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What to know about sleep deprivation

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The lack of sleep is a common problem in modern society which affects many people at some point in their lives.

Sleep deprivation happens if an individual sleeps less than they need to feel awake and alert. People vary in the amount of sleep it requires to be considered sleep-deprived. Some people, such as older adults, tend to be more resistant to the effects of sleep deprivation while others are more vulnerable, especially children and young adults.

Although occasional interruptions of sleep are typically nothing more than a inconvenience, chronic lack of sleep can lead to excessive daytime sleepiness, emotional problems, poor job performance, obesity and a lower perception of quality of life.

The value of restorative sleep is not questioned, and a certain amount of care is required both to handle and to prevent sleep deprivation.

This report from the Nccmed Information Center discusses the effects of sleep deprivation, as well as what can be done to treat and avoid it.

Fast facts on sleep deprivation

  • Sleep loss alters normal functioning of attention and disrupts the ability to focus on environmental sensory input
  • Lack of sleep has been implicated as playing a significant role in tragic accidents involving airplanes, ships, trains, automobiles and nuclear power plants
  • Children and young adults are most vulnerable to the negative effects of sleep deprivation
  • Sleep deprivation can be a symptom of an undiagnosed sleep disorder or other medical problem
  • When you fail to get your required amount of sufficient sleep, you start to accumulate a sleep debt.

Symptoms

When an individual does not get enough sleep to feel awake and alert, they begin to experience symptoms of sleep deprivation.
When an individual does not get enough sleep to feel awake and alert, they begin to experience symptoms of sleep deprivation.

Excessive daytime sleepiness is the major key symptom of ongoing sleep loss but other symptoms include:

  • yawning
  • moodiness
  • Fatigue
  • irritability
  • depressed mood
  • difficulty learning new concepts
  • forgetfulness
  • inability to concentrate or a “fuzzy” head
  • lack of motivation
  • clumsiness
  • increased appetite and carbohydrate cravings
  • reduced sex drive

Effects

Sleep deprivation can negatively affect a range of systems in the body.

It can have the following impact:

  • Not getting enough sleep prevents the body from strengthening the immune system and producing more cytokines to fight infection. This can mean a person can take longer to recover from illness as well as having an increased risk of chronic illness.
  • Sleep deprivation can also result in an increased risk of new and advanced respiratory diseases.
  • A lack of sleep can affect body weight. Two hormones in the body, leptin and ghrelin, control feelings of hunger and satiety, or fullness. The levels of these hormones are affected by sleep. Sleep deprivation also causes the release of insulin, which leads to increased fat storage and a higher risk of type 2 diabetes.
  • Sleep helps the heart vessels to heal and rebuild as well as affecting processes that maintain blood pressure and sugar levels as well as inflammation control. Not sleeping enough increases the risk of cardiovascular disease.
  • Insufficient sleep can affect hormone production, including growth hormones and testosterone in men.

Causes

Deprivation of sleep occurs when one does not get a healthy amount of sleep.

The official guidelines of the National Sleep Foundation (NSF) 2015 for appropriate sleeping times for different age groups are:

  • Newborns (0 to 3 months): 14 to 17 hours each day
  • Infants (4 to 11 months): 12 to 15 hours
  • Toddlers (1 to 2 years): 11 to 14 hours
  • Preschoolers (3 to 5 years): 10 to 13 hours
  • School-age children (6 to 13 years): 9 to 11 hours
  • Teenagers (14 to 17 years): 8 to 10 hours
  • Adults (18 to 64 years): 7 to 9 hours
  • Older adults (over 65 years): 7 to 8 hours

Some groups of people may consider sleep as a waste of time and purposefully deprive themselves of sleep to pursue other things like entertainment, educational goals, or pursuits to make money.

This intentional deprivation of sleep is more likely to be seen in adolescents and young adults.

Unintentionally, other people can not get enough sleep due to shift work , family responsibilities or stressful jobs.

Consistent sleep-wake habits of going to bed late, repeated nighttime excitements, or early waking up can lead to sleep deprivation and sleep debt accumulation.

Many causes of sleep deprivation include medical problems including depression, obstructive sleep apnea, hormone imbalances and other chronic illnesses.

Treatment

Treatment is only necessary if, due to physical or psychological difficulties, a person can not get to sleep.

A psychiatrist or sleep specialist should be able to offer support and coping strategies to achieve a restful and sleeping state.

There are two key methods for sleep deprivation treatment: behavioral and cognitive interventions, and medications.

