Narcolepsy Research Paper
Narcolepsy
Narcolepsy is a chronic sleep disorder characterized by overwhelming daytime drowsiness and sudden attacks of sleep. Narcolepsy in the only known neurological disorder that affects the brain in such a dramatic way where symptoms can include; sleep paralysis (cataplexy) and hallucinations. According to Jerome Siegel, a professor of psychiatry at UCLA symptoms such as cataplexy can be brought on by "laughter, embarrassment, social interactions with strangers, sudden anger, athletic exertion or sexual intercourse may trigger an episode." (Siegel, 2000) There is no cure for narcolepsy and is often misdiagnosed for depression, epilepsy, and fainting and sleep deprivation.
Many people when they think of narcolepsy tend to laugh at its …show more content…
symptoms and find it to be a very strange but an entertaining sleep disorder. There are even some famous people who have narcolepsy; Harold Ickes (Bill Clinton's deputy White House Chief of staff), Nicole Jeray (professional golfer), Natsassja Kinski (actress) and one other famous person who did not waste anytime letting the disorder hinder her from freeing thousands of slaves back in the 1800's; the late Harriet Tubman (abolitionist). There are also several breeds of animals that suffer from narcolepsy. The videos of dogs that are narcoleptic are all over the internet entertaining people who find it "cute and funny". Dogs however, have been part of many research projects that have aided in the understanding of the disorder. Contrary to the connotations made about narcolepsy, it disrupts the lives of people who have it. Narcoleptics have problems in school, holding down a job and not surprisingly they are accident prone, with about 10 times the rate of car accidents as the general population. Getting some insight in this perplexing sleep disorder can help us understand Narcolepsy and its symptoms and reveal to us that it is not that uncommon as we think it is.
Reason for the Selection of Narcolepsy I chose this topic for many reasons, one of the reasons is because you rarely hear people talk about it and it is a very mystifying subject. The sleep disorder that I am familiar with is insomnia and I have suffered from insomnia off and on in my life and know many people who do have insomnia. Narcolepsy to me is a disorder that I wanted to research on because I have known little about the subject and find it fascinating. I had worked with a man who throughout the day he would fall asleep. This is normal I would assume for those who possibly did not sleep enough or have problems sleeping but I have never known someone to sleep standing up or would fall asleep in the middle of doing a task at work. I can only imagine he suffered from Narcolepsy and because of the stigma that is attached to this disorder; I don't think he was the type of person to let anyone know he had this disorder. I have to be honest and say that I am one of the many that had also found it funny and entertaining when seeing videos on the internet or hear about someone's having it and the situations they would get into. Now after researching the subject I feel I have much more empathy for people who suffer with this disorder.
1st Article- Narcolepsy by Jerome Siegel This article was authored by a professor of psychiatry and a member of the Brain Research Institute at the University of California at Los Angeles Medical Center.
In the article Mr. Siegel identifies the symptoms and how through many research studies within the past several years, researchers are beginning to unveil many of the mysteries surrounding the disorder of narcolepsy. Within citing many research projects that have gone on and including the research Mr. Siegel himself has spear-headed he has identified the specific regions of the brain that appear to be affected in one of the symptoms that come with narcolepsy, which is cataplexy, according to Mr. Siegel "have discovered that they are the same regions that normally prevent us from moving in synchrony with our dreams (for example, thrashing our legs when we dream we are in a race)."(Siegel, 2000) Cataplexy is definitely one of the most interesting symptoms of narcolepsy; this symptom is when there is a loss of skeletal muscle tone without the loss of consciousness. What could bring on the cataplectic attack of a narcoleptic individual would be such things as laughter, embarrassment, any social dealings with strangers, anger, exercise and sexual intercourse. Of course the most incapacitating symptom is the daytime sleepiness. This poses a big problem for narcoleptics whether driving a vehicle, or job related duties. Narcoleptics are potentially at high risk for car accidents and far as job related duties it is …show more content…
hard to reach their potential because of their disability. Narcoleptics affects between one in 1,000 and one in 2,000 people in the United States. In Israel the rate is one in 500,000 and the highest rate is in Japan at one in 600. The first signs of narcolepsy begin in the teens or 20's. Symptoms tend to get worse for a few years then levels off. Mr. Siegel states that narcolepsy is associated to a disorder of the sleep control mechanism. The sleep cycle normally consists of two primary phases: rapid eye movement (REM) sleep and non- REM sleep. "Non-REM sleep is a quiet sleep state, the muscles are relaxed but maintain some tone, breathing is regular, the cerebral cortex generates high-voltage waves, and consumption of energy by the brain is minimal." (Siegel, 2000) As to REM sleep the breathing and heart rate are not as regular and the characteristic rapid eye movement occurs and this is the stage at which vivid dreams take place. The reason for pointing this out is that people who are not narcoleptic begin their sleep with non-REM sleep and then about 90 minutes later they go into REM sleep. However, with narcoleptics they go right into REM sleep. Mr. Siegel points out that people in general from time to time experience sleepiness which is normal, but with narcoleptics it is the amount of sleepiness that is abnormal. And of course the symptom that is distinguishable is the cataplexy that comes with narcolepsy. Cataplexy does not occur in