extended shifts or more than one job, are especially prone to experience sleepiness.
- Alcohol consumption and use of certain medications. Both can cause sleepiness or exacerbate sedating effects from any other cause.
- Naturally occurring circadian factors. Our circadian pacemaker, or biological clock in the brain, naturally regulates our body to sleep at specific times. There is a natural increase in the brain’s drive to sleep during the mid-afternoon and at night. These “zones of vulnerability” are times when accidents while driving are most likely to occur and are particularly dangerous for shift workers or employees working long hours.
Who is at risk?
Everyone is at risk. However, shift workers who work at night or long and irregular hours, people with untreated sleep apnea and narcolepsy, and young males are more likely to suffer from a traffic accident caused by sleepiness.
How does a crash relate to sleepiness?
According to the National Commission on Sleep Disorders Research, a typical crash has the following characteristics:
- It is likely to be serious.
- It occurs during late night/ early morning or mid-afternoon.
- The driver does not attempt to avoid the crash.
- A single vehicle leaves the roadway and occurs on a high-speed road.
- The driver is alone in the vehicle.
The time of the day and driver’s behavior indicate that sleepiness may play a role in traffic accidents. For example, there may be an absence of skid marks or other attempts to take corrective action to avoid the accident.
Drowsy drivers engage in unproductive, unhealthy or unsafe behaviors
According to the National Sleep Foundation’s 2009 Sleep in America Poll, chronic drowsy drivers that do so at least once per month are twice as likely than others to report that they are unable to do the following activities because they are too sleepy:
Tips to ensure that you’re getting the sleep you need to get behind the wheel
- Get at least 7 to 8 hours of sleep every night.
- Have a quiet, comfortable environment in which to sleep, free from distractions such as light and noise.
- Go to bed and wake up at approximately the same time every day, follow a set routine even on the weekends.
- Do not eat big meals before going to bed.
- Avoid caffeine within six hours, and alcohol within three to four hours of going to bed.
When it’s time to hit the road, keep the following tips in mind:
- Start out well rested
- Stay involved in driving
- Avoid using cruise control for long trips
- Keep the car cool
- Listen to lively music
- Keep conversation alive with another passenger, relieving monotony
- Avoid fixing you eyes straight ahead; but instead scan the road and landscape
- Share driving on a long trip, if possible
- When traveling, get out the car and exercise at least once every two hours, or take a 15-20 minute nap at a rest stop, but never on the shoulder of the road
- Do not drive for long periods at night
- Watch your posture; slouching brings on fatigue and drowsiness
- When traveling, get out the car and exercise at least once every two hours, or take a 15-20 minute nap at a rest stop, but never on the shoulder of the road
- Do not drive for long periods at night
Narcolepsy is a sleep disorder characterized by excessive sleepiness, sleep paralysis, hallucinations, and in some cases episodes of cataplexy (partial or total loss of muscle control, often triggered by a strong emotion such as laughter). Narcolepsy occurs equally in men and women and is thought to affect roughly 1 in 2,000 people. The symptoms appear in childhood or adolescence, but many people have symptoms of narcolepsy for years before getting a proper diagnosis.
People with narcolepsy feel very sleepy during the day and may involuntarily fall asleep during normal activities. In narcolepsy, the normal boundary between awake and asleep is blurred, so characteristics of sleeping can occur while a person is awake. For example, cataplexy is the muscle paralysis of REM sleep occurring during waking hours. It causes sudden loss of muscle tone that leads to a slack jaw, or weakness of the arms, legs, or trunk. People with narcolepsy can also experience dream-like hallucinations and paralysis as they are falling asleep or waking up, as well as disrupted nighttime sleep and vivid nightmares.
Narcolepsy with cataplexy is caused by the loss of a chemical in the brain called hypocretin. Hypocretin acts on the alerting systems in the brain, keeping us awake and regulating sleep wake cycles. In narcolepsy, the cluster of cells that produce hypocretin—located in a region called the hypothalamus—is damaged or completely destroyed. Without hypocretin, the person has trouble staying awake, and also experiences disruptions in the normal sleep-wake cycles.
Currently there is no cure for narcolepsy, but medications and behavioral treatments can improve symptoms for people so they can lead normal, productive lives.
Narcolepsy is diagnosed by a physical exam, taking a medical history, as well as conducting sleep studies. If you do have narcolepsy, the most effective treatment is often a combination of medications and behavioral changes. People who are diagnosed with narcolepsy should seek counseling through educational networks and support groups. Getting a diagnosis of narcolepsy and managing the symptoms can be overwhelming and the disorder is not well understood by the general public. It helps to learn best practices and access support through others who have the disorder.
Narcolepsy is a chronic disease of the brain that causes excessive sleepiness during the daytime. Narcolepsy usually begins in teenagers or young adults.
Signs and symptoms of narcolepsy include excessive daytime sleepiness, loss of muscle tone, abnormalities in perception (referred to as hypnagogic hallucinations), and sleep paralysis (an inability to move or talk). Other associated symptoms can include disturbed sleep at night, blurred vision, frequent awakening at night, carrying out actions without conscious awareness (automatic behavior) when transitioning from wakefulness to sleep.
Causes of narcolepsy
While the cause of narcolepsy is not fully understood, abnormalities in the structure and function of a group of nerve cells in the brain known as hypocretin neurons seem to play a role in its development.
Other narcolepsy symptoms and signs
- Abnormalities in Perception (Hypnagogic Hallucinations)
- Blurred Vision
- Disturbed Sleep at Night
- Excessive Daytime Sleepiness
- Frequent Night Awakenings
- Loss of Muscle Tone
- Sleep Paralysis
Main Article on Narcolepsy Symptoms and Signs
Causes of narcolepsy, a chronic disease of the central nervous system, have not been fully determined. Some theories include…
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