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Why do people talk in their sleep?
Indeed, there is a disease in which there is an irresistible desire to sleep, regardless of where the person is. This is narcolepsy - from the Greek “narkē” - numbness and “lēpsis” - sleep, in another way - Gelineau’s disease, or paroxysms of irresistible drowsiness. This disease is quite rare, usually developing between the ages of 20 and 50, more often in men. The prevalence of narcolepsy in developed countries is 20–40 cases per 100,000 people.
Strange story
Of course, not all sleepiness is narcolepsy. There are times in any person's life when the need for sleep increases. Here, for example, is the story that happened to the author of these lines in his youth.
After two unsuccessful attempts to become a student and service in the army, I entered the university. The day before I had an affair with one girl, we were going to get married, but then we broke up. I was very painfully experiencing the breakup and then, while studying in my first year, I suddenly felt a strange state...
I was attacked by a stupefying drowsiness, I could not stay awake for more than thirty to forty minutes, a maximum of an hour, then I inevitably fell asleep. Moreover, it came at the most inopportune time, in the most inopportune place: on the subway, at a lecture. To prevent this from happening, I decided to get enough sleep: during recess I would find an empty classroom and, sitting down on three pushed-together chairs, instantly fell asleep. Luckily, I only needed 5-10 minutes to fall asleep. Then I got up, invigorated, and could exist normally for about another hour. Then something like dizziness began again and it was necessary to urgently take a horizontal position. This state lasted two or three days and passed.
Ten years later, these attacks of drowsiness were repeated after another stress - the death of my father. On weekends I slept around the clock. I fell asleep on the train and in the subway. So, maybe this is narcolepsy?
At the Center for Somnological Research of the Ministry of Health and Social Development of the Russian Federation, Professor Yakov Iosifovich Levin explained to me that attacks of drowsiness recurring once every ten years are unlikely to be a disease. Normal stress from prolonged overexertion manifests itself differently in different people. Some cannot fall asleep, others, on the contrary, sleep like marmots, and this helps them recover and come to their senses. In patients with narcolepsy, attacks are much more severe and occur more often.
Why does a person fall asleep while walking?
The human brain is responsible for sleep, its normal course and deviations; the causes of problems must be looked for there. Recent research by scientists has shown that sleep disorders occur due to a lack of orexin. Orexin or hypocretin is a brain neurotransmitter that is responsible for wakefulness. In people suffering from this disease, orexin is found in reduced amounts in the cerebrospinal fluid. For what reasons its production decreases is unknown.
Hereditary predisposition is considered as the main hypothesis for the development of pathological drowsiness. Certain chromosomes provoke the destruction of neurons, their production of orexin in the hypothalamus slows down, disrupting the structure of sleep - the ratio of slow and fast phases. The fast phase, which is in excess, is ahead of the norm. Reduced activity of the activating part of the brain contributes to the appearance of REM sleep during wakefulness, manifesting itself as symptoms of falling asleep in an unexpected place at the most inopportune time.
According to scientists, hereditary causes are not enough to disrupt the structure of genes; there must also be factors that provoke a narcoleptic state, but these are only assumptions. The mechanism of development is under study. Possible influencing factors include:
- traumatic brain and cranial injuries of varying severity;
- stress leading to excess emotions, positive and negative;
- infectious diseases;
- dysfunction associated with hormonal changes.
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Phase confusion
Scientists equate the sensations of a patient with narcolepsy to the state of a person deprived of sleep for two days. Despite their excruciating sleepiness, narcoleptics often cannot fall asleep properly at night.
With this disease, there are repeated attacks of sleep, which are no different from normal, but occur in an inadequate situation. If you watched the movie “Oklahoma As It Is,” then you probably remember how its hero fell anywhere due to bouts of drowsiness.
Perhaps the internal cause of narcolepsy is disintegration syndrome, the untimely onset of stages of sleep, especially fast sleep. Let us remember that sleep is divided into phases. “Slow sleep” consists of four stages, levels. The first is the most superficial, the last is the deepest. The changes that occur during each stage or during the transition from one to another can be traced on the encephalogram.
During sleep, the encephalogram shows the presence of faster waves. When we fall asleep, the pattern changes, as if calm sets in. As sleep deepens, the waves smooth out even more, and “delta sleep” begins.
After an hour and a half, dreams arise, and the encephalogram again resembles the curve of a waking person. At this time, the sleeper can observe eye movement under closed eyelids - this is the “REM sleep phase.”
Patients with narcolepsy fall asleep in less than 10 minutes - the REM sleep phase begins early in them, but the deep, delta sleep phase is completely absent. That is, they sleep superficially, and there are many night awakenings.
general description
As a rule, narcolepsy develops in young people (15-25 years), mainly in men, although the possibility of narcolepsy at any other age is possible. The main presumed factor contributing to the development of this disease is heredity, combined with the influence of certain external factors, one of which can be, for example, viral diseases. In general, the causes that provoke this disease have not been fully studied. A number of experts are of the opinion that the cause of narcolepsy is a lack of such a biologically active substance, due to which the processes associated with falling asleep and waking up are regulated in the brain; orexin (hypocretin) is considered as such a substance.