normal individuals, so researchers and scientists can gain some insight into the disorder by observing this phenomenon; cataplexy. There has been major studies and advancement in research in narcolepsy due to the fact that scientists in the early 70's discovered that certain breeds of dogs were also narcoleptic. William C. Dement of Stanford University had observed that the dogs who were narcoleptic and the disease was transmitted as a recessive trait, when Dement bred two narcoleptic dogs the offspring were also narcoleptic. They observed also that when the dogs were playing or given their favorite treat they experienced the symptom of cataplexy, same with people who have the narcolepsy cataplexy. Mr. Siegel for further advancing his own studies gathered information from research that was very pertinent to cataplexy and what actually could be responsible for the symptoms. Based on a study done in 1940 by Horace W. Magoun of Northwestern University, Magoun discovered that when he electrically stimulated the medial medulla (a part of the brain stem), muscle tone disappeared. In some way this "turned off any type of movement". Magoun was at the time researching on other neurological diseases and discovered that damage to the medulla could be the reason for increased muscle tone. Magoun did not connect this with sleep because this study was done before the discovery of REM in 1953, however studies in animals now suggest that although the main function of the muscle-tone control system in the medulla is in suppressing muscle activity in REM sleep, it also plays a part in regulating the general level of muscle tone in waking. With this in mind, Mr. Siegel had discovered that unusual activity in the medial medulla might be responsible for the cataplectic episodes experienced by narcoleptics. Mr. Siegel states that "neurons in this region fired when narcoleptic dogs had a cataplectic attack." (Siegel, 2000) He also noted that with normal dogs, cells in the medulla fired at high levels only when they were in full REM. Mr. Siegel upon discovering this fact and comparing other studies that REM sleep in the only time when normal individuals lose all muscle tone. Another study that was conducted from Mr. Siegel's laboratory by Frank Wu suggests that a second group of nerve cells in the area of the brain stem called the locus coeruleus also plays a part in REM and narcolepsy. These cells produce norepinephrine, a neurotransmitter that neurons use to communicate with one another. When this neurotransmitter gets into the bloodstream, this is when the "fight-or-flight" response takes place during emergencies. Now in normal animals this is active throughout waking but is inactive in animals during REM sleep, but with the narcoleptic dogs this is inactive before and during cataplexy, as the same during their REM sleep. Researching the activity of neurons in animals have provided some insight on how cataplexy can be activated, in the genetic studies that were conducted out of Stanford University by Emmauel Mignot, have discovered the gene for narcolepsy in dogs. This study suggests that dogs carry a mutation in the receptor for a neurotransmitter called hypocretin, this receptor is missing a critical part, which is responsible for the dogs not being able to respond to the messages they receive. This mutation might be responsible for some cases of narcolepsy in humans, but Siegel suggests that it could for most narcoleptics it would be highly improbable due to the fact that most narcoleptics have no narcoleptic relatives. Also he adds that "75 percent of cases in an identical twin the other is unaffected." (Siegel, 2000) With other studies that hypothesized that it could be from an autoimmune disease which seemed to be futile and as a result Mr. Siegel has basically concluded that while answering one question it only produced more, and still labeling the puzzling disorder as a mystery. There is some hope as far as trying to alleviate some of the symptoms with drugs. Ritalin and Cylert can counteract the sleepiness and drugs such as Prozac can aid in minimizing the symptoms that pose a tremendous problem to people who have the sleep disorder of narcolepsy. Comments on the 1st Article I found that the two areas of learning that were mentioned in this article about narcolepsy were that one; is the fact that animals have played a large part in research and studies involving narcolepsy. The fact that they dogs carry a gene for narcolepsy was very surprising. And that although animals can aid in giving insight to this sleep disorder, there is still questions that need to be answered about this mysterious disorder. The other factor that was strange is that in Humans a narcoleptic has no relatives and that with 75% of the cases in an identical twin the other is unaffected. The research has identified what area of the brain (medial medulla) can be largely responsible or that the role of brain chemicals; in the case of narcolepsy it would be low levels of hypocretin, and by this can lead to diagnostic testing for narcolepsy but overall there is still no cure or concrete evidence of how and why it exists. The second area of learning had to do with the rates of narcolepsy between cultures. I can't help but wonder why it is equal among men and women, and yet is higher in Japan then in the United States, which could present the environmental factor and auto-immune diseases playing a role in the sleep disorder that afflicts humans unlike dogs who carry a gene. My opinion on this article is that the information was very insightful, well written and mentioned many studies and research that were done on the sleep disorder of narcolepsy I felt that the outline from what the symptoms were, who it affects and the research itself was very informative but also left me with no conclusions and I cannot criticize the article because in my own research on narcolepsy I found that there is still so many unanswered questions and the disorder still remains a mystery. The fact that Mr. Siegel is a professor of psychiatry and a member of the Brain Research Institute at UCLA would lead me to conclude that he would be very credible and a reliable source on the subject of Narcolepsy.
