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Endocrinology

Everything you need to know about exophthalmos

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Exophthalmos defines a disorder in which the eyeball protrudes from the socket of the eye, thereby making it appear to be bulging. This has the ability to damage one or both eyes.

Exophthalmos can cause eye problems, such as corneal dryness and conjunctivitis, which is an inflammation of the membrane lining the eye, depending on how serious this is.

Symptoms continue to improve in the long term but that can take years. There’s a chance that if care is not provided, the eyes can start to bulge.

Exophthalmos is a symptom of a disorder, not a condition. Commonly, this may indicate a thyroid gland problem. The most severe condition of Graves is the most common cause of exophthalmos.

Graves’ disease and thyroid disorders

Graves’ disease affects the thyroid gland.
Graves’ disease affects the thyroid gland.

Disease of Graves is an autoimmune disease which causes hyperthyroidism. A person with hyperthyroidism has an overactive thyroid gland that produces and causes the excess hormones to rise.

The thyroid lies in the heart, under the apple of Adam. The hormones that it produces help control growth, metabolism rate and other important body functions. The hormones are called thyroxine and triiodothyronine, and usually kept in balance.

Thyroid eye disease is a disorder in which the soft tissues and muscles around the eyes swell and become inflamed.

This sometimes stems from hyperthyroidism, and often from hypothyroidism, triggered by an underactive thyroid gland.

Hyperthyroidism or hypothyroidism can not necessarily cause the eyes to wallow. It could take some time to happen.

The immune system fights bacteria, the organisms and the chemicals which are bad for us in a healthy person. Which involve other bacteria , viruses , parasites, cancer cells, fungi, etc. For certain cases, however, the immune system starts destroying normal tissue. They describe this as an autoimmune reaction.

The disease of Graves is an example of the autoimmune reaction. Experts aren’t sure what causes autoimmune diseases. When an individual’s immune system attacks the thyroid gland, it may respond with the development of extra hormones.

The autoimmune antibodies will invade the muscles and soft tissue around the eyes which can cause them to protrude from the sockets.

This can lead to:

  • dry or gritty eyes
  • redness
  • puffy eyes
  • inflammation and swelling
  • vision problems

Common cause

Exophthalmos is a symptom of Graves’ disease.
Exophthalmos is a symptom of Graves’ disease.

The most common cause of the exophthalmos is the disease of Graves. Anywhere from 25-50 per cent of people with this disorder would be active in the eye.

Interestingly, eye involvement can occur up to 10 years before thyroid disorders are detected, and up to 20 years afterwards. During Graves’ disease the immune cells that invade the thyroid also accumulate inside the eye socket. The fatty tissue and muscles around the eye get high, moving the eye forward and outwards.

Symptoms

A person who has Graves’ exophthalmos may experience the following symptoms:

  • pain in the eyes
  • dry eyes
  • eye irritation
  • photophobia, or sensitivity to light
  • lacrimation, or eye secretions, and shedding of tears
  • diplopia, or double vision caused by weakening of the eye muscles
  • blurred vision
  • blindness if the optic nerve is compressed
  • difficulty in moving eyes, as the eye muscles are affected
  • feeling pressure behind and around the eyes

Many non-eye-related signs and symptoms of Graves’ disease include irregular heartbeats, anxiety, high blood pressure, excessive appetite, weight loss, vomiting, and sleep issues.

While Graves ‘ disease is the most common condition that can protrude the eyes, it is not the only one.

Other causes

It may also happen to protruding eyes, or a protruding eye, if there is anything in the eye socket that forces the eyeball forward. This could be:

  • a cancerous or non-cancerous tumor
  • a blood clot
  • an eye injury
  • orbital cellulitis (infection of tissue around the eye)
  • abnormalities within the brain

Anybody who notices that one or both eyes are starting to bulge should seek medical attention.

Diagnosis

A doctor can usually note a protruding eye by looking at it, but because exophthalmos is usually a sign of some disease or disorder, tests may be required to determine the cause.

