Least obvious are the truly rare sleep disorders like narcolepsy. People with narcolepsy have significant symptoms an AVERAGE of 17 YEARS before the diagnosis is made. Partly thats because the majority of docs out there have had very little training in sleep disorders, but its also because patients jsut think its normal to feel the way they do -- theyve never known any differently. On TV, narcolepsy is shown like some kind of sleep seizure, where people can fall asleep in the middle of a sentence, but like many things TV has it wrong. The sleepiness of narcolepsy is more like an incredible pressure to fall asleep, like you've pulled an all nighter and you're in a boring meeting.
What causes narcolepsy is the absence of a critical brain chemical that only shows up in a single small place in the brain. Without that neurotransmitter, the regulation of sleep and wake gets totally messed up...so wake intrudes into sleep time, sleep intrudes into wake time, dreams show up when people are awake, and having the normal paralysis during dreams (that protects our spouses from getting punched when we dream we're fighting) show up when we're awake.
The four primary symptoms of narcolepsy are:[list=1]
- Excessive daytime fatigue with sleep attacks
- Cataplexy -- drop attacks, where varying degrees of paralysis show up in awake people when they get angry or laugh
- Sleep paralysis -- where people can wake up or be about to fall asleep, and find that they simply cannot move even a muscle, no matter how hard they try
- Hypnogognic hallucinations -- where dream like material shows up even though people are awake. For example, I had one patient see and feel their dog on the bed, down to the warmth of the covers and the creases in the blanket, but the dog wasn't there, and they put their hand right through when they tried to pet it. More commonly, people will actually hear something that isnt there, like a phone or a car or a doorbell.
(Don't panic about the last one...most normal people can have this if they get tired enough.)
Sleep apnea and narcolepsy absolutely require a sleep study for diagnosis, and narcolepsy requires a Multiple Sleep Latency Test (four or five nap attempts 2 hours apart, done the day after the sleep study). Final diagnosis of narcolepsy depends on a specific dream pattern during the sleep study and MSLT.
Most doctors don't have a lot of training in sleep disorders, because the area is glossed over in med school and most residency training. If you have a sleep problem, do some research and be prepared, so that if your doctor isnt really strong in sleep stuff you know to see the specialist.
Here's a link to the American Academy of Sleep Medicine:
AASM and here's one to help you find a high standard, accredited sleep laboratory:
Sleep Labs by state Lastly, here's a link to a list of Board Certified Sleep Specialists:
Board Certified Sleep Specialists There are an embarrassing number of Dollar Generating Unit sleep labs, where the main emphasis is maxing out the number of sleep studies they do. There are also many who do sleep medicine with very little training in the less common (IE non-sleep apnea) disorders. Be aware of those factors when you choose where to go.