2nd Article- Narcolepsy by Michael S. Aldrich, MD This article was written by Dr. Michael S. Aldrich, professor of medicine in the Department of Neurology at the University of Michigan. He is also director of the Sleep Disorder Center and is an international expert in the neurobiology of narcolepsy. Dr. Aldrich describes Narcolepsy as a chronic sleep disorder that usually begins in adolescence with symptoms of daytime sleepiness, cataplexy, and disturbances occurring in REM sleep. He also states that the sleep disorder can bring about psychosocial problems, poor job performance and accidents. With treatment, narcoleptics can alleviate some of the symptoms, but narcolepsy cannot be cured as of yet. Diagnosing narcolepsy can be challenging, but anyone who has suspected narcolepsy does enter sleep studies to apply specific treatment. Tests that are performed are the nocturnal polysomnography performed when patient is off any medication, on a routine schedule and has had sufficient amount of sleep for at least 10 days. An assessment is made to observe the severity of sleep apnea, moving of the limbs, and nocturnal sleep disturbance. A Multiple Sleep Latency Test (MSLT), usually performed the next day, assesses the mean time to fall asleep (mean sleep latency) and the ability to enter REM sleep prematurely during 4 or 5 nap opportunities. The MLST has been one of the best ways to test for narcolepsy but there have been false positives and negatives. Dr. Aldrich says that the criterion for a positive in narcolepsy would be that the patient had two or more sleep onset REM periods (SOREMPS) during the MSLT. However he adds that the absence of SOREMPs on MSLT does not exclude narcolepsy. "In a series of narcoleptics, 20% had <2 SOREMPs, 7 SOREMPS also can occur with sleep-wake schedule disturbances, drug and alcohol withdrawal, REM sleep deprivation from sleep apnea, and depression." (Aldrich, 1999) Dr. Aldrich does touch on the genetic factors and considers the abnormalities of the neurons in the brain stem; particularly in the areas of the medial medulla and the locus coeruleus to be the source of the disorder, and supports the idea that the sleep/wake state boundaries are being disruptive. And in managing narcolepsy, Dr. Aldrich suggest counseling, support, education on the disorder, and adequate sleep at night (lack of sleep can worsen the symptoms). If necessary taking naps along with medications such as Ritalin and Cylert have proven to minimize symptoms of the disorder. With the symptom of Cataplexy and sleep paralysis, antidepressants can aid in alleviating the episodes.
Comments on the 2nd Article The two areas of new learning taken from this article were first that the onset of the disorder of narcolepsy happens in adolescence and the other is the tests that are given to people who are suspected of having narcolepsy, which are the MLST(multiple sleep latency test) and the Nocturnal Polysomnography. These tests can help but not 100 per cent accurate, due to so many other illnesses or disorders that can impair the testing; disorders such as sleep apnea, epilepsy, chronic fatigue, and patient withdrawal of drugs or alcohol. My critical opinion of this article was that it really wasn't lucid with the overall topic of Narcolepsy and in one part of the article Dr. Aldrich goes into the subject of Idiopathic Hypersomnia and does not define or correlate narcolepsy with this disorder. I asked myself is this one form of narcolepsy or is it another sleep disorder, is it another name for it? He kind of leaves you in the dust with that and also the studies, he does not tell you who conducted them, why, where and the test results were really not explained well at all.
Summary of the Two Articles Narcolepsy is one of the most perplexing and mysterious disorders. Narcolepsy is a sleep disorder that is defined by its characteristics such as excessive daytime sleepiness, sudden sleep attacks, cataplexy, sleep paralysis, and hypnagogic hallucinations. It affects between one in 1,000 and one in 2,000 people in the United States. As far as gender between male and female they are equal in rates. But in Japan the rates are higher occurring 1 in 600 people. Mr. Siegel a professor of psychiatry of UCLA Medical Center states that narcolepsy is associated to a disorder of the sleep control mechanism. The sleep cycle normally consists of two primary phases: rapid eye movement (REM) sleep and non- REM sleep. "Non-REM sleep is a quiet sleep state, the muscles are relaxed but maintain some tone, breathing is regular, the cerebral cortex generates high-voltage waves, and consumption of energy by the brain is minimal." (Siegel, 2000) As to REM sleep the breathing and heart rate are not as regular and the characteristic rapid eye movement occurs and this is the stage at which vivid dreams take place. The reason for pointing this out is that people who are not narcoleptic begin their sleep with non-REM sleep and then about 90 minutes later they go into REM sleep. However, with narcoleptics they go right into REM sleep. Mr. Siegel points out that people in general from time to time experience sleepiness which is normal, but with narcoleptics it is the amount of sleepiness that is abnormal. And of course the symptom that is distinguishable is the cataplexy that comes with narcolepsy. Cataplexy does not occur in normal individuals, so researchers and scientists can gain some insight into the disorder by observing this phenomenon; cataplexy. There has been major studies and advancement in research in narcolepsy due to the fact that scientists in the early 70's discovered that certain breeds of dogs were also narcoleptic. William C. Dement of Stanford University had observed that the dogs who were narcoleptic and the disease was transmitted as a recessive trait, when Dement bred two narcoleptic dogs the offspring were also narcoleptic. They observed also that when the dogs were playing or given their favorite treat they experienced the symptom of cataplexy, same with people who have the narcolepsy cataplexy. Cataplexy which is the most distinctive symptom that can have a person drop to the floor fully conscious for up to a few moments and get up and feel refreshed, these episodes are usually brought on by physical exertion, anger, laughter, social settings with strangers. Human Narcolepsy is said to be a genetic disorder that is also has environmental factors that have been connected to the illness. Due to the study and research into dogs with narcolepsy they have discovered that a mutation of the gene is responsible for the disorder. "The product of this gene is a receptor for the neurotransmitter called hypocretin."(Carlson, 2008) This receptor is missing a critical part, which is responsible for the dogs not being able to respond to the messages they receive. Most Humans who have narcolepsy are born with hypocretinergic neurons, but at some point during the onset which is in adolescence the immune system attacks these neurons which causes the symptoms of narcolepsy to manifest. There has yet to be a cure for narcolepsy but there is treatment for the symptoms that can pose a problem for many narcoleptics. Drugs such as Ritalin, Cylert and Prozac have aided in minimizing the symptoms, also counseling, support, education on narcolepsy and getting adequate sleep at night(lack of sleep worsens symptoms) can help in managing the sleep disorder, narcolepsy. The article that I thought was the most informative and valuable on the subject of Narcolepsy was the first article by Mr. Siegel. Mr. Siegel outlined every study and research done on narcolepsy and what was fascinating was the fact that with the findings on the original studies he extended the line of research from his own laboratory with other associates and produced findings that were insightful into the disorder of narcolepsy. I found his article to be above the textbooks information about narcolepsy. He went into depth on the subject and it was lucid for me to understand the information given. The textbook only provided two pages worth of information and really did not go into details about the subject.
Conclusion Narcolepsy is a mysterious neurological disorder that can pose serious problems for the ones affected by it.
With all the entertainment and jokes that come with this sleep disorder, we can see that it is not so funny after all and that instead can be quite dangerous. Although there is still no cure for narcolepsy we have seen that with medication, education on the disorder, counseling, support from family members and friends, that there can be some relief from the symptoms such as cataplexy and hallucinations. With the information given we can better understand what actually takes place when a narcoleptic has such dramatic symptoms and be more empathetic to their
struggles.
Reference
Aldrich, M (1999) Narcolepsy retrieved on October 13, 2007 from www.thecni.org
Carlson, N (2008) Narcolepsy retrieved on October 13, 2007, In Allyn and Bacon (7th Ed.), Foundations of Physiological Psychology ( p.228-230) Boston, MA.