Tests may include:

  • A blood test to see if the thyroid gland is functioning properly.
  • Measurement of the degree of protrusion, using an exophthalmometer.
  • Imaging scans, such as a CT scan or an MRI, to examine the orbit, or eye socket. A scan can detect a tumor or any abnormality in or around the eyes.
  • A CT scan or MRI of the brain to evaluate the structure of the brain.

Exophthalmos appears to be a progressive disease and over time, the symptoms get worse. So treatment should start as soon as possible.

Treatment

Eye drops may help relieve dry eyes in cases of exophthalmos.
Eye drops may help relieve dry eyes in cases of exophthalmos.

The ophthalmologist or eye-specialist will periodically examine the individual.

Treatment depends on many factors including the origin, age of the individual and general health of the person.

It’s recommended that someone with this disorder stop smoking. Smoking has been shown to worsen the exophthalmos and make treatment more difficult.

If the person has thyroid problems, the doctor will treat the root cause and restore the levels of thyroid hormone to normal. While it is necessary to treat the thyroid problem, that the exophthalmos may not be resolved by itself. Other therapies also need to be replaced.

The exophthalmos have a variety of medical choices. Surgery can be helpful for those with a more serious involvement of the eyes.

Treatment options which are not surgical can include:

  • natural tears for eye lubrication
  • sunglasses for light sensitivity
  • corticosteroids
  • medications that decrease the immune response, such as cyclosporin
  • medications that block certain antibodies, such as rituximab (Rituxan)
  • radiotherapy

In radiotherapy, diagnosis with low dose radiation is usually reserved for more severe cases, and is often merged with corticosteroids.

Surgical options for treatment can include:

  • Orbital decompression: Enlarging the orbit of the eye can make more room for the eye and its muscle and tissue.
  • Eye muscle surgery: This can be done to correct abnormal eye muscles.
  • Eyelid surgery: This works by protecting the cornea and outer eyeball from damage.

Complications

The eyelids that fail to close during sleep if left untreated, resulting in drying of the cornea and becoming damage. There is a chance of infection or ulcers if the cornea dries out too soon, which can impair vision.

People with exophthalmos are more likely to develop conjunctivitis, and especially superior limbic keratoconjunctivitis, in which the region above the cornea is inflamed due to irregular tearing and blinking.

Rarely, some people may experience optic nerve or ophthalmic artery compression which may ultimately impair their eyesight and may lead to blindness.

Outlook

In general, finding medical attention is the first step for any person who sees bulging eyes. Know, exophthalmos is a warning that something is happening in, around, or inside the brain.

Graves ‘ disease is the most prevalent cause of exophthalmos. It is important to work closely with the medical team to establish a treatment plan for treating all thyroid issues, along with any complications of the eyes. Quitting smoking is crucial to improving exophthalmos results, while better follow-up would ensure the best possible treatment.

Endocrinology

Hypothyroidism, sweating, and night sweats: What to know

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Hypothyroidism is commonly associated with decreased sweating and feeling cold, according to doctors. Sweating is a symptom of hypothyroidism in some people. This could be due to the fact that thyroid hormones assist control body temperature, and a lack of them causes instability.

There are, however, other, more plausible reasons for similar symptoms.

For example, if someone takes more levothyroxine than they require, a hypothyroidism drug called levothyroxine might cause sweating as a side effect. Other variables, such as menopause, can cause sweating and may occur in conjunction with hypothyroidism.

In this article, the connection between hypothyroidism, sweating, and nite sweats is examined. It also looks into how people might live more comfortably when they are sweating profusely.

When to consult a physician

If a person has night sweats on a frequent basis, they should consult a doctor. If they already have hypothyroidism, the doctor may suggest changing their medication dosage or checking for other possible causes.

If someone does not have a diagnosis of hypothyroidism, consulting a doctor will allow them to run tests to confirm or rule out the condition.

Hypothyroidism and sweating

sweating

Although doctors connect hypothyroidism with feeling chilly and hyperthyroidism with feeling hot, low thyroid hormone levels may cause overall difficulties controlling body temperature. This could imply that some hypothyroid people suffer perspiration. There is, however, insufficient scientific evidence to back this claim.

