Cataplexy
is the crucial symptom for diagnosis of narcolepsy (Dement
1976).
It
is a sudden attack of complete or partial muscular paralysis brought
on by a strong emotion.In other words, after hitting the
game winning homer, or telling an outrageous joke, a narcoleptic may abruptly
slump over due to the emotional overload (Dement
1976).
Surprise
and laughter are particularly notable culprits for precipitating cataplectic
seizures (Hobson 1995).
During
a cataplectic seizure, the patient remains fully awake and alert, however
he cannot move.
To
an extent, the number of cataplectic attacks a patient experiences is a
function of how much he can control his emotions (Dement
1976).
The
Curing of the Possessed Woman (detail), Andrea del Sarto
Sleep
Attacks and Overwhelming Daytime Sleepiness
Sleep
attacks and irresistible sleepiness are probably the two symptoms that most
of us imagine when we conjure up an image of the typical narcoleptic.
A
narcoleptic generally experiences one or the other. He may feel irresistibly
sleepy during the entire waking period, or experience sudden sleep attacks
lasting a few seconds to a minute or two (Dement
1976).
Sleep
attacks occur at around 90-100 min intervals during waking (a frequency
that coincides with the frequency of REM episodes during sleep).
This
can be an incredible health hazard due to possibilities of falling asleep
during activities for which one must be alert, such as driving or operating
heavy machinery.
Sleep
Paralysis
Sleep
paralysis
is an interesting symptom in which the patient realizes he cannot move just
as he is about to fall asleep. In other words, he feels completely paralyzed.
This
occurs because narcoleptics drift immediately into REM sleep instead of
passing through deep sleep first.
Now,
during REM sleep, the spinal cord must exert an inhibitory influence on
the limbs and trunk, or a person’s vivid dreaming would literally be brought
to life right there in his bed (Dement 1976).
In fact, only an occasional muscle twitch escapes during REM sleep
A
normal person would never even notice this paralysis because he has been
asleep for over an hour by the time it occurs.
However,
the narcoleptic is fully aware of this paralysis because he is verging
on the sleep/wake barrier and has not yet passed through any stages of
deep sleep.
Hypnagogic
Hallucinations
Like
sleep paralysis, hypnagogic hallucinations occur at the time of sleep onset
before the patient has lost complete awareness of his surroundings.
The
hallucinations are vivid, frightening dreams that are often continuous
with the immediate prior waking events (Dement
1976).
This
results in a blurring of the sleep/wake boundary for narcoleptics in which
dreams and reality may meld together with seemingly terrifying consequences.
The
Curing of the Possessed Woman (detail), Andrea del Sarto
