Narcolepsy Is An Unusual Condition With The Typical Stereotype Being Of A Person Sleeping Throughout The Day Or Falling Asleep With Little Provocation Including Falling Asleep In The Middle Of The Party It Has A Genetic Basis And Can Certainly Run In Families The Cause Of Typical Narcolepsy Has Been Identified And Specific Treatments Are Currently Being Developed
As narcolepsy in its most severe forms can significantly impact the ability to maintain alertness, a full and frank discussion as to how it may affect your well-being and your livelihood is usually undertaken. Individuals in task critical occupations such as driving or materials handling may be at risk of harming themselves or others.
The focus of narcolepsy treatment is to trial a stimulant medication of which there are two major types. Narcoleptics should take the necessary steps to keep themselves safe and work out a strategy for work and for driving. For the group of individuals who have a more severe form of narcolepsy where they fall asleep with little provocation, such as during the day or with emotional stimuli, further medication is usually trialled. Support groups are available but a reliance on postings on the Internet is often fraught with inaccuracy and inappropriate individual cases which cannot be generalised.
There are also a number of atypical forms of narcolepsy with people describing excessive sleepiness, tiredness and fatigue, despite adequate time in bed and no obvious cause for complaint. This is often termed idiopathic hypersomnolence and can overlap with chronic fatigue syndrome.
How To Get Better Sleep
- Create a consistent bedtime routine. Whether its a warm shower before bed or a sleep playlist, sticking with a relaxing, 30- to 60-minute routine may help your body wind down.
- Set the right temperature. The ideal sleep temperature for adults is 60-67 degrees Fahrenheit.
- Listen to pink or white noise. Some find these soothing sounds that sound a bit like TV static or nature sounds like rain and waterfalls helpful when trying to fall asleep.
- Try a sleep mask. If you have street lamps peeking through your window or your partner likes to read with a light on, you can try blocking out light with a comfortable sleep mask.
- Do a body scan. With this relaxation technique, you mindfully focus on each section of your body until it feels completely relaxed.
Your bed is an essential component of restful nights. At Casper, we want you to get your best sleep in order to be the best version of you during the day. Browse our selection of mattresses, pillows, and more to help you create your coziest bed yet.
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Me Association: Sleep Disturbance In Me/cfs
Extract taken from the authoritative and very popular MEA Clinical and Research Guide 2020 , section 5.12 .
ME/CFS patients may complain of excessive sleep/hypersomnia in the early stages of their illness. This is often followed by a general decrease in sleep efficiency once the illness enters a more chronic stage.
Reported sleep disturbances include difficulty in initiating sleep, frequent waking during the night and vivid dreams. Periodic limb movements during sleep and restless legs syndrome are also quite frequently reported.
Overall, the result is what many people with ME/CFS describe as unrefreshing sleep. A variety of abnormalities in normal sleep patterns, which may act as perpetuating factors, have been reported in ME/CFS patients.
These include changes in alpha nonrapid eye movement and blunted slow-wave activity in a twin study in response to a sleep challenge the latter results suggesting that a normal homeostatic response is impaired.
Another study found very little evidence to support the hypothesis that ME/CFS patients with a concurrent diagnosis of anxiety, depression or somatisation disorder have any more sleep disorders than those with no psychiatric disorder.
So, it appears that sleep disorder in ME/CFS is an integral part of the disease process.
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What Is Chronic Fatigue Syndrome /myalgic Encephalomyelitis
Chronic fatigue syndrome , also known as myalgic encephalomyelitis , is a chronic , complex and disabling illness that causes extreme fatigue and other symptoms that cannot be explained by any other medical condition.
If you have ME/CFS, you are likely to feel very tired, very often, even if you have not been active. You may also have a host of other symptoms.
Doctors do not yet understand the cause of ME/CFS, and there is no simple cure. If you or your child has ME/CFS, your doctor can suggest treatments you may find helpful.
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Treatment Response In Patients With Seid Vs Those Without Seid
The average number of medications unsuccessfully used for hypersomnolence treatment was 3.6 . Of the 165 patients who had tried traditional wake-promoting agents , 46 experienced an adequate response and 119 did not. Patients meeting SEID criteria were more likely to have failed treatment with these agents =6.0, p=0.01). One-hundred eighteen patients were prescribed clarithromycin for hypersomnolence . Patients with and without SEID exhibited similar response rates to clarithromycin =0.7, p=0.38). Ninety-one patients were prescribed flumazenil and response rates were similar for those meeting and not meeting SEID criteria =0.1, p=0.77).
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Subjective Measures Of Sleepiness And Fatigue In Patients With And Without Seid
As anticipated, the group as a whole also demonstrated substantial subjective sleepiness, with average ESS of 15.0 . There was no difference in ESS between the two groups =0.4, p=0.71). Because individual questions were used for SEID determination from the Fatigue Severity Scale, the Multidimensional Fatigue Inventory, and the Functional Outcomes of Sleep scale, sum scores for these scales may have differed between groups by definition . Questions from the Horne-Ostberg were also used for SEID determination, but this scale did not differ between groups. Pairwise comparisons of individual criteria were typically only modestly correlated or non-significant, with the exception of moderate-to-strong and statistically significant relationships between: criteria 1 and 3 , 3 and 6 , 5 and 7 , and 7 and 9 .
Multidimensional Fatigue Inventory
The mean MFI total score for all patients in our cohort was 71.7 +/ 14.4. When the mental fatigue component was removed from the score, the SEID group remained significantly more fatigued than the group not meeting SEID criteria = 3.0, p=0.003). On MFI domains, those with SEID reported higher levels of general fatigue = 3.2, p=0.002) and physical fatigue = 3.0, p=0.003), with more reduction in activity = 2.5, p=0.01). There were no differences between those with and without SEID on motivation = 1.6, p=0.11) or mental fatigue = 1.7, p=0.09), despite the latter being used in SEID determination.
Fatigue Severity Scale
Idiopathic Hypersomnia: Feeling Tired All The Time
To be sure, the fatigue is real: were working overtime, not sleeping enough, and hauling around a sizable amount of sleep debt as a result.
But theres a small fragment of the population who suffers from a sleep disorder that leaves them feeling tired the moment they wake up from 10 hours of good sleep.
They are easily defeated by the irresistible siren song of daytime sleepiness in the middle of the work day. They never feel awake, no matter how much caffeine they consume.
Whats more, these people who suffer from a condition called idiopathic hypersomnia are challenged to find solutions to this life-altering condition.
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Hypersomnia Comorbid To Psychiatric Disease
Hypersomnolence, broadly defined as excessive daytime sleepiness and/or excessive sleep duration, commonly occurs in patients with psychiatric disorders, but is rarely studied . Although mood disorders are classically associated with insomnia rather than hypersomnia, atypical depression is characterized by a complaint of prolonged sleep time and sleep inertia, congruent with depressive mood . Fluctuating sleep times, which oscillate from reduced sleep time with absent daytime sleepiness for a few days followed by a progressive increase of sleep time , are classical in bipolar disorders, even without frank manic or depressive switches. In seasonal affective disorders, patients have increased sleep time, apathy, and decreased mood during winter. In all these cases, objective sleep tests may find either no increased sleep time or no shortened multiple sleep latency test despite long time in bed or, on the contrary, may find objective increase in nighttime sleep duration and abnormal multiple sleep latency test values . The presence of hypersomnia in mood disorders may be a marker of severity, associated with more frequent suicidal attempts and resistance to treatment . The mechanisms of hypersomnolence in association with major depressive disorder are yet unknown, but may include impairment in the thalamostriatal connectivity .
Health Issues Connected To Hypersomnia
Another motivation to seek diagnosis, and possible treatment, for hypersomnia are the health ramifications that come with it.
Hypersomnia, again, tends to be a signal of a larger health problem that has gone untreated. As mentioned earlier, sleep apnea is often connected to hypersomnia. Left untreated, sleep apnea has been shown to increase your risk of heart failure by 140%.
Diabetes, depression, hypertension also known as high blood pressure and erectile dysfunction are also common health problems encountered by those suffering from sleep apnea. These are serious medical conditions that can shave years off a persons life and make their day-to-day lives more challenging.
