What is Narcolepsy

Raena Morgan: Hi. I'm Raena Morgan and we're here at the sleep center and we're visiting with Dr. Hajal. Dr. Hajal, there are several sleep disorders that affect people. Could we talk about those? Like one of them is narcolepsy. I don't understand what narcolepsy is. Dr. Rizan Hajal: Narcolepsy is a neurological disease, which means it's a brain malfunction. What happens is that there is a -- at the centers of the brain that usually orchestrate the sleep are not functioning very well. So, there is no cyclical changes; so we don't go into sleep and then we would wake up. What happens is that the sleep can intrude at any part of the wakefulness. Raena Morgan: So, they don't have a normal sleep cycle. Dr. Rizan Hajal: That's true because the center of the brain that orchestrates all of this is not there. So, there is a little bit of free-flowing. In addition, when they do fall asleep, they don't sleep heavy either and they don't get restful sleep because of the narcolepsy. And now it's been linked to one specific hormone in the brain called hypocretin. That was diagnosed around 2000 or 2001 -- that this is the hormone that is lacking, which orchestrates the sleep in our brains. Raena Morgan: So, the symptoms would be falling asleep in the middle of the day. Dr. Rizan Hajal: There are -- the symptoms of narcolepsy are quite typical. Mainly, falling asleep throughout the day, which is the number one complaint that people show up to. And there is a misconception out there that it has to be a sleep attack, which means you're doing anything that you want and all of a sudden, you feel that you have to sleep, which is -- could be true. But most of the time, those people cannot function. They get up in the morning not feeling well and throughout the day they feel sleepiness. So, that's a number one symptom. Another symptom is called cataplexy, which means when they're doing something and they feel a little bit emotional about what they're doing -- or laughter sometimes tells them a joke -- they feel like they're going to fall to the ground. Their knees buckle and they could fall to the ground. And this is without falling asleep; just muscle weakness. Raena Morgan: So, they just go lax. Dr. Rizan Hajal: Exactly. Raena Morgan: With laughter or tears? Dr. Rizan Hajal: With laughter or any emotions. And you can imagine if this starts in childhood. It's so hard to tell why the child would actually fall to the ground. And when they do grow up and they're 21 and showing up in our office, sometimes to complain about it, they have had those symptoms since they were children. So, they don't even know what is normal, what is not anymore. So, that's one. Another one that's very common is sleep paralysis, which means they would wake up and not being able to move at all. They're completely frozen. They cannot move their muscles, even though they are awake. They frequently can move their eyes and look around the room. And this could last for just two or three minutes. But to the person going through it, it could seem an eternity. Raena Morgan: But that would be terrifying, wouldn't it? Dr. Rizan Hajal: It would be very terrifying and this frequently is a reason why they would show up sometimes. Raena Morgan: Now you said that children get narcolepsy. Dr. Rizan Hajal: Right. Raena Morgan: Is that typical? Dr. Rizan Hajal: It is typical because we think that at some point in childhood, they would lose the center. And frequently -- Raena Morgan: They would lose the center? Dr. Rizan Hajal: The center that orchestrates the sleep. Raena Morgan: Okay. Dr. Rizan Hajal: And frequently when we see people and start asking them, they can trace it back to when they were teens. They say, "Yeah, I was showing some signs there." But it may not mature. It will become a full picture of narcolepsy usually in their 20s. Raena Morgan: In puberty? Does it hit? Dr. Rizan Hajal: Around puberty is when the symptoms show up, yeah. Raena Morgan: Okay. And so a lot of times they don't know that that's what's affecting them. Dr. Rizan Hajal: No. And, you know, I feel very good when I diagnose somebody very early because sometime their schooling could be affected. So you have somebody who is labeled to be lazy by their teacher, and then what they have is actually narcolepsy. And it's very nice -- fulfilling -- to diagnose somebody who's 16 and you can alter their schooling and their whole life when we diagnose them early, as opposed to diagnosing somebody who's 55 or something. Raena Morgan: So, a child might be labeled as lazy, but they wouldn't be manifesting the most dramatic symptoms of it, right? Dr. Rizan Hajal: That's true, which makes it harder. So, the first symptoms would be sleepiness, which could be, you know, labeled as lazy. But you could have other sleep disorders and this is what we should caution the teachers about that -- about that if somebody's not really participating in class, falling asleep. There could be other reasons. It could be social reasons, but also medical reasons for them to behave like that. Raena Morgan: And it could also be very dramatic. Like, I had a friend who had it and she fell asleep driving her car in the middle of the day. Dr. Rizan Hajal: Oh, yes. Raena Morgan: And hit a parked car. Dr. Rizan Hajal: And this is terrible. There's so many people who get into car accidents from narcolepsy. And that's the problem is that they are undiagnosed. They never really showed up to get that worked up. And unfortunately, that's how they show up after a car accident. And the highway patrolman makes them come in to get the workup. Raena Morgan: Thank you very much for that explanation.