Behavioral and cognitive treatments

There are a number of successful sleep enhancement methods which do not require medication, including:

  • Relaxation techniques: Progressive muscle relaxation involving tensing and untensing different muscles in the body to help calm the body. Meditation techniques, mindfulness training, breathing exercises, and guided imagery can also help in this area. Audio recordings are available that can help a person fall asleep at night.
  • Stimulation control: This involves controlling pre-bedtime activities and surroundings to moderate the sleeping pattern. For example, a person controlling their stimulus would spend time in bed only when they feel sleepy, which controls the association between being in bed and feeling ready to sleep.
    • Cognitive behavioral therapy (CBT): This is a type of therapy designed to help people understand and change the thought patterns behind certain behaviors. It can challenge beliefs that may not be healthy and promote rational, positive thought. CBT can help a person to develop a healthier sleeping pattern.

Medications

When non-medicinal treatment is ineffective, there are drugs available which can help induce sleep. Some are over-the-counter ( OTC) available, and some are only available with a valid prescription.

There are a wide range of options available, including benzodiazepines, non-benzodiazepine hypnotics, and antagonists to the melatonin receptor.

Some people, however, develop a reliance on sleeping medicines. Limiting dosage is essential, and attempting to use non-medicinal measures where possible.

Home management

The good news is that when adequate sleep is received most of the negative effects of sleep deprivation reverse. Sleep deprivation treatment is intended to meet the need for biological sleep, avoid deprivation and “pay back” accumulated sleep debt.

Reading to avoid sleeping
If you cannot get to sleep, experts recommend carrying out an activity such as reading until you feel sleepy.

Some suggestions for good sleep habits include:

  • going to bed when tired
  • following a routine for bed and wake-up times, keeping it consistent every day of the week
  • avoiding eating 2 to 3 hours before bedtime
  • if unable to fall asleep after 20 minutes of trying, going to another room and trying to read until feeling sleepy, then returning to bed
  • engaging in regular exercise during the day
  • keeping the bedroom quiet, dark and a comfortably cool temperature
  • turning off electronic devices when you go to bed

Paying off the sleep debt

You start accumulating a sleep debt when you don’t get your needed amount of sleep sufficiently. For instance, if you need 7 hours of nightly sleep to feel awake and alert, and only get 5 hours, you have 2 hours of sleep debt. If you follow that trend for five days, you will have 10 hours of accrued sleep debt.

The only way to pay off a sleep debt is to sleep more. It can take some time to fully recover, depending on the sleep debt scale. The positive effects of paying this debt will be quickly felt however.

To repay a sleep debt, you will start getting the sleep you need, plus an extra hour or two every night before the debt is paid. Afterwards, you can restore the necessary amount of sleep without the extra hour.

However if the sleep debt is hundreds or even thousands of hours, it can still be reconciled effectively with a deliberate attempt to restructure commitments, and give enough time off to heal. You’ll know that when you wake up feeling refreshed, you’ve paid off your sleep debt so you don’t feel too drowsy during the day.

If sleep deprivation is ongoing, and negative symptoms persist despite practicing good sleep hygiene measures, consultation with a healthcare provider is recommended.

Diagnosis

It’s necessary to recognise a continuing period of inadequate sleep when diagnosing sleep deprivation.

The first step to understanding a question of sleep is to maintain a recorded history of sleep in a sleep log. Write down every day how many hours you sleep, how many times you wake up at night, how rested you feel after waking up, and any sensations of sleep that you experience throughout the day.

If you have a friend, it might be worth asking them to mention any snoring, gasping, or limb-jerking, because a doctor might inquire about this as well.

Then, any doctor you visit will be able to present this information in a meaningful way.

Sleep specialists can also use a polysomnogram or sleep analysis to recognize a pattern. This is done in a sleep laboratory.

Electrodes are mounted on the body at different points like the scalp and ears. The person with suspected sleep deprivation will sleep in a sleep clinic overnight and these monitors will track breathing, blood, heart rate and rhythm, muscle function, and brain and eye movements while sleeping.

Diagnosis can be as simple as realizing that you don’t get enough sleep and agreeing to make adjustments, especially in those who wilfully sleep too little.

Complications

Doctors sleeping
Shift work and demanding jobs can lead to sleep deprivation over time.

Sleep deprivation weakens the brain’s ability to control the emotional part, the amygdala, of the part that handles reasoning, known as the prefrontal cortex. That leads to abnormal emotional processing.

It also seems important to sleep to prepare the brain for the learning. When the brain is deprived of sleep, the attention and the development of new memories is difficult.

If we stay awake all night or cut sleep shortened significantly, the body does not release the hormones needed to regulate growth and appetite, and instead forms an overabundance of stress chemicals such as norepinephrine and cortisol.

Research suggests shorter sleep periods may be a weight gain predictor of adults and children. A rise in body weight by 0.35 kilograms (kg) is associated with each 1 hour reduction in sleep time per day. These changes result in an increased risk in the sleep-deprived person for hypertension, diabetes, obesity, heart attack and stroke.

