Narcolepsy related reports
Narcolepsy (narcolepsy) is a physiologic disorder that usually occurs in the 15- to 30-year-old age group, but some people experience narcolepsy earlier or later in life. Narcolepsy is very difficult to eradicate, affecting men and women equally, and once present it can last a lifetime. Narcolepsy is difficult to diagnose; its first symptom is usually a feeling of severe sleepiness during the day, and there are many causes of excessive daytime sleepiness, so it usually takes years to diagnose that a patient does have the disorder
Main features
(1) excessive daytime sleepiness or sleep episodes, with sleep episodes that cannot be explained by lack of sleep, and prolonged transitions to a fully awake state during waking hours. prolonged transition time to the state; narcoleptic manifestations
(2) daily occurrence of such sleep disturbances lasting more than 1 month or recurrent sleep episodes causing significant distress or interfering with work or family life. (3) Excluding daytime sleepiness and episodic sleepiness caused by various organic diseases, the onset of narcolepsy is mostly related to psychological factors. [2]
Main symptoms
Medicine defines narcolepsy in terms of four main symptoms, which are known as the narcoleptic tetrad: sleep attack (sleep attack) This symptom is the most obvious symptom of narcolepsy, the irresistible desire to sleep during the daytime, and the patient will feel refreshed after the sleep attack. Sudden collapse (cataplexy) This symptom is a sudden loss of muscle tone while fully awake, which causes paralysis of the head or body without loss of consciousness, and it can last for a few seconds or minutes. Mild symptoms are characterized by slurred speech, stuttering, drooping eyelids or weakness in the fingers to hold things. A severe sudden fall can cause the knees to buckle and make the person weak. Laughter, excitement or anger are typical causes of sudden collapse, and the sudden relaxation of muscle mass may be the result of the brain suddenly going into REM sleep. Sudden collapse is not very common and occurs in less than half of patients with narcolepsy. Sleep paralysis (sleep paralysis) This symptom is a temporary inability to move when a person goes to sleep or wakes up. It lasts only a few minutes. Similar to sudden collapse, sleep paralysis may be associated with an inadequate transition between REM sleep and wakefulness. Sleep hallucinations (hypnagogic hallucination) are mental, dream-like images, often frightening, that commonly occur during sleep or before sleep paralysis occurs. In adolescents or young adults, these symptoms have not been seen before and usually occur suddenly. People with narcolepsy will complain of easy fatigue as well as poor performance at work, school, and in social relationships. Excessive daytime sleepiness can be disabling, memory loss, and therefore greatly reduce quality of life, and the visual disturbances caused by narcolepsy can be particularly disconcerting. More than half of people who suffer from narcolepsy also experience memory loss or memory disruption, caused by "microsleeps" that intrude on the waking state. During these stages, narcoleptics are overwhelmed when walking or driving, babbling or writing nonsense, misplacing things or bumping into things, and are representative of the fact that they are unable to control their behavior during these stages and cannot remember what happened afterwards. [3]
Drowsiness is a common clinical condition, so what are the causes of drowsiness that you know? 1, sleep apnea syndrome and other sleep-induced breathing disorders; 2, lethargy; 3, sleep limb hyperactivity (such as limb hyperactivity or teeth grinding, etc.); 4, depression; 5, sleepiness after viral infections; 6, head trauma; 7, metabolic disease toxin or drug-induced drowsiness; 8, unexplained drowsiness; 9, sleep deprivation; 10, circadian biorhythm disorders disease; if the If the drowsiness is found to be caused by some internal factors, we will treat the symptoms of the disease. If it is caused by other exogenous factors, the doctor will treat it by adjusting the patient's sleep habits[4]
Narcolepsy can be diagnosed by the process of onset of typical stages and by the results of sleep studies performed overnight during multilevel sleep latency testing. Sleep studies can verify other causes of excessive daytime sleepiness, such as sleep deprivation, sleep apnea, and depressed mood. Latent testing for multilevel sleep is performed in a sleep study, usually after sleep. Electronic control of brain waves, eye movement counts, muscle activity, heartbeat, blood oxygen levels, and breathing has been performed through the use of polysomnographic equipment. This test is usually done after getting enough night sleep so that the results are clearer. British 15-year-old girl with narcolepsy can sleep for up to two weeks
The multilevel sleep latency test consists of four 20-minute nap opportunities, which are separated from each other by two hours and spread evenly throughout the day. Narcoleptic people fall asleep in about 5 minutes or less, and the transition to REM sleep occurs in at least two of the four naps. By contrast, normal people typically take 12 to 14 minutes to fall asleep and do not enter the REM sleep stage during such naps.
