Patients can have sleeping disorders, such as narcolepsy and cataplexy, and sleep aids may help provide them relief.
What are Narcolepsy and Cataplexy?
The brain is in charge of regulating the cycles of sleeping and waking. Narcolepsy occurs when the brain is unable to regulate these cycles properly. Narcolepsy is marked by “fatigue and cataplexy” with symptoms such as insomnia, “dream-like hallucinations”, sleep attacks, and sleep paralysis. In normal sleep, people first enter a light sleep stage, progressing deeper. The light and the deep stages of sleep are the non-REM (rapid eye movement) parts of sleep. REM is the stage of sleep where dreaming happens. The sleep cycles alternate. In the case of narcolepsy, patients start the sleep with REM and parts of REM “occur involuntarily throughout the waking hours”. Unfortunately, during REM, “our muscles are paralyzed”. Interestingly, people with narcolepsy actually sleep a normal amount of hours, but they are unable to control sleep timing. Daytime sleepiness is common with this disorder.1 One of the symptoms of narcolepsy might be cataplexy. Cataplexy is “a sudden loss of voluntary muscle tone”, which makes the patient “go limp”. Aside from sleep paralysis, daytime fatigue, hallucinations, and disrupted sleep, people with narcolepsy are at risk for obesity. Narcolepsy affects females and males, and the condition lasts a lifetime.2 Not everyone with narcolepsy has cataplexy. Narcolepsy appears to be related to “reduced levels of…hypocretin in their brain”. Hypocretin is a neurotransmitter that is involved in controlling the sleep-wake cycle. It is believed that hypocretin is part of the “rapid switching between being awake and entering REM sleep”. It is possible narcolepsy is an autoimmune disease where the hypocretin cells are damaged, but there are other thoughts that a virus damages these cells in certain people. Genes may play a role.3
Treatment Options for Sleep Disorders
If a patient is thought to have a sleep disorder, a doctor may make a referral to a sleep specialist for a sleep study. In a sleep study, patients spend the night in a sleep laboratory to be tested via polysomnogram. Electrodes are attached to the chest, chin, scalp, and eyelids, and the sleeping may be recorded. Eye and muscle movements, breathing patterns, and brainwaves are monitored. For narcolepsy, patients may also have hypocretin levels measured with a lumbar puncture, in which “a needle is pushed through the skin…into the space around the spinal cord” to collect the cerebrospinal fluid. Blood tests and MRIs may also be ordered to diagnose the problem. In terms of treatment, there is no cure. Controlling symptoms is possible, however, such as having a regular sleep routine, getting up at the same time, going to bed at the same time, and scheduling short naps (10-15 minutes). There are some medications as well, such as modafinil, a stimulant. The side effects include having a runny nose, headache, nausea, and it interferes with contraceptive pills. Past stimulant medications led to tolerance, so they are not used as much now. As for cataplexy, sodium oxybate is often prescribed. It can also help with hallucinations, daytime sleepiness, disturbed sleep at night, and sleep paralysis. Sleep paralysis is being conscious but not able to move. Patients on this medication should avoid drinking alcohol. Sometimes SSRI antidepressants are prescribed for cataplexy. All of these medications carry side effects. Patients may also benefit from regular exercise and counseling, as well.4 Some patients may also seek chiropractic care for their sleep disorder, in order to receive nutritional advice and adjustments.5
Medical and Prescription Sleep Aids
There are many types of sleep aids, from prescription to natural. Some patients who cannot sleep turn to prescription medications from their doctors. Benzodiazepines are some of those medications, and they “slow down the nervous system”. Newer sleeping pills have fewer risks, but there are some issues for patients with kidney or liver disease. Typically, doctors will recommend lifestyle changes before sleeping pills. It is important to know how to take the medications safely, to report side effects, and to take them for a limited time to make sure the benefits outweigh the risks. Some of the sleeping pills help patients fall asleep, a few assist with staying asleep, but many lead to dependence. Lunestra, Restoril, and Ambien have all of those qualities. Side effects of sleeping pills include sleep behaviors (driving, eating), daytime performance and memory issues, “prolonged drowsiness”, gastrointestinal troubles, dizziness, headache, or even an allergic reaction. A few antidepressants may also be prescribed for sleep.6
Over-the-Counter Sleep Aids
There are also over-the-counter medications and supplements that are available, such as antihistamines (Benadryl), melatonin, and valerian. It is easy to develop a tolerance for antihistamines. Additional side effects include dry mouth, drowsiness, and blurred vision. The hormone melatonin is in charge of the sleep-wake cycle, and supplements can make it easier to fall asleep or even treat jet lag. Side effects include daytime sleepiness and headache. Valerian does not seem to have side effects, but the results are mixed. Sleep aids should never be used with alcohol or while driving. It is important to make sure that even over-the-counter medications or supplements do not interfere with other medications or certain medical conditions.7
Lifestyle and Natural Sleep Aids
One natural sleep aid is cognitive behavioral therapy (CBT). CBT programs include practicing good sleep hygiene, stimulus control, sleep restriction, cognitive therapy, relaxation techniques, and even biofeedback, to help “patients identify and learn to control physiological factors that could impede sleep”.8 Sleep hygiene practices allow patients to have daytime alertness as well as normal sleep. It is important to only spend prescribed amounts of time in bed depending on the sleep issue. Patients should avoid napping, stimulants (caffeine), alcohol, and nicotine around bedtime. Exercise, such as yoga, in the late afternoon or morning can help with sleep. Large meals before bedtime should be avoided. It is important to get enough exposure to natural light to “maintain a healthy sleep-wake cycle”. A regular bedtime routine is also crucial. The bed should be used for sleep and not for reading or watching television.9 Some other alternative sleep aids include meditation, progressive relaxation, deep breathing exercises, and aromatherapy. A white noise machine may also be beneficial.10 Yoga lowers stress and can relieve body tension and calm the mind.11 Sleeping less than 8 hours in a night leads to “sleep debt”, and that cannot be reversed by sleeping in on the weekends. Massage is useful for reducing anxiety, for digestive disorders, headaches, fibromyalgia and nerve pain, for injuries and joint pain, and it can decrease “insomnia-related stress”. Massage is another drug-free alternative that can contribute to healthy sleep. Research from the American Massage Therapy Association has shown that massage can “improve sleep in infants, children, adults, and the elderly”. It works by helping patients achieve more deep sleep time, which is a restorative state. Because the body does not really move during this state, the neurotransmitters associated with pain are reduced. Massage also influences serotonin production, which is necessary for producing melatonin. Melatonin is important because it “influences the sleep state of an individual’s circadian rhythm.” A study showed improved sleep in massage therapy patients who received 30-minute massages over 5 weeks, twice a week.12
Find out more about treatments for insomnia.