Siegel, J (2000) Narcolepsy retrieved on October 11, 2007 from www.npi.ucla.edu
Narcolepsy is a chronic sleep disorder characterized by overwhelming daytime drowsiness and sudden attacks of sleep. Narcolepsy in the only known neurological disorder that affects the brain in such a dramatic way where symptoms can include; sleep paralysis (cataplexy) and hallucinations. According to Jerome Siegel, a professor of psychiatry at UCLA symptoms such as cataplexy can be brought on by "laughter, embarrassment, social interactions with strangers, sudden anger, athletic exertion or sexual intercourse may trigger an episode." (Siegel, 2000) There is no cure for narcolepsy and is often misdiagnosed for depression, epilepsy, and fainting and sleep deprivation.
Many people when they think of narcolepsy tend to laugh at its …show more content…
symptoms and find it to be a very strange but an entertaining sleep disorder. There are even some famous people who have narcolepsy; Harold Ickes (Bill Clinton's deputy White House Chief of staff), Nicole Jeray (professional golfer), Natsassja Kinski (actress) and one other famous person who did not waste anytime letting the disorder hinder her from freeing thousands of slaves back in the 1800's; the late Harriet Tubman (abolitionist). There are also several breeds of animals that suffer from narcolepsy. The videos of dogs that are narcoleptic are all over the internet entertaining people who find it "cute and funny". Dogs however, have been part of many research projects that have aided in the understanding of the disorder. Contrary to the connotations made about narcolepsy, it disrupts the lives of people who have it. Narcoleptics have problems in school, holding down a job and not surprisingly they are accident prone, with about 10 times the rate of car accidents as the general population. Getting some insight in this perplexing sleep disorder can help us understand Narcolepsy and its symptoms and reveal to us that it is not that uncommon as we think it is.
Reason for the Selection of Narcolepsy I chose this topic for many reasons, one of the reasons is because you rarely hear people talk about it and it is a very mystifying subject. The sleep disorder that I am familiar with is insomnia and I have suffered from insomnia off and on in my life and know many people who do have insomnia. Narcolepsy to me is a disorder that I wanted to research on because I have known little about the subject and find it fascinating. I had worked with a man who throughout the day he would fall asleep. This is normal I would assume for those who possibly did not sleep enough or have problems sleeping but I have never known someone to sleep standing up or would fall asleep in the middle of doing a task at work. I can only imagine he suffered from Narcolepsy and because of the stigma that is attached to this disorder; I don't think he was the type of person to let anyone know he had this disorder. I have to be honest and say that I am one of the many that had also found it funny and entertaining when seeing videos on the internet or hear about someone's having it and the situations they would get into. Now after researching the subject I feel I have much more empathy for people who suffer with this disorder.
1st Article- Narcolepsy by Jerome Siegel This article was authored by a professor of psychiatry and a member of the Brain Research Institute at the University of California at Los Angeles Medical Center.
In the article Mr. Siegel identifies the symptoms and how through many research studies within the past several years, researchers are beginning to unveil many of the mysteries surrounding the disorder of narcolepsy. Within citing many research projects that have gone on and including the research Mr. Siegel himself has spear-headed he has identified the specific regions of the brain that appear to be affected in one of the symptoms that come with narcolepsy, which is cataplexy, according to Mr. Siegel "have discovered that they are the same regions that normally prevent us from moving in synchrony with our dreams (for example, thrashing our legs when we dream we are in a race)."(Siegel, 2000) Cataplexy is definitely one of the most interesting symptoms of narcolepsy; this symptom is when there is a loss of skeletal muscle tone without the loss of consciousness. What could bring on the cataplectic attack of a narcoleptic individual would be such things as laughter, embarrassment, any social dealings with strangers, anger, exercise and sexual intercourse. Of course the most incapacitating symptom is the daytime sleepiness. This poses a big problem for narcoleptics whether driving a vehicle, or job related duties. Narcoleptics are potentially at high risk for car accidents and far as job related duties it is …show more content…
hard to reach their potential because of their disability. Narcoleptics affects between one in 1,000 and one in 2,000 people in the United States. In Israel the rate is one in 500,000 and the highest rate is in Japan at one in 600. The first signs of narcolepsy begin in the teens or 20's. Symptoms tend to get worse for a few years then levels off. Mr. Siegel states that narcolepsy is associated to a disorder of the sleep control mechanism. The sleep cycle normally consists of two primary phases: rapid eye movement (REM) sleep and non- REM sleep. "Non-REM sleep is a quiet sleep state, the muscles are relaxed but maintain some tone, breathing is regular, the cerebral cortex generates high-voltage waves, and consumption of energy by the brain is minimal." (Siegel, 2000) As to REM sleep the breathing and heart rate are not as regular and the characteristic rapid eye movement occurs and this is the stage at which vivid dreams take place. The reason for pointing this out is that people who are not narcoleptic begin their sleep with non-REM sleep and then about 90 minutes later they go into REM sleep. However, with narcoleptics they go right into REM sleep. Mr. Siegel points out that people in general from time to time experience sleepiness which is normal, but with narcoleptics it is the amount of sleepiness that is abnormal. And of course the symptom that is distinguishable is the cataplexy that comes with narcolepsy. Cataplexy