Another possibility is that the individual is taking too much levothyroxine. Levothyroxine substitutes thyroid hormones that the body can not produce enough of. Taking more of this medication than is necessary may result in:

  • difficulty sleeping
  • chest pain
  • nausea or vomiting
  • diarrhea
  • sweating
  • headaches
  • a racing heartbeat
  • anxiety or agitation

Hypothyroidism and night sweats

Night sweats can be caused by hypothyroidism, but clinicians rarely link the two. There could be other causes for this condition. For example, levothyroxine, a hypothyroidism drug, may cause a person to feel excessively hot in general, including at night.

Thyroid hormone levels influence other hormone levels in the body and vice versa. This is especially important for women, who are five to eight times more likely than men to have hypothyroidism.

In their mid-to-late 40s, most women experience the first signs of menopause. At this point, estrogen and progesterone levels begin to fall. This can cause in symptoms, the most prevalent of which are hot flashes and nocturnal sweats. Doctors believe that estrogen levels may have an effect on thyroid function as well.

Menopause and hypothyroidism have several symptoms, and each can aggravate the other. This could imply that some hypothyroid people suffer both thyroid and menopausal symptoms at the same time.

Estrogen influences how much triiodothyronine and thyroxine the thyroid produces, and the thyroid may struggle to meet the body’s needs during menopause. According to a 2011 study, estrogen has a direct influence on human thyroid cells.

An earlier 2007 study looked at females with hypothyroidism or hyperthyroidism and severe menopausal symptoms. The researchers discovered that treating thyroid dysfunction reduced patients menopausal symptoms, such as night sweats.

Other hypothyroidism symptoms

The symptoms of hypothyroidism might vary from person to person. However, some common symptoms are as follows:

  • forgetfulness
  • constipation
  • tiredness
  • weight gain
  • dry skin
  • an inability to tolerate cold
  • heavy or irregular periods
  • fertility problems
  • dry, thinning hair
  • voice changes
  • muscle pain
  • joint pain
  • a slowed heart rate
  • depression

Treatment

People who have frequent sweating and nocturnal sweats should consult a doctor about their symptoms. They may need to be tested for thyroid disease. Alternatively, if they already have a diagnosis, they may need to alter their prescription dosage.

To alleviate the discomfort caused by sweating, it may be beneficial to:

  • Sleep in a cool bedroom: Turning down the thermostat and sleeping with less or lighter bedding might help minimize heat around the body during sleeping. Make an effort to use bedding composed of breathable, natural fibers such as cotton.
  • Choose breathable clothing: Wherever feasible, use lightweight, flowy clothing made of natural fibers. This can assist in keeping the body cool and wicking away perspiration. Wearing light layers allows someone to remove or reapply garments as their body temperature changes.
  • Reduce sweat triggers: Spicy meals, cigarettes, and alcohol can aggravate night sweats, therefore avoiding these can help to alleviate this condition.
  • Use a cooling pillow or ice pack: Some pillows feature a gel filling that keeps you cool while you sleep. Alternatively, a cool pack can be placed under the pillow. When a person has night sweats, flipping the pillow to the cool side can help them chill down.

Other causes

If levothyroxine and lifestyle adjustments do not alleviate sweating, it is possible that something else is causing this symptom. The following are some further explanations.

Menopause

Perimenopause, or the earliest stage of menopause, is characterized by hot flashes and nocturnal sweats. These are known as vasomotor symptoms by doctors.

According to research, more than 80% of females experience hot flashes throughout menopause. These often cause in a sudden feeling of heat, perspiration, flushing, anxiousness, and chills. This can persist 1–5 minutes before dissipating.

Medications

Many drugs might cause night sweats. Night sweats, for example, are reported by up to 22% of people who take antidepressants.

Among the other drugs that may have this effect are:

  • aspirin
  • acetaminophen
  • steroids
  • antipsychotics
  • hormone therapy drugs
  • medications that decrease blood sugar

A doctor may propose alternatives if a person is taking a medicine that can cause perspiration. Do not change the dosage or discontinue a medicine without first consulting a medical expert.

Diabetes

Diabetes can cause havoc on the body’s natural capacity to regulate its internal temperature. This frequently leads to less sweating than is desirable, putting people at higher risk of heat-related diseases including heat stroke.