Thats why its critical to look at hypersomnia as a check engine light that should be inspected by a medical professional immediately. It can help you determine whether you have primary or secondary hypersomnia.
If you have secondary hypersomnia, you can treat the underlying health issue, and reduce your odds of suffering a medical emergency. If you have primary hypersomnia, a diagnosis can greatly improve your everyday life, and allow you to get the help you need.
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Fatigue In Patients With Subjective Sleepiness Versus Idiopathic Hypersomnia
There was no difference in the percentage of patients meeting SEID criteria in the sEDS group compared to other diagnoses, even though PSG/MSLT were normal in the sEDS group by definition. To further evaluate the possibility that patients with sEDS may have fatigue that they misperceive as sleepiness, we compared sEDS patients to those with idiopathic hypersomnia, who are clinically similar to sEDS patients other than in MSLT results . Rates of SEID positivity were no different between the sEDS and IH groups =0.43, p = 0.52). The sEDS and IH groups were similar on MFI scores = 0.3, p=0.78) and FSS scores = 0.4, p=0.69).
Cognitive And Somatic Symptoms
Some somatic problems regarding the autonomic nervous system have already been described in hypersomnia . In this study, some functional equivalents are indeed more frequent in hypersomniacs than in controls, while there is no more headache in the patient group. In addition, half of the hypersomniacs are near-sighted, 38% are allergic and 25% have problems regulating their temperature. The mechanism of these symptoms is unknown, they could contribute to the burden of the disease.
The symptoms reported in this article are subjective, which constitutes a limitation of this work. There is no formal testing of the cognitive status by a neuropsychologist, no measure of supine hypotension, no systematic sight assessment in the controls, so that a bias towards over-reporting in patients is still possible. The questionnaire is, however, the same for any subject, whether hypersomniac or not. On the contrary, we try to catch the somatic problems of the patients, which are by definition subjective.
Lynn Marie Trotti, MD, MSc, of Emory University, and the Chair of our MAB
QUESTION: Whats the difference between chronic fatigue syndrome and idiopathic hypersomnia ? Is it just sleep attacks? Or is it part of the differential diagnosis? What about fibromyalgia? How does the medical community differentiate between these 3 diseases? How many patients with IH ALSO have fibromyalgia or CFS?
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Fibromyalgia Chronic Fatigue And Chronic Fatigue Syndrome
Editors Note: This article is excerpted from Dr. Goldenbergs new book, Chronic Widespread Pain: Lessons Learned from Fibromyalgia and Related Disorders. To purchase the entire e-book, go to ppmjournal.com/fibro and use the promo code READPPM for a 15% discount.
Persistent exhaustion is almost always present in patients with fibromyalgia and is prominent in each of the overlapping chronic functional illnesses, including irritable bowel syndrome , chronic migraine, and chronic bladder and pelvic pain. Unfortunately, there is no universal definition of what constitutes pathologic fatigue. The most common description of excess fatigue suggests that it is an extreme and persistent form of mental and/or physical tiredness, weakness, or exhaustion.
Chronic fatigue, like chronic pain, is a common symptom in the general population, with prevalence estimates between 10% and 40%.
Chronic fatigue, like chronic pain, is a common symptom in the general population, with prevalence estimates between 10% and 40%. In 1 study, nearly 20% of 31,000 men and women in a general practice reported substantial fatigue lasting 6 months or longer.2 During the past decade, most studies have defined chronic fatigue as fatigue lasting 6 months or longer with fatigue scores of 8 or greater on the Fatigue Scale.3 Women are more likely to report fatigue and more often report severe fatigue.2-4 The prevalence of fatigue was 30% in older women compared with 15% in older men.5
Management Of Ih Symptoms Beyond Excessive Daytime Sleepiness
In addition to treatment of sleepiness, it is often necessary to treat sleep inertia in people with IH, although there are no medications specifically approved or tested for this symptom. Clinical experience has suggested that use of wake-promoting medications at bedtime, including traditional stimulants, can help with sleep inertia on morning awakening , although these medications may not be tolerated at bedtime due to insomnia. Delayed-release methylphenidate, taken at bedtime for the treatment of next-day ADHD symptoms, might be particularly beneficial for the treatment of sleep inertia, because it ensures morning bioavailability of methylphenidate without as much risk of insomnia as with bedtime dosing. However, this strategy awaits formal testing.