Loss of sleep can have a significant effect in healthy individuals on both emotional function and normal thinking skills, resulting in:

  • reduced tendency to think positively
  • bad moods, a decreased willingness to solve problems
  • a greater tendency towards superstitious and magical thinking
  • intolerance and less empathy toward others
  • poor impulse control
  • inability to delay gratification

Sleep-deprived people are more likely to experience increased feelings of worthlessness, inadequacy, powerlessness, failure, low self-esteem , poor job performance, conflicts with coworkers, and reduced living standards. Many of these deficits remain, even as stimulants such as caffeine sustain alertness.

Finally, sleep-deprived individuals score higher on clinical scales measuring depression, anxiety, and paranoia.

Increased risk of accidents

The body attempts to balance the need for sleep after some 16 hours of remaining awake. If there is not enough sleep in a human, the brain gets sleep through short sleep attacks called microsleeps.

This is an uncontrollable brain response that makes a person incapable for a short time of processing environmental stimulation and sensory information.

The eyes of a person frequently remain open during microsleep but are effectively “zoned out.” Because the nature of such assaults is unexpected, the effects of a sleep-deprived individual operating heavy machinery or driving may be disastrous for both the individual and innocent bystanders.

Microsleeps can tend to occur given an individual’s forced effort to remain awake, so it’s incredibly difficult for an person to stay awake for more than 48 hours straight because of this built-in sleep mechanism.

Prevention

Sleep deficiency can be associated with serious accidents and poor results at work or in school. This can significantly lower overall quality of life for an person. Lack of sleep disrupts the capacity of the brain to regulate emotions and cognitive skills, decreases the normal defenses of the body and raises the risk of having chronic medical problems.

Although the occasional bad night’s sleep is not a serious problem in itself, persistent deprivation of sleep can be possible.

There is no substitute for restorative sleep. A certain amount of caution should be taken to avoid chronic sleep deprivation in people of all ages.

Endocrinology

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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Neurology / Neuroscience

What to know about narcolepsy without cataplexy

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Narcolepsy without cataplexy, often known as narcolepsy type 2, is a condition that causes excessive daytime sleepiness. It does not cause an abrupt loss of muscle tone, unlike narcolepsy type 1.

Narcolepsy is a neurological condition that is classified into two types: type 1 and type 2. Cataplexy is a condition that causes a section of the body to go limp in people with type 1 diabetes.

Depending on the severity of the cataplexy, a person may experience eyelid drooping, an inability to contract specific muscles, or actual collapse.

However, people with narcolepsy type 2 do not experience this symptom. They may feel brief and acute bouts of tiredness, but they do not experience alterations in the way their muscles function. Doctors are baffled as to what causes type 2.

In this post, we will examine narcolepsy without cataplexy in further detail, including symptoms, diagnosis, and treatment.

What is it?

Narcolepsy without cataplexy is a neurological condition that causes excessive daily sleepiness and unexpected sleep bouts. It is also referred to as “type 2 narcolepsy.”

Type 2 narcolepsy, unlike type 1, does not cause an abrupt decrease of muscular tone. The medical word for this is cataplexy. Cataplexy occurs when a person temporarily loses the capacity to use a muscle, usually in response to powerful emotions such as fear, anger, or excitement.

Hypocretin is another trait that distinguishes type 2 narcolepsy from type 1. This is a hormone that affects daytime wakefulness and nighttime rapid eye movement (REM) sleep. People with type 2 narcolepsy have normal levels of this hormone, whereas those with type 1 have low levels.

Narcolepsy is uncommon, but many experts believe that many people with it go undetected.

When to see a doctor

If you suspect you could have narcolepsy or if you have any of the following people, you should see a doctor.

  • sleep issues such as hallucinations or sleep paralysis
  • intense daytime sleepiness, regardless of how well they sleep
  • loss of voluntary muscle control

If you have narcolepsy and are experiencing any of the following people, you should see a doctor.

  • their medication causes side effects that feel intolerable
  • they develop new or worsening symptoms
  • treatment stops working

Symptoms

cataplexy

The sole symptom required for a narcolepsy type 2 diagnosis is daily sleep attacks. During these assaults, a person abruptly enters REM sleep. This is the stage of sleep when dreams occur.

Other signs that a person may observe include:

  • excessive sleepiness during the day
  • fragmented sleep at night or insomnia
  • sleep paralysis, which is when a person wakes from sleep but cannot move
  • hallucinations

Mild narcolepsy

Narcolepsy exists on a scale. Symptoms might be modest or severe, interfering with practically every part of living. However, because narcolepsy causes brief bouts of sleep, most people regard the condition as severe or disturbing.