People who have low blood sugar, or hypoglycemia, may also have excessive sweating. A condition known as gustatory sweating is also a known consequence of diabetes. This causes excessive sweating during or immediately following meals.

Other causes

Other causes for sweating or night sweats include:

  • hyperthyroidism
  • pregnancy
  • anxiety
  • hyperhidrosis
  • infections
  • excessive alcohol consumption
  • autoimmune conditions
  • gastroesophageal reflux disease
  • Parkinson’s disease and other neurological conditions
  • cancer, such as pheochromocytoma, leukemia, and lymphoma

Conclusion

Hypothyroidism is a condition in which the thyroid produces insufficient thyroid hormone. Although sweating is more frequently associated with hyperthyroidism, or an overactive thyroid, it is possible that low levels of thyroid hormone may cause sweating in some hypothyroid patients.

There are, however, numerous other causes that can cause perspiration. Menopause, medication side effects, diabetes, and other conditions could all be factors. As a cause, anyone who sweats during the day or night for no apparent reason should consult a doctor.

Sources:

  • https://pubmed.ncbi.nlm.nih.gov/17701801/
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6459071/
  • https://www.ncbi.nlm.nih.gov/books/NBK459227/
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6619426/
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  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5898980/
  • https://www.medicalnewstoday.com/articles/what-to-know-about-hypothyroidism-sweating-and-night-sweats
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4861190/
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8502225/
  • https://www.womenshealth.gov/menopause/menopause-basics
  • https://www.sweathelp.org/where-do-you-sweat/other-sweating/night-sweats.html
  • https://www.ncbi.nlm.nih.gov/books/NBK499850/
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3113168/
  • https://www.ncbi.nlm.nih.gov/books/NBK500006/
  • https://www.btf-thyroid.org/thyroid-and-menopause

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Insomnia and hypothyroidism: Is there a link?

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Rather than an underactive thyroid, doctors usually connect difficulties sleeping with an overactive thyroid. However, there is little evidence that hypothyroidism may be linked to sleep issues.

There is little research on the link between hypothyroidism and insomnia, and what little research there is has inconsistent outcomes.

According to one study, hypothyroidism is linked to insomnia but does not cause it directly. There was no link between the two in an older, smaller study.

This article examines whether hypothyroidism is associated to insomnia, as well as the reasons for such a link. It also looks into how people can manage their symptoms.

Hypothyroidism and insomnia

insomnia

Hypothyroidism and insomnia may be linked. A 2019 study looked at hypothyroidism and sleep quality.

For a full-blown diagnosis of hypothyroidism, a condition must have subclinical hypothyroidism.

The scientists discovered several associations between sleep of 2,224 people with subclinical hypothyroidism and 12,622 people with normal thyroid hormone levels. Subclinical hypothyroidism was associated with:

  • lower satisfaction with sleep quality
  • longer sleep latency, which is the amount of time it takes to go to sleep
  • shorter sleep duration

The researchers also discovered that people with both subclinical hypothyroidism and poor sleep quality were more likely to be female, younger, and underweight.

A 2014 study looked into the possibility of a link between subclinical hypothyroidism and poor sleep quality, however the sample size was smaller and less diversified. There were 682 men in the study, 38 of whom had hypothyroidism.

There was no link between thyroid hormone levels and poor sleep quality, according to the findings. However, due to the study’s limitations, it may not be accurate.

Is there a link?

Thyroid-stimulating hormone levels are high in subclinical hypothyroidism (TSH). The hypothalamus, a component of the brain, causes the pituitary gland to release more TSH when thyroid levels in the body are low.

TSH stimulates the thyroid gland to produce more of the hormone known as free thyroxine when it reaches the gland (T4).

Subclinical hypothyroidism is defined by normal T4 levels in the blood and increased TSH levels, which can indicate that hypothyroidism symptoms are nonexistent or moderate.

Researchers don’t entirely understand how elevated TSH levels can lead to poor sleep, but they do have an idea.

The hypothalamic-pituitary-thyroid (HPT) axis connects the hypothalamus, pituitary gland, and thyroid gland. The HPT axis gets increasingly active as a person falls asleep.

This stimulates the thyroid gland by increasing the secretion of TSH. Thyroid stimulation may cause sleep disturbances under specific physiological situations.

Other ways hypothyroidism can affect sleep

While it is unknown if hypothyroidism can cause insomnia directly, it is plausible that it can affect sleep indirectly. Hypothyroidism can cause the following symptoms:

Discomfort

Hypothyroidism’s physical effects can sometimes make it difficult to sleep. For example, if a person has joint or muscular pain, is sensitive to the cold, or is anxious, sleeping may be difficult.

According to an older 2011 study, insomnia is more common in people who have a higher number of medical issues. With this in mind, the vast range of symptoms caused by hypothyroidism might have a severe impact on sleep quality.

Side effects of medications

Hypothyroidism is treated with thyroxine, a hormone that increases low thyroid hormone levels and relieves hypothyroidism symptoms. It is an effective medication for many people when given at the proper dose.

If someone takes more than they require, they may encounter side effects such as:

  • feeling hot
  • shakiness
  • racing heartbeat
  • inability to sleep
  • anxiety or nervousness
  • increased appetite

Other health conditions

Hypothyroidism is linked to other sleep-disrupting conditions, such as obstructive sleep apnea (OSA), a condition in which breathing stops and causes periodically during the night.

Daytime tiredness, frequent waking, and difficulty sleeping can all be symptoms of OSA. If someone has OSA, others sleeping in the same room may hear excessive snoring, choking, or gasping noises.

Restless legs syndrome, which causes unpleasant crawling or tingling feelings in the legs while someone is sleeping, is linked to hypothyroidism.

What helps?

What relieves insomnia depends on the source of the problem. If you have hypothyroidism, your doctor may recommend:

  • lowering the dose of someone’s thyroxine to a more comfortable level if they are having side effects
  • beginning thyroxine treatment to relieve physical discomfort
  • testing for other conditions that may be causing insomnia

It is important not to change the dose of thyroxine without first consulting with a doctor.

If taking or altering thyroid medication does not help, a doctor may investigate other possible causes. They may inquire as to when their insomnia began, how frequently it occurs, and any changes that occurred in their life around that time.

If a doctor detects a sleep issue, such as OSA, he or she may refer the patient for a sleep study to confirm the diagnosis. Alternatively, if the insomnia is caused by another medical or mental health condition, the individual may begin treatment for it as well.

Is there anything else that can increase thyroid hormone levels?

Although there is no cure for hypothyroidism, it may nearly always be managed with medicine, which restores thyroid hormone levels to normal.

There is evidence that there are additional strategies for people to support their thyroid hormone levels, such as:

Exercise

An older study from 2015 looked at the effect of a regular physical activity program on 20 people who were being treated for hypothyroidism. Thyroid hormone levels were measured in blood before and after three months of daily one-hour exercise sessions, according to the authors.

They determined that exercise can improve thyroid function after comparing the results to people who did not engage in any physical activity at all.

Diet

Iodine is a nutrient used by the thyroid gland to produce thyroid hormones. The majority of people in the United States obtain enough iodine.

Iodine deficiency, on the other hand, can cause hypothyroidism in rare situations. People who are deficient in iodine can supplement their diet with foods like seaweed or take pills.

Taking iodine pills will not help if iodine insufficiency is not the cause.

Furthermore, people with autoimmune thyroid disease, such as Hashimoto’s disease, may discover that iodine in food or supplements aggravates their condition. A doctor or dietician can advise on the best course of action for each individual.

A diet that reduces inflammation is something that practically everyone can benefit from. Inflammation has been associated to a number of chronic illnesses, including autoimmune thyroiditis, according to the United States Department of Veterans Affairs. Thyroiditis can result in hypothyroidism.

An anti-inflammatory diet may help people with autoimmune hypothyroidism. This entails eating:

  • foods that contain omega-3 fatty acids, such as wild salmon
  • plenty of fresh fruits, vegetables, and whole grains
  • monounsaturated or “healthy” fats, such as olive oil, rather than saturated fat
  • at least 30 grams of fiber per day

Can people with hypothyroidism take melatonin?

Melatonin is a hormone that the body makes naturally as part of the sleep-wake cycle. Its production increases in the evening darkness, promoting healthy sleep, and decreases when a person is exposed to light, assisting them in waking up.

As a result, the sleep-wake cycle is synchronized with the rhythms of night and day.

Some people use extra melatonin to help them sleep. Short-term use of melatonin supplements appears to be safe, according to the National Institutes of Health, but there is limited evidence on long-term consequences.

A small study published in 2001 examined the effect of melatonin on females with hypothyroidism, 36 of whom were perimenopausal and 18 of whom were postmenopausal. The individuals were divided into two groups at random by the researchers. At bedtime, one group received a placebo, while the other received melatonin.

After 3–6 months, the scientists discovered that the melatonin group had significantly greater levels of thyroid hormones than the placebo group.

They hypothesized that low levels of melatonin due to aging were linked to low levels of thyroid hormones, which explains why taking a melatonin pill increased TSH levels as well.

To confirm that melatonin is safe and effective for people with hypothyroidism, large-scale investigations are required. People who want to use a melatonin supplement should see a doctor about appropriate amounts and keep in mind that the quality of supplements might vary greatly.

Other causes of insomnia

Insomnia can be caused by a variety of conditions, including:

  • stress
  • shift work
  • hormone changes, such as during pregnancy or menopause
  • lifestyle factors, such as:
    • using electronic devices close to bedtime
    • exercising too little
    • using caffeine, nicotine, illegal drugs, or alcohol
    • taking long naps in the day
    • having an irregular sleep schedule
  • environmental factors, such as:
    • noise or light
    • frequent travel to different time zones
    • a temperature that is too hot or cool in the bedroom

People who are having trouble sleeping may benefit from minimizing any of the probable risk factors for insomnia that they have control over. It can, for example, aid in:

  • quit smoking
  • get regular exercise, while avoiding exercise in the evening before sleep
  • manage stress or practice relaxation techniques
  • create a cool, dark, and comfortable sleep environment
  • wake up and go to bed at the same time every day
  • reduce or stop caffeine and alcohol consumption

Conclusion

In conclusion, hypothyroidism may be connected to insomnia, however evidence to date has been inconsistent.

People with hypothyroidism, on the other hand, frequently have difficulty tolerating low temperatures at night, as well as joint and muscular pain that can interfere with sleep. If the dose is too high, the side effects of thyroxine might also cause trouble sleeping.

Even if thyroid hormone shortage isn’t directly causing insomnia, the vast variety of symptoms associated with thyroid dysfunction can easily exacerbate sleeping problems and limit a person’s capacity to attain quality, deep sleep.

Consult a doctor if insomnia becomes a persistent issue. Treating the underlying issue and implementing sleep-promoting lifestyle modifications may be beneficial.

Sources:

  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4363141/
  • https://pubmed.ncbi.nlm.nih.gov/11226744/
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6770945/
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3119827/
  • https://www.thyroid.org/thyroid-disease-cam/
  • https://www.medicalnewstoday.com/articles/hypothyroidism-and-insomnia
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8423342/
  • https://www.va.gov/WHOLEHEALTHLIBRARY/tools/hypothyroidism.asp
  • https://www.thyroid.org/hypothyroidism/
  • https://www.niddk.nih.gov/health-information/endocrine-diseases/hypothyroidism
  • https://www.nhlbi.nih.gov/health-topics/insomnia
  • https://www.nccih.nih.gov/health/melatonin-what-you-need-to-know
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6927586/

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What exactly is the difference between narcolepsy and sleep apnea?

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Narcolepsy and sleep apnea are two diseases that can cause you weary during the day. Their symptoms, causes, and therapies, on the other hand, are vastly different.

Narcolepsy is an uncommon condition that causes episodes of extreme tiredness that can occur at any time. Cataplexy is a condition in which some people experience an abrupt loss of muscular tone.

Sleep apnea, on the other hand, is a frequent condition in which a person’s breathing stops and causes disturbances while sleeping. It can cause fatigue as a result of poor sleep quality.