does not occur in normal individuals, so researchers and scientists can gain some insight into the disorder by observing this phenomenon; cataplexy. There has been major studies and advancement in research in narcolepsy due to the fact that scientists in the early 70's discovered that certain breeds of dogs were also narcoleptic. William C. Dement of Stanford University had observed that the dogs who were narcoleptic and the disease was transmitted as a recessive trait, when Dement bred two narcoleptic dogs the offspring were also narcoleptic. They observed also that when the dogs were playing or given their favorite treat they experienced the symptom of cataplexy, same with people who have the narcolepsy cataplexy. Mr. Siegel for further advancing his own studies gathered information from research that was very pertinent to cataplexy and what actually could be responsible for the symptoms. Based on a study done in 1940 by Horace W. Magoun of Northwestern University, Magoun discovered that when he electrically stimulated the medial medulla (a part of the brain stem), muscle tone disappeared. In some way this "turned off any type of movement". Magoun was at the time researching on other neurological diseases and discovered that damage to the medulla could be the reason for increased muscle tone. Magoun did not connect this with sleep because this study was done before the discovery of REM in 1953, however studies in animals now suggest that although the main function of the muscle-tone control system in the medulla is in suppressing muscle activity in REM sleep, it also plays a part in regulating the general level of muscle tone in waking. With this in mind, Mr. Siegel had discovered that unusual activity in the medial medulla might be responsible for the cataplectic episodes experienced by narcoleptics. Mr. Siegel states that "neurons in this region fired when narcoleptic dogs had a cataplectic attack." (Siegel, 2000) He also noted that with normal dogs, cells in the medulla fired at high levels only when they were in full REM. Mr. Siegel upon discovering this fact and comparing other studies that REM sleep in the only time when normal individuals lose all muscle tone. Another study that was conducted from Mr. Siegel's laboratory by Frank Wu suggests that a second group of nerve cells in the area of the brain stem called the locus coeruleus also plays a part in REM and narcolepsy. These cells produce norepinephrine, a neurotransmitter that neurons use to communicate with one another. When this neurotransmitter gets into the bloodstream, this is when the "fight-or-flight" response takes place during emergencies. Now in normal animals this is active throughout waking but is inactive in animals during REM sleep, but with the narcoleptic dogs this is inactive before and during cataplexy, as the same during their REM sleep. Researching the activity of neurons in animals have provided some insight on how cataplexy can be activated, in the genetic studies that were conducted out of Stanford University by Emmauel Mignot, have discovered the gene for narcolepsy in dogs. This study suggests that dogs carry a mutation in the receptor for a neurotransmitter called hypocretin, this receptor is missing a critical part, which is responsible for the dogs not being able to respond to the messages they receive. This mutation might be responsible for some cases of narcolepsy in humans, but Siegel suggests that it could for most narcoleptics it would be highly improbable due to the fact that most narcoleptics have no narcoleptic relatives. Also he adds that "75 percent of cases in an identical twin the other is unaffected." (Siegel, 2000) With other studies that hypothesized that it could be from an autoimmune disease which seemed to be futile and as a result Mr. Siegel has basically concluded that while answering one question it only produced more, and still labeling the puzzling disorder as a mystery. There is some hope as far as trying to alleviate some of the symptoms with drugs. Ritalin and Cylert can counteract the sleepiness and drugs such as Prozac can aid in minimizing the symptoms that pose a tremendous problem to people who have the sleep disorder of narcolepsy. Comments on the 1st Article I found that the two areas of learning that were mentioned in this article about narcolepsy were that one; is the fact that animals have played a large part in research and studies involving narcolepsy. The fact that they dogs carry a gene for narcolepsy was very surprising. And that although animals can aid in giving insight to this sleep disorder, there is still questions that need to be answered about this mysterious disorder. The other factor that was strange is that in Humans a narcoleptic has no relatives and that with 75% of the cases in an identical twin the other is unaffected. The research has identified what area of the brain (medial medulla) can be largely responsible or that the role of brain chemicals; in the case of narcolepsy it would be low levels of hypocretin, and by this can lead to diagnostic testing for narcolepsy but overall there is still no cure or concrete evidence of how and why it exists. The second area of learning had to do with the rates of narcolepsy between cultures. I can't help but wonder why it is equal among men and women, and yet is higher in Japan then in the United States, which could present the environmental factor and auto-immune diseases playing a role in the sleep disorder that afflicts humans unlike dogs who carry a gene. My opinion on this article is that the information was very insightful, well written and mentioned many studies and research that were done on the sleep disorder of narcolepsy I felt that the outline from what the symptoms were, who it affects and the research itself was very informative but also left me with no conclusions and I cannot criticize the article because in my own research on narcolepsy I found that there is still so many unanswered questions and the disorder still remains a mystery. The fact that Mr. Siegel is a professor of psychiatry and a member of the Brain Research Institute at UCLA would lead me to conclude that he would be very credible and a reliable source on the subject of Narcolepsy.
2nd Article- Narcolepsy by Michael S. Aldrich, MD This article was written by Dr. Michael S. Aldrich, professor of medicine in the Department of Neurology at the University of Michigan. He is also director of the Sleep Disorder Center and is an international expert in the neurobiology of narcolepsy. Dr. Aldrich describes Narcolepsy as a chronic sleep disorder that usually begins in adolescence with symptoms of daytime sleepiness, cataplexy, and disturbances occurring in REM sleep. He also states that the sleep disorder can bring about psychosocial problems, poor job performance and accidents. With treatment, narcoleptics can alleviate some of the symptoms, but narcolepsy cannot be cured as of yet. Diagnosing narcolepsy can be challenging, but anyone who has suspected narcolepsy does enter sleep studies to apply specific treatment. Tests that are performed are the nocturnal polysomnography performed when patient is off any medication, on a routine schedule and has had sufficient amount of sleep for at least 10 days. An assessment is made to observe the severity of sleep apnea, moving of the limbs, and nocturnal sleep disturbance. A Multiple Sleep Latency Test (MSLT), usually performed the next day, assesses the mean time to fall asleep (mean sleep latency) and the ability to enter REM sleep prematurely during 4 or 5 nap opportunities. The MLST has been one of the best ways to test for narcolepsy but there have been false positives and negatives. Dr. Aldrich says that the criterion for a positive in narcolepsy would be that the patient had two or more sleep onset REM periods (SOREMPS) during the MSLT. However he adds that the absence of SOREMPs on MSLT does not exclude narcolepsy. "In a series of narcoleptics, 20% had <2 SOREMPs, 7 SOREMPS also can occur with sleep-wake schedule disturbances, drug and alcohol withdrawal, REM sleep deprivation from sleep apnea, and depression." (Aldrich, 1999) Dr. Aldrich does touch on the genetic factors and considers the abnormalities of the neurons in the brain stem; particularly in the areas of the medial medulla and the locus coeruleus to be the source of the disorder, and supports the idea that the sleep/wake state boundaries are being disruptive. And in managing narcolepsy, Dr. Aldrich suggest counseling, support, education on the disorder, and adequate sleep at night (lack of sleep can worsen the symptoms). If necessary taking naps along with medications such as Ritalin and Cylert have proven to minimize symptoms of the disorder. With the symptom of Cataplexy and sleep paralysis, antidepressants can aid in alleviating the episodes.
Comments on the 2nd Article The two areas of new learning taken from this article were first that the onset of the disorder of narcolepsy happens in adolescence and the other is the tests that are given to people who are suspected of having narcolepsy, which are the MLST(multiple sleep latency test) and the Nocturnal Polysomnography. These tests can help but not 100 per cent accurate, due to so many other illnesses or disorders that can impair the testing; disorders such as sleep apnea, epilepsy, chronic fatigue, and patient withdrawal of drugs or alcohol. My critical opinion of this article was that it really wasn't lucid with the overall topic of Narcolepsy and in one part of the article Dr. Aldrich goes into the subject of Idiopathic Hypersomnia and does not define or correlate narcolepsy with this disorder. I asked myself is this one form of narcolepsy or is it another sleep disorder, is it another name for it? He kind of leaves you in the dust with that and also the studies, he does not tell you who conducted them, why, where and the test results were really not explained well at all.
