Symptoms
“Fatigue is not the same as sleepiness!”
Increased sleep can manifest itself in the form of daytime sleepiness with unwanted falling asleep during the day, a prolonged need for sleep of 10 hours per day, increased difficulty awakening in the morning (hypersomnia) or fatigue in the sense of a lack of energy or even physical exhaustion.
Causes
DAYTIME SLEEPINESS
The most frequent cause of daytime sleepiness is certainly a simple sleep deficit, which those affected can remedy themselves by sleeping for longer periods with constant bedtimes over at least 10 days. If this test does not lead to a normal waking state during the day, a disease-related cause must be suspected.
The most common disease is obstructive sleep apnea syndrome, also called “snoring with pauses in breathing”, which affects at least 10% of men and 5% of women.
Narcolepsy with or without cataplexy is rare, but because of its onset during puberty, it is associated with serious social consequences at school or at work. Therefore, early diagnosis and therapy are particularly important here. These are usually young patients, who suffer from rapidly progressive extreme daytime sleepiness, leading to attacks of falling asleep even in active situations such as during meals or in the middle of a conversation. One or more power naps a day is the only thing that can temporarily relieve this sleepiness. Some narcolepsy patients also describe sleep paralysis or hallucinations when falling asleep or waking up. Paradoxically, some patients report sleep disturbance throughout the night with repeated periods of wakefulness. Some patients report unusual, acute onset of muscle paralysis (cataplexy) every time they experience an emotion (e.g., laughing), resulting in dropping of the eyelids, lower jaw, head, or even buckling of the knees to the point of falling. In this type 1 narcolepsy, severely decreased production of the neurotransmitter hypocretin can be detected in the cerebrospinal fluid.
The diagnosis of narcolepsy must be confirmed in the sleep laboratory.
HYPERSOMNIA
Closely related to narcolepsy is Idiopathic Hypersomnia, which is characterized by a prolonged need for sleep of 11 hours or more per day and is relatively often inherited. These patients mainly suffer from difficulty awakening in the morning because they do not hear the alarm clock at all and are then late for work or school. Certain patients with depression or an anxiety disorder do not suffer from insomnia, but from a need to sleep for far too long, which is then referred to as non-organic hypersomnia.
FATIGUE
In chronic fatigue syndrome (chonic fatigue syndrome), the focus is on pronounced fatigue in the sense of a lack of energy to the point of physical exhaustion. However, falling asleep is often difficult.
Sleepiness occurs in neurological diseases such as Parkinson’s, dementia, or certain muscle diseases, and fatigue tends to occur in Multiple Sclerosis. Conversely, it is important not to miss obstructive sleep apnea syndrome or other causes of non-restorative sleep in neurological patients because they can be treated.
What we can offer
Treatment/progression
The treatment of narcolepsy consists of a combination of behavioral measures, mainly regularly scheduled power naps, and various medications. Daytime sleepiness is treated with so-called stimulants such as Ritalin®, while cataplexies and the often disturbed nighttime sleep are treated with completely different medications.
In addition to the treatment of the various narcolepsy symptoms, targeted counseling in many areas of life is also of great importance, including fitness to drive in the case of daytime sleepiness, career choices, family planning, military and sports activities. Here, close cooperation between patients, family members, family doctor, employer or school administration as well as the sleep specialist is often necessary. Not infrequently, social workers and psychologists must also be consulted for advice.