The differences between narcolepsy and sleep apnea, as well as the link between the two sleep disorders and how doctors diagnose them, are discussed in this article.

What is narcolepsy?

narcolepsy

Narcolepsy is a neurological condition that impairs the brain’s capacity to regulate its sleep-wake cycle. This can cause people to fall asleep spontaneously and unexpectedly during the day, even when performing tasks that need focus, such as driving.

Narcolepsy patients frequently have disrupted sleep owing to intense dreams, hallucinations, or sleep paralysis.

Narcolepsy is classified into two types: type 1 and type 2. Cataplexy, or a decrease of muscular tone, is a symptom of type 1. Cataplexy causes a section of or the entire body to become limp. Type 2 occurs in the absence of cataplexy.

Narcolepsy symptoms often appear in childhood or early adulthood, but they can appear at any age. Many studies believe that the condition is frequently misdiagnosed or underdiagnosed.

What is sleep apnea?

Sleep apnea is a frequent condition in which a person’s breathing temporarily stop or becomes very shallow during sleep. These are known as “breathing pauses” by doctors, and they can last anywhere from a few seconds to a few minutes.

People who suffer from sleep apnea experience frequent breathing pauses, which can occur 30 times or more per hour. Sleep apnea can be classified into numerous categories, including:

  • OSA (obstructive sleep apnea): This is the most frequent type of sleep apnea, and it is caused by an obstruction in the upper airways.
  • Central sleep apnea: This condition happens when the brain fails to provide the necessary impulses for breathing.
  • Complex sleep apnea syndrome: This is a combination of obstructive and central sleep apnea.

Symptom differences

The symptoms of sleep apnea and narcolepsy are compared in the table below:

Sleep apneaNarcolepsy
excessive daytime sleepinessexcessive daytime sleepiness that may occur suddenly
gasping or choking noises during sleepcataplexy, which strong emotions such as fear, laughter, stress, anger, or excitement often trigger
loud snoringvivid dreams, sleep paralysis, or hallucinations
dry mouth when wakingacting out dreams
frequent waking during sleepdifficulty sleeping at night
difficulty focusing or rememberingautomatic behaviors, which occur when a person briefly falls asleep but carries on with their activity
headaches

Sleep apnea is also linked to bedwetting, exacerbated asthma, and academic performance difficulties in children.

Can sleep apnea progress to narcolepsy?

According to research, OSA is widespread in people who have narcolepsy. An earlier 2010 study discovered that 33 people with narcolepsy — nearly 25 percent — also had sleep apnea symptoms.

Sleep apnea, on the other hand, does not cause narcolepsy. Narcolepsy is a neurological condition in which the brain is unable to control its sleep-wake cycle.

Sleep apnea is common in people with narcolepsy, although it may be related to the other sleep abnormalities that people with narcolepsy frequently encounter, according to doctors.

Hypocretin, a hormone, is deficient in people with type 1 narcolepsy. Hypocretin awakens people and regulates rapid eye movement (REM) sleep. Excessive tiredness during waking hours and irregular sleep cycles cause in symptoms such as vivid nightmares when this hormone is deficient.

Doctors aren’t clear why certain people have low hypocretin levels, although various variables could be at play:

  • Autoimmune disease: Autoimmune disorders, in which the immune system assaults healthy cells, are common in people with type 1 narcolepsy. The immune system may also assault the cells that produce hypocretin, resulting in a deficit, according to researchers.
  • History of the family: Most cases of narcolepsy do not have a familial history of the condition. However, approximately 10% of people indicate they have a family relative who likewise suffers with narcolepsy symptoms. This shows that in some circumstances, there may be a hereditary component.
  • Injuries or diseases to the brain: In rare cases, narcolepsy develops as a result of an injury to a brain area that regulates sleep or as a result of another condition that affects the brain, such as a tumor.

Hypocretin levels in people with type 2 narcolepsy are frequently normal. Researchers are still trying to figure out what causes this condition.

Similar conditions

There are numerous reasons why a person may feel excessively fatigued during the day. Other things that may contribute to this symptom are as follows:

  • insufficient sleep
  • certain medications, such as antihistamines, antidepressants, and beta-blockers
  • other sleep disorders, such as circadian rhythm disorder
  • hypothyroidism
  • depression
  • insomnia
  • traumatic brain injuries

Some more serious illnesses, such as Parkinson’s disease, multiple sclerosis, and muscular dystrophy, can also cause extreme sleepiness. However, these are generally accompanied by additional symptoms.

Diagnosis

A doctor can determine the cause of extreme tiredness, frequent awakening during the night, and other symptoms that may indicate sleep apnea or narcolepsy. They will start the diagnostic procedure by:

  • asking the person to keep a sleep journal to record their symptoms
  • taking a medical history
  • performing a physical examination

Sleep studies, on the other hand, are the major tool used by doctors to identify sleep apnea. A person will spend the night at a health center, where doctors will monitor them and count the number of breathing pauses in an hour. Doctors will also look to see if the blood oxygen levels change.

If a doctor suspects narcolepsy, he or she may order a polysomnography (PSG) and a multiple sleep latency test (MSLT).

A PSG is a form of sleep study that monitors breathing, eye movements, brain activity, and muscle movements while the patient is sleeping. It can detect narcolepsy and other sleep-related problems, such as sleep apnea.

An MSLT is usually performed the morning after a PSG. The individual will take a nap every two hours until they have had five naps in total. This test allows doctors to detect how quickly a person falls asleep and whether they enter REM sleep.

A lumbar puncture is sometimes performed to assess the hypocretin levels in a person’s cerebrospinal fluid.

Treatment

To treat these sleeping disorders, doctors employ a variety of treatments.

Treatment for sleep apnea

The following are some of the possible therapies for OSA:

  • surgery, if OSA is due to enlarged tonsils or adenoids
  • mouthpieces
  • breathing devices
  • lifestyle changes, such as quitting smoking or maintaining a moderate weight

A continuous positive air pressure (CPAP) machine is the most commonly recommended breathing equipment by doctors. To keep the airway from collapsing, these devices blast pressurized air into the individual’s neck.

Sleep apnea mouthpieces move the lower jaw forward sufficiently to keep the airway open. If OSA treatment is ineffective, it could be a symptom that the person has another kind of sleep apnea, another sleep disorder, or a condition such as narcolepsy.

Treatment for Narcolepsy

There is no cure for narcolepsy, however medication can help most people regulate their extreme sleepiness and cataplexy. A doctor may order:

  • tricyclic antidepressants
  • selective serotonin reuptake inhibitors
  • modafinil (Provigil)
  • amphetamine-like stimulants
  • noradrenergic reuptake inhibitors

To help control their symptoms, an individual may need to make lifestyle changes like as avoiding coffee before bed, taking short naps, exercising everyday, and maintaining a regular sleep pattern.

Conclusion

Both sleep apnea and narcolepsy cause daytime tiredness. Sleep apnea, on the other hand, causes weariness as a result of sleep disturbances caused by frequent pauses in breathing. People with the condition frequently snore, produce gasping or choking noises while sleeping, or wake up with a dry mouth.

Narcolepsy is a neurological condition that causes excessive sleepiness, causing people to fall asleep unexpectedly throughout normal tasks. Insomnia, vivid dreams, sleep paralysis, and hallucinations are also possible. It is conceivable to have both sleep apnea and narcolepsy, but sleep apnea is significantly more prevalent on its own.

People who are concerned about their symptoms should seek medical attention, especially if their tiredness is interfering with their mental health or activities that could be risky, such as driving.

Sources:

  • https://www.sciencedirect.com/science/article/abs/pii/S1389945720301210?via%3Dihub
  • https://rarediseases.org/rare-diseases/narcolepsy/
  • https://www.medicalnewstoday.com/articles/narcolepsy-vs-sleep-apnea
  • https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Narcolepsy-Fact-Sheet
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6815780/
  • https://pubmed.ncbi.nlm.nih.gov/19699146/
  • https://medlineplus.gov/sleepapnea.html
  • https://www.nhlbi.nih.gov/health-topics/sleep-apnea

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