Narcolepsy Test
Epworth Sleepiness Scale (ESS) Likelihood of nodding off, dozing off, or falling asleep in the following situations Score Sitting and reading while watching TV Sitting motionless in a public *** place (such as in a theater or at a meeting) Long rides in a car without a break in between (more than one hour) Sitting and talking to people Taking a break from a meal (without When driving through traffic lights When lying down in the afternoon Note: ①Never=0; Rarely=1; Sometimes=2; Often=3; ②If the total number of points exceeds 9, then drowsiness is likely to be present. This scale is a common tool and method used in clinical practice to diagnose narcolepsy.
Treatment
General treatment
Mainly from the routine of life to regulate. First of all, to participate in more sports activities, no less than one hour a day, so that their mind and body to get excited; secondly, to participate in more group activities, such as singing, etc., and participate in more social activities, and once again, to have a positive attitude towards life, every day to make a good life and study plan for themselves, and make a serious effort to complete, etc..
Medication
The main goal is to control the patient's symptoms and improve the patient's quality of life. (1), Improve daytime sleepiness Stimulants such as methylphenidate (Ritalin and other brand names) or dextroamphetamine (Dexedrine) can be used for treatment, and regular daytime naps should be taken. (2) Eliminating Sudden Collapse and Sleep Paralysis Sudden collapse and sleep paralysis can be treated with tricyclic antidepressants. They can also be treated by taking hydroxybutyl sodium salt, which must be applied under the guidance of a doctor because of the specificity of the side effects of this drug. (3), Regulating psychological conditions Psychological counseling for problems arising from self-esteem and emotional support related is important, especially for those who are drowsy because they cannot fully realize their potential and may be considered lazy and inactive by their family and peers. Psychotherapy is mostly used in such cases to remove adverse psychological factors related to the onset of the disease, avoid mental stimulation, and help the patient establish a normal routine. In addition, small doses of psychostimulant drugs, such as amphetamine and methylphenidate, can be given, if necessary, under the guidance of a doctor. (4) Traditional Chinese medicine therapy: Qi and blood deficiency: weakness of the physical body, little energy and laziness, fatigue, dizziness, palpitations and restlessness. Menstruation is scanty, pale in color and thin in quality. Drowsiness at the time of menstruation, especially after meals. Yellowish color, pale tongue with white moss, thin and weak pulse. Treatment: tonifying Qi and nourishing Blood. Preferred formula: Ten Complete Great Tonic Soup. Codonopsis, Atractylodes macrocephala, Poria, Radix Rehmanniae Praeparata, Radix Angelicae Sinensis, Radix Paeoniae Alba 10 g each, Astragalus 15 g, Rhizoma Ligustici Chuanxiong 6 g, Cinnamomum Cassiae, Glycyrrhiza Uralensis 3 g each. If deficiency of spleen qi is the main cause, Xiangsha Liu Junzi Tang should be preferred to strengthen the spleen and qi; if blood deficiency is obvious, doubling peony and angelica, and adding 10g of Colla Corii Asini to nourish blood and enrich the camp. The formula can also be added calamus, yi zhi ren and other medicines in order to open up the mind. Spleen deficiency due to dampness: obesity, often accompanied by swelling, asthma when moving, poor appetite, fullness in the stomach and epigastric region, leucorrhea in large quantities, sticky and thick. Mental fatigue at the time of menstruation, heavy head, heavy limbs, drowsiness, sleepiness, drowsiness all day long. The tongue is white and greasy, and the pulse is moist and slow. Treatment is to dry dampness and strengthen the spleen, and to benefit the vital energy. The preferred formula is Tai Wu Shen Shu San ("Medical Formulas Collection and Explanation"): 12 grams each of Atractylodes macrocephala and Pericarpium Citri Reticulatae, 10 grams each of Huo Xiang, Huperzia, Calamus, 6 grams of ginger, and 10 jujubes. Dampness is stored in the heat, yellow urine, yellow and greasy tongue, it is appropriate to reduce the amount of aroma and dry qi products, and add scutellaria, gardenia 10 grams each, 15 grams of coix seed, 6 grams of grass, in order to clear the heat and dampness. This kind of patient should add calamus dosage, in order to wake up the brain and refresh the mind. Kidney essence deficiency: menstruation tiredness good sleep, tinnitus deafness, dullness. Weekday energy, lumbar and knee pain and weakness. Late menstruation, low menstrual flow. The tongue is pale, and the pulse is dull and thin. The treatment is to benefit the kidney and fill in the essence. Preferred formula: He Che Da Zao Wan. This medicine is commercially available. Accompanied by cold limbs cold, night urination frequency and clear long more for the kidney yang insufficiency, can be added horny goatweed 12 grams, 6 grams of cannon appendage, or change the right pill to yin and yang double supplementation Often said that the treatment of the big disease of the prescription, that is also the need for symptomatic treatment, is not necessarily suitable for each patient, so the treatment of narcolepsy, or should look for a professional treatment institutions, in the treatment of at the same time, it is recommended that patients pay more attention to the diet and the daily life of the patients to maintain a reasonable and normal, on the The treatment of narcolepsy should be carried out by a professional treatment organization. Successful cases of Chinese medicine treatment of narcolepsy Li XX, male 18 years old, high school student, his father is a thoracic surgery specialist, his mother is a gynecologist, on October 10, 1978, his father asked me to go to his home for consultation. Into the home of the patient is sleeping soundly, forcibly woke him up, to see his spirit seems to be bright like sleep, eyes dull speechless, pulse diagnosis is completed, to the head and fell asleep. His mother reported that the patient had been sleeping for five days. Because of the college entrance examination, mental fatigue, and on the way home after being rained on. After the People's Hospital examination diagnosed as neurasthenia. After taking western medicine for 4 days, no improvement, but aggravated day and night sleepiness, do not think of food, three days without stool, urine yellow and red, tongue dark, moss white thick and greasy. Etiology and pathogenesis analysis: the patient is overworked, the positive qi is weak and weakened, after the rain, the dampness and turbidity take advantage of the weakness to invade, obscuring the clear orifices and triggering drowsiness. Treatment: Aromatizing and removing dampness, awakening the spleen and opening the orifices. Prescription: "Wake up the spleen and open the orifices" plus subtractions. After taking 3 doses, the patient's drowsiness was reduced, and she could eat three meals a day on time, and had the spirit to chat with her family, but her speech was still a bit weak. According to the original formula, add 15 grams of Astragalus, 12 grams of Atractylodes macrocephala, and continue to take 6 doses. Completely restored to normal. The patient's family is very high, many days locked eyebrows finally stretch, his father said: "really did not think that Chinese medicine is so magical, so quickly cured my son's disease, really thank you! A year later, his father brought another patient to my consultation, and when I asked him about his son's condition, he said, "Everything is very good, there has been no recurrence of the disease, and now his son is attending university in Beijing. Life should be regular To overcome drowsiness, first of all, the rhythm of life should be grasped, not three days on impulse to learn to stay up all night, bedtime early and late, should be developed into a more regular living habits. Practice has proved that the winter habits for appropriate adjustment, so that the body gradually adapted to the rising temperatures of the climate, is to lift the sleepiness of the key link. For example, in winter to keep warm, usually close the door, to the spring should often open the door and windows, so that the indoor air flow; living should also pay attention to ensure that a certain amount of sleep time. Enough sleep helps to eliminate fatigue. More exercise Exercise to help prevent narcolepsy
Earth and spring, the time of recovery, should be more out of the outdoor activities, some moderate fitness exercise program can effectively improve physiological function, so that the body's respiratory metabolism function to increase, accelerate the body's circulation, to improve the brain's oxygen supply, narcolepsy will be relieved. For example, early in the morning walking, doing exercises, running, playing tai chi is very useful for invigorating the spirit. Dietary management Modern medical research suggests that drowsiness and lack of human protein, the body is in the acidic environment and vitamin intake is insufficient, so the spring sleepy diet should pay attention to increase the intake of protein, such as an appropriate increase in fish, eggs, milk, soybean products, pork liver, chicken, peanuts and other foods.
Edit paragraph narcolepsy easily confused with what diseases
1) episodic sleepiness. The disease is usually accompanied by one or more additional symptoms, such as sudden collapse, sleep paralysis and hallucinations before falling asleep; sleep attacks are irresistible; and nighttime sleep is fragmentary and shortened. In contrast, narcolepsy has fewer but longer episodes during the day; the patient is often able to prevent them from occurring; and nighttime sleep is usually prolonged. 2) Sleep apnea. Narcolepsy associated with sleep apnea. In addition to the symptoms of excessive daytime sleepiness, these patients have a history of nocturnal apnea, typical intermittent snoring, obesity, hypertension, cognitive deficits, nocturnal sweating and hyperactivity, morning headache, and **** dyskinesia. The timing and duration of apnea episodes can be determined with the help of sleep lab recordings. It is not difficult to differentiate the above from narcolepsy. 3) Organic diseases associated with narcolepsy, encephalitis, meningitis, concussion and other psychiatric disorders, metabolic disorders, poisoning, endocrine abnormalities, post-radiation syndrome, etc. can cause narcolepsy. Through history, physical examination, clinical observation and corresponding laboratory tests, the diagnosis of sleepiness caused by organic diseases is clearly diagnosed, then wood consider the diagnosis of (nonorganic) narcolepsy. [9]
Edit this section of the causative factors of narcolepsy
1, sleep apnea syndrome and other sleep-induced breathing disorders; 2, lethargy; 3, sleep limb hyperactivity (such as tetralogy of fallot or teeth grinding, etc.); 4, depression; 5, sleepiness after viral infections; 6, head trauma; 7, metabolic disease toxins or drug-induced drowsiness; 8, unknown reasons for the cause of the Sleepiness; 9, sleep deprivation; 10, circadian biorhythm disorders [10]