Long sleep durations are another problematic symptom for many people with IH. Because long sleep durations are atypical in narcolepsy, especially in narcolepsy with cataplexy , clinical trials of narcolepsy treatments often have not assessed changes in sleep duration as a treatment outcome. It is therefore difficult to predict their efficacy in shortening sleep duration in those with IH. The only modafinil RCT limited to those participants with IH did not enroll IH participants with long sleep times , so does not inform the question. Considering all participants, including only half with IH and only a quarter with IH with long sleep time, there was no significant reduction in nocturnal sleep time in the clarithromycin RCT .
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Chronic Fatigue Vs Idiopathic Hypersomnia
Since IH is a bit of a mystery, it can go undiagnosed for a long time. It can seem like other conditions. That might have something to do with how we think and talk about sleep. You might hear people use terms like âfatigueâ and âsleepinessâ interchangeably, but they arent the same thing.
Heres how Trotti explains the difference: Hypersomnia means you either sleep too long or you fall asleep when you shouldnt, such as taking naps during the day. Fatigue, on the other hand, is a weariness or lack of energy that doesnt tend to raise your sleep time.
With that said, Trotti says about 20% of people with hypersomnia also have chronic fatigue syndrome. But a careful history of your symptoms can help your doctor figure out whats going on.
They might ask:
Upper Airway Resistance Syndrome
This syndrome is associated with excessive daytime sleepiness and heavy snoring causing frequent arousals during nocturnal sleep. Obesity is common patients may have anatomic abnormalities of the upper airway, such as a high, narrow, arched palate malocclusion of the mouth or retrognathia.
Polysomnographic recording shows short alpha-electroencephalogram arousals lasting 314 seconds. Monitoring esophageal pressure or quantifying airflow using a pneumotachometer is required to confirm the presence of this syndrome. The use of nasal continuous positive airway pressure as a therapeutic test can help to confirm the diagnosis.
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Summary Narcolepsy Vs Chronic Fatigue
Narcolepsy and chronic fatigue are categorized under neurological disorders. Narcolepsy is a chronic neurological disorder that is characterized by daytime drowsiness and sudden attacks of sleep while chronic fatigue is a chronic neurological disorder that is characterized by extreme tiredness and fatigue. So, this is the key difference between narcolepsy and chronic fatigue.
2. Sampson, Stacy. Chronic Fatigue Syndrome. Healthline, Healthline Media.
Maintaining A Healthy Weight With Narcolepsy
Obesity and narcolepsy can be closely related. Individuals with narcolepsy may have a body weight between 15 percent and 20 percent higher than expected on average in the general population. Some evidence suggests this could be related to both lower resting energy expenditure as well as eating behaviors .
Lack of sleep can create hormone disruption that may contribute to weight gain as well. Hypocretin is a brain chemical that regulates wakefulness and appetite. Hypocretin deficiency is linked with narcolepsy, and may decrease basal metabolic rate and food intake. However, more research in humans needs to be done to determine whether this is a direct result of hypocretin deficiency or other causes.
Below are some healthy eating basics that can help improve health and wellness.
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Symptoms Of Idiopathic Hypersomnia
- difficulty remaining awake and attentive during the day
- Falling asleep unintentionally at inopportune times
- Difficulty waking up after sleeping all night or after daytime naps
Other indicators of IH include excessive sleeping which can be upwards of 10 hours at night. sleep drunkenness is another indicator. This is where a person vacillates between various stages of being awake up to four hours after initially waking up. This state can lead to people being violent, clumsy and irritable, and can sometimes occur following naps as well.
Sleep deprivation and idiopathic hypersomnia have similar symptoms. The difference however is that once someone who is sleep deprived gets additional sleep, most of the symptoms are resolved. This additional sleep is referred to as paying off a sleep debt. This isnt the case for idiopathic hypersomnia. With IH, getting extra sleep does not erase the feeling of excessive sleepiness or other common symptoms associated with it.