Summary of the Two Articles Narcolepsy is one of the most perplexing and mysterious disorders. Narcolepsy is a sleep disorder that is defined by its characteristics such as excessive daytime sleepiness, sudden sleep attacks, cataplexy, sleep paralysis, and hypnagogic hallucinations. It affects between one in 1,000 and one in 2,000 people in the United States. As far as gender between male and female they are equal in rates. But in Japan the rates are higher occurring 1 in 600 people. Mr. Siegel a professor of psychiatry of UCLA Medical Center states that narcolepsy is associated to a disorder of the sleep control mechanism. The sleep cycle normally consists of two primary phases: rapid eye movement (REM) sleep and non- REM sleep. "Non-REM sleep is a quiet sleep state, the muscles are relaxed but maintain some tone, breathing is regular, the cerebral cortex generates high-voltage waves, and consumption of energy by the brain is minimal." (Siegel, 2000) As to REM sleep the breathing and heart rate are not as regular and the characteristic rapid eye movement occurs and this is the stage at which vivid dreams take place. The reason for pointing this out is that people who are not narcoleptic begin their sleep with non-REM sleep and then about 90 minutes later they go into REM sleep. However, with narcoleptics they go right into REM sleep. Mr. Siegel points out that people in general from time to time experience sleepiness which is normal, but with narcoleptics it is the amount of sleepiness that is abnormal. And of course the symptom that is distinguishable is the cataplexy that comes with narcolepsy. Cataplexy does not occur in normal individuals, so researchers and scientists can gain some insight into the disorder by observing this phenomenon; cataplexy. There has been major studies and advancement in research in narcolepsy due to the fact that scientists in the early 70's discovered that certain breeds of dogs were also narcoleptic. William C. Dement of Stanford University had observed that the dogs who were narcoleptic and the disease was transmitted as a recessive trait, when Dement bred two narcoleptic dogs the offspring were also narcoleptic. They observed also that when the dogs were playing or given their favorite treat they experienced the symptom of cataplexy, same with people who have the narcolepsy cataplexy. Cataplexy which is the most distinctive symptom that can have a person drop to the floor fully conscious for up to a few moments and get up and feel refreshed, these episodes are usually brought on by physical exertion, anger, laughter, social settings with strangers. Human Narcolepsy is said to be a genetic disorder that is also has environmental factors that have been connected to the illness. Due to the study and research into dogs with narcolepsy they have discovered that a mutation of the gene is responsible for the disorder. "The product of this gene is a receptor for the neurotransmitter called hypocretin."(Carlson, 2008) This receptor is missing a critical part, which is responsible for the dogs not being able to respond to the messages they receive. Most Humans who have narcolepsy are born with hypocretinergic neurons, but at some point during the onset which is in adolescence the immune system attacks these neurons which causes the symptoms of narcolepsy to manifest. There has yet to be a cure for narcolepsy but there is treatment for the symptoms that can pose a problem for many narcoleptics. Drugs such as Ritalin, Cylert and Prozac have aided in minimizing the symptoms, also counseling, support, education on narcolepsy and getting adequate sleep at night(lack of sleep worsens symptoms) can help in managing the sleep disorder, narcolepsy. The article that I thought was the most informative and valuable on the subject of Narcolepsy was the first article by Mr. Siegel. Mr. Siegel outlined every study and research done on narcolepsy and what was fascinating was the fact that with the findings on the original studies he extended the line of research from his own laboratory with other associates and produced findings that were insightful into the disorder of narcolepsy. I found his article to be above the textbooks information about narcolepsy. He went into depth on the subject and it was lucid for me to understand the information given. The textbook only provided two pages worth of information and really did not go into details about the subject.
Conclusion Narcolepsy is a mysterious neurological disorder that can pose serious problems for the ones affected by it.
With all the entertainment and jokes that come with this sleep disorder, we can see that it is not so funny after all and that instead can be quite dangerous. Although there is still no cure for narcolepsy we have seen that with medication, education on the disorder, counseling, support from family members and friends, that there can be some relief from the symptoms such as cataplexy and hallucinations. With the information given we can better understand what actually takes place when a narcoleptic has such dramatic symptoms and be more empathetic to their
struggles.
Reference
Aldrich, M (1999) Narcolepsy retrieved on October 13, 2007 from www.thecni.org
Carlson, N (2008) Narcolepsy retrieved on October 13, 2007, In Allyn and Bacon (7th Ed.), Foundations of Physiological Psychology ( p.228-230) Boston, MA.
Siegel, J (2000) Narcolepsy retrieved on October 11, 2007 from www.npi.ucla.edu