People may suffer extreme tiredness throughout the day for a variety of reasons, including narcolepsy. Other conditions that may look like narcolepsy but do not cause cataplexy include:

  • mental health conditions, such as depression
  • substance misuse
  • shift work sleep disorder
  • a longer daily sleep requirement than is typical, especially when paired with inadequate sleep
  • inadequate sleep
  • sleep apnea
  • medication-induced sleepiness

Diagnosis of Narcolepsy Type 2

A doctor may begin by taking a medical history if a person is experiencing symptoms that could indicate narcolepsy type 2. They will inquire about a person’s symptoms, including when they began and how frequently they recur.

They may also check at their medical records to see what medications they are taking, as well as any preexisting diseases, to see if these can explain the symptoms.

They may next ask the individual to keep a sleep diary for two weeks. A doctor cannot diagnose narcolepsy in someone who gets less than 6 hours of sleep each night, according to a 2021 article, because sleep deprivation can also cause daytime sleepiness.

If a person is obtaining more than 6 hours of sleep each night and still experiencing symptoms, the doctor may advise a polysomnogram (PSG) and several sleep latency tests (MSLT). A PSG is a sleep study in which doctors observe a patient overnight. This can help rule out other possible causes of fatigue, such as sleep apnea.

Doctors can perform the MSLT the morning following a PSG. This entails taking planned naps throughout the day, during which doctors will assess how quickly a person enters REM sleep.

According to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders, a person must have at least one of the following symptoms to be diagnosed with narcolepsy:

  • REM sleep that begins less than 15 minutes after the beginning of sleep, or two or more periods of sudden REM sleep where it takes 8 minutes or less to fall asleep
  • episodes of cataplexy that occur several times each month
  • low or absent hypocretin

Because people with narcolepsy type 2 do not exhibit cataplexy and typically have normal hypocretin levels, finding rapid REM sleep with an MSLT is an important step in confirming a diagnosis.

Treatment for Narcolepsy Type 2

Narcolepsy has no known cure. Instead, treatment focuses on symptom management.

The predominant symptom of narcolepsy without cataplexy is excessive tiredness. A variety of drugs can assist a person in remaining awake. Most doctors advise starting with modafinil (Provigil) or armodafinil. Amphetamine-like stimulant medications, such as methylphenidate, are used as a second-line treatment.

The Food and Drug Administration (FDA) has not authorized these medications for use in children due to a lack of evidence regarding their safety.

In addition to drugs, some people with narcolepsy find that experimenting with behavioral adjustments might help them manage their symptoms. Among the strategies are:

  • avoiding bright lights and screens before bed, and keeping them out of the bedroom
  • maintaining a consistent sleep schedule at night
  • taking strategic 15–20-minute naps during the day
  • having a relaxing bedtime routine

People can help their circadian rhythm as much as possible during the day by waking up at the same time every day, obtaining safe exposure to natural daylight, and remaining active.

Work and school accommodations may be beneficial, especially if a person has not yet found a medication that alleviates their symptoms.

Living with narcolepsy

Narcolepsy type 2 might be difficult to manage. Excessive drowsiness during the day might make it difficult to work or keep up with other commitments. In some cases, it can also be harmful to one’s health. Activities such as driving or operating machinery, for example, might be hazardous for persons who suffer from sleep attacks.

As a result of this, living with narcolepsy can necessitate major adaptations. A person may need to avoid particular activities or circumstances, rely on others for transportation, and plan their job and social life around their fatigued periods.

It is important to have enough assistance. This may entail seeking assistance from a narcolepsy specialist, as well as from friends and family, and, if necessary, a therapist or counselor. Mental health assistance can assist someone in coming to terms with their diagnosis and coping with the challenges of living with a chronic condition.

Conclusion

Narcolepsy is a neurological condition that can have a lot of implications. It causes extreme and overpowering tiredness that can come at any time during the day.

Narcolepsy type 2 is a subtype of narcolepsy that does not include cataplexy. It signifies that someone has narcolepsy symptoms like tiredness and other symptoms, but not cataplexy, which is an abrupt loss of muscle tone.

Narcolepsy can only be diagnosed and treated by a medical practitioner. People who think they might have this condition should see a sleep expert or a neurologist.

Narcolepsy can be managed with the correct combination of medicines and lifestyle adjustments. Support for social and mental health is equally important.

Sources:

  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7371435/
  • https://rarediseases.org/rare-diseases/narcolepsy/
  • https://www.medicalnewstoday.com/articles/narcolepsy-without-cataplexy
  • https://www.ncbi.nlm.nih.gov/books/NBK459236/

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Endocrinology

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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