Many suffer from sleep attacks
YOUR HEALTH
DR. DONOHUE

DEAR DR. DONOHUE: Have you addressed narcolepsy and cataplexy? I am asking you to share what you know about them. Perhaps you're not interested in narcolepsy. Doctors aren't clamoring to specialize in sleep disorders. Thank you for any information you might have. -- C.S.

ANSWER: I am interested in narcolepsy. One in 4,000 people suffers from it. If you divide 4,000 into the combined populations of Canada and the United States, you have a large number of people.

Narcolepsy is the inability to stay awake during the day. Said another way, it's attacks of irresistible urges to fall asleep at times and in places where it's inappropriate to do so -- while driving a car, listening to the boss speak, talking on the phone or sitting at a desk doing work. Along with sleep attacks, the other signs of this illness are hypnagogic hallucinations, sleep paralysis and cataplexy.

Hypnagogic hallucinations are vivid, frightening, imagined sights of people or things when falling asleep or waking from sleep. Sleep paralysis is the inability to move the body for one to two minutes upon wakening. Cataplexy is muscle weakness that comes on during times of emotional involvement, like laughter, anger or excitement. The muscle weakness might be only the dropping of the jaw, or it can be a total collapse to the floor. The cataplexy episode lasts about two minutes, and the person remains conscious throughout the event. Not all people with narcolepsy have all four signs of it, but having even two puts the diagnosis on firm ground.

Many doctors are involved in the research of narcolepsy. One newer discovery is a deficiency of the brain chemical orexin in people with this condition. Orexin keeps the brain awake and active. Furthermore, people with narcolepsy have disrupted REM sleep, the sleep stage when the eyes are moving rapidly and when most dreaming occurs. These discoveries offer new treatment possibilities.

Twenty-minute naps during the day can lessen the number and intensity of narcolepsy attacks. Provigil, while not the only treatment medicine, is the one most often prescribed. Venlafaxine, an antidepressant, increases the brain's supply of norepinephrine and serotonin, two brain messenger chemicals that can ease or even abolish cataplexy occurrences.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall. com. 2006 North America Syndicate Inc. All Rights Reserved