Q: I am a 24-year-old woman and I am falling asleep driving. I get plenty of sleep at night and I eat right. I have minimal stress. I go to sleep within a couple seconds and have almost wrecked several times. My husband is very worried. My doctor says I should go on antidepressants but there is no depression or stress. I’m just going to sleep, especially during the day. I’ve tried everything I know to stay awake and nothing is working. What is wrong with me?
A: There are important clues in your question that may give us the answer. The first is falling asleep at inappropriate times, such as while driving, despite getting plenty of rest; the second, falling asleep during the day; third, you fall asleep within seconds of going to bed (the average person takes 10-20 minutes). These three facts alone have me concerned that you may be affected with a type of sleep disorder known as narcolepsy.
Narcolepsy’s effects vary from person to person. Many of those affected don’t just fall asleep during quiet times, but often during times of activity such as when driving, eating, talking, swimming, or even during sex. In fact, narcoleptics often fall asleep in spite of doing everything they can to stay awake. As you have experienced, this is a frustrating—and sometimes dangerous—road to travel.
Narcolepsy is a lifelong disorder affecting the area of the brain regulating our sleep and wake cycles. It usually makes its first appearance between the ages of 15 and 30 (that can vary), equally affects men and women, and may initially be so mild that it takes years to diagnose. While daytime sleepiness is a common theme, some sufferers may experience a more severe form that results in sudden “sleep attacks” lasting from several seconds to minutes. Additional symptoms include:
- Lack of energy
- Trouble with concentration
- Impaired memory
- Waking up unable to move or talk for several seconds.
It is important to know that almost 70 percent of those affected with narcolepsy also experience cataplexy. This complication causes a sudden muscle weakness while the person is awake. This may lead to sudden head nodding, difficulty forming words or speaking, dropping things out of one’s hands, and even buckling of the knees, potentially leading to a fall. These attacks may last for several seconds or up to a few minutes, all while the person is fully aware of their occurrence.
Other symptoms of narcolepsy may include sleep paralysis, very real appearing hallucinations—complete with smells, sights and sounds—or automatic behavior—a frightening phenomenon where the affected person may be involved in an activity (driving, talking, writing) while alternating between sleep and wakefulness.
In addition to symptoms, a diagnosis of narcolepsy is based on specific diagnostic tests. Questions your doctor or sleep specialist will need answers to include but aren’t limited to:
- How long have your symptoms occurred?
- What time you usually go to bed and wake up?
- How long does it take you to fall asleep?
- Do you frequently awake or have difficulty sleeping through the night?
- Do you snore and do you wake up gasping for breath?
- Do you have difficulty staying awake during the day?
- Do any sleep disorders run in your family?
- Do you have frequent accidents due to clumsiness or from lack of concentration?
Additionally, your physician will complete a medical work-up to exclude other potential causes of your symptoms. These include infections, diabetes, depression, substance abuse, thyroid disease or even autoimmune disorders.
Next: specific sleep tests. These include a polysomnogram (requires sleeping overnight at a sleep center) followed by a multiple sleep latency test (MSLT), also known as a nap study. This last test checks to see how easy it is for the affected person to fall asleep during the day and how quickly they enter into a phase of sleep known as rapid eye movement (REM). Some centers may also check for hypocretin; low levels of this brain chemical may be an indicator of narcolepsy.
If narcolepsy is suspected after this thorough evaluation, medication(s) as well as lifestyle changes—going to bed at regular times, naps throughout the day, avoidance of stimulants, to name a few—would be recommended. This combination approach usually has the best success in decreasing symptoms while improving the quality of the affected persons’ everyday life.
As a matter of safety, please visit a physician skilled in the diagnosis and management of sleep disorders. For further information, check out the National Institute of Neurological Disorders and Stroke or Sleepnet.
More From Dr. Rob:
- Unusual Food Allergies
- Silencing a Snoring Spouse
- Listening to the Female Heart
- When Menopause Dampens Desire
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