This record, the electrocardiogram (also known as an ECG). Electrodes are also attached to other areas of the body to record heart rate ( electrocardiography Electrocardiography Electrocardiography (ECG) is a quick, simple, painless procedure in which the heart’s electrical impulses are amplified and recorded. The recordings help provide doctors with information about sleep stages. read more, or EEG) as well as eye movements.

Imaging tests commonly used to diagnose nervous system (neurologic) disorders. Electrodes are pasted to the scalp and face to record the brain's electrical activity ( electroencephalography Electroencephalography Diagnostic procedures may be needed to confirm a diagnosis suggested by the medical history and neurologic examination. The discovery that narcolepsy/cataplexy results from the absence of neuroexcitatory properties of the hypothalamic hypocretin-peptidergic system will significantly advance understanding and treatment of the symptom complex in the future.Polysomnography is usually done in a sleep laboratory, which may be located in a hospital, clinic, hotel room, or other facility that is equipped with a bed, bathroom, and monitoring equipment. Obstructive sleep apnoea and PLMs are more common in narcolepsy and should be suspected when previously well controlled older narcolepsy patients exhibit a worsening of symptoms. Cataplexy is especially responsive to antidepressants which enhance synaptic levels of noradrenaline (norepinephrine) and/or serotonin. More recently, treatment with the 'activating' antidepressants and the novel wake-promoting agent modafinil has been advocated. Wake-promoting agents include the traditional psychostimulants. Thereafter, treatment is highly individualised, depending on the severity of daytime sleepiness, cataplexy and sleep disruption. Nonpharmacological management also includes maintenance of a strict wake-sleep schedule, good sleep hygiene, the benefits of afternoon naps and a programme of regular exercise. Elderly narcoleptic patients, despite age-related decrements in sleep quality, are generally less sleepy and less likely to evidence REM sleep dyscontrol. Treatment includes counselling as to the chronic nature of narcolepsy, the potential for developing further symptoms reflective of REM sleep dyscontrol, and the hazards associated with driving and operating machinery. The MSLT diagnostic criteria for narcolepsy include short sleep latencies (<8 minutes) and at least two naps with sleep-onset REM sleep. The NPSG of a narcoleptic patient may be totally normal, or demonstrate the patient has a short nocturnal REM sleep latency, exhibits unexplained arousals or PLM. Diagnosis requires nocturnal polysomnography (NPSG) followed by multiple sleep latency testing (MSLT). Attention to periodic leg movements (PLM), sleep apnoea and RBD is particularly important in the management of the older narcoleptic patient, in whom these conditions are more likely to occur. Only 15-30% of narcoleptic individuals are ever diagnosed or treated, and nearly half first present for diagnosis after the age of 40 years. Mild disease severity, misdiagnoses or long delays in cataplexy expression often cause long intervals between symptom onset, presentation and diagnosis. While the natural history is poorly defined, narcolepsy appears to be lifelong but not progressive. Only cataplexy exhibits a high specificity for diagnosis of narcolepsy. Excessive sleepiness typically begins in the second or third decade followed by expression of auxiliary symptoms. hypnagogic and hypnopompic hallucinations). REM sleep behaviour disorder ), and dream imagery intruding into wakefulness (e.g.

This manifests as excessive daytime sleepiness and expression of individual physiological correlates of REM sleep that include cataplexy and sleep paralysis (REM sleep atonia intruding into wakefulness), impaired maintenance of REM sleep atonia (e.g. Narcolepsy is a disorder of impaired expression of wakefulness and rapid-eye-movement (REM) sleep.

Cataplexy treatment