An attack of falling asleep in narcolepsy is accompanied, as is understandable, by sudden falling asleep, combined with an immediate loss of muscle tone. Narcolepsy is accompanied by constant drowsiness and fatigue, and these conditions are relevant regardless of the total duration of sleep of the patient. Again, as is clear, narcolepsy can be a serious hindrance affecting the level of quality of life, especially if we are talking about its uncontrolled and unrecognized form.
Regarding the prevalence of narcolepsy, there is data indicating the frequency of its diagnosis in an average of 20-40 people out of 100,000. Current treatment methods are aimed at correcting this disease, but not at getting rid of it.
First symptoms
In addition to severe daytime sleepiness, the symptoms of the disease are as follows.
● Cataplexy is an attack of sudden general weakness against the background of any strong emotions, no matter positive or negative, laughter, crying or amazement. The attack can develop so quickly that the patient is at risk of falling and getting injured. Its duration ranges from several seconds to several minutes. This is usually followed by falling asleep.
● Waking dreams are vivid visions similar to a dream. They are usually accompanied by anxiety. Visions occur either at the moment of falling asleep or during awakening. Patients may see objects or people, hear music or voices.
● Sleep paralysis is complete immobility that lasts from a few seconds to several minutes after waking up. The person is fully conscious, able to assess the situation, but unable to move. Sleep paralysis is most common in the morning, but can occur at other times. Over time, other symptoms may appear.
You can suspect the disease yourself by daytime sleepiness, but only a specialist in the field of sleep medicine can make an accurate diagnosis after conducting diagnostic studies: polysomnography, encephalography, and so on. Unfortunately, it is not always possible to diagnose the disease quickly, because various sleep disorders are common, so many doctors do not even think about the rare disease.
It is not yet possible to completely get rid of narcolepsy, but symptomatic treatment of the disease can significantly improve the quality of life. Your doctor may prescribe medications to help relieve daytime sleepiness and improve nighttime sleep. Medications with a psychostimulating effect are effective - antidepressants of various groups.
Drug therapy
Modafinil
In many cases, the effective medicine Modafinil or its analogues is used. An effective psychostimulant was developed in the last century by an American pharmaceutical company. It is used to eliminate daytime sleepiness and treat narcolepsy. Take the drug in the morning at a standard dose of 100-200 mg.
The mechanism of action of Modafinil is different from Amphetamine. The components of the drug have a direct effect on specific areas of the brain. Under the influence of the drug, the speed of mental reactions increases. The activation of the neural pathway increases and the effect of the neurotransmitter hypocretin increases. The drug activates the central nervous system and regulates sleep/wakefulness.
If the patient does not respond well to treatment with Modafinil, the drugs Methamphetamine and Methylphenidate are prescribed. The drugs may cause some adverse reactions - increased heart rate, hypertension, agitation. The body may become accustomed to the medicine. If adverse reactions develop, you should inform your doctor.
Indopan
The drug Indopan is a nervous system stimulant. It relieves the manifestations of various psychosomatic diseases, schizophrenia, depression and narcolepsy. The drug eliminates the appearance of hallucinations and sleep disorders. Prescribed in tablets 2-3 times a day. The dosage is determined individually by the doctor depending on the clinical manifestations. The therapeutic course of Indopan lasts from 8 to 12 weeks. The withdrawal of the drug is carried out gradually.
Imipramine
The antidepressant Imipramine has high bioavailability and is prescribed to normalize sleep disorders. The active ingredient of the drug captures neurotransmitter monoamines - serotonin, dopamine, norepinephrine. The adrenergic blocking effect of the drug calms the central nervous system. Side effects may include dizziness and headaches, convulsions, and tremors of the limbs.
Sidnocarb
The drug Sidnocarb is prescribed for sleep disorders, lethargy, apathy, and asthenic disorders. The drug is widely used in eliminating the symptoms of narcolepsy and depression. The drug includes psychostimulants that reduce the uptake of catecholamines and affect certain brain structures.
Sidnocarb is administered orally before meals. For a single use, it is taken in the morning. The reception can also be divided into two times - in the morning and in the evening. The maintenance dosage for narcolepsy is 5-10 mg per day. Sidnocarb is started with a minimum dose of 5 mg. Then the dosage is gradually increased.
there is hope
Of course, this is a disease that cannot be ignored. Those who suffer from it should choose their profession with special care. They are contraindicated from working at heights, with moving mechanisms, requiring increased attention, or night shifts. During an exacerbation, it is necessary to have the opportunity for short sleep breaks of 15–20 minutes at 2–3 hour intervals during the day.
At the beginning of this century, a scientific discovery was made that finally helped to understand the nature of this mysterious disease. Researchers have found that patients with narcolepsy lack orexin, a special hormone found in the brain. American scientists have developed a nasal spray that contains the hormone orexin A. During experiments (the drug was tested on monkeys), it turned out that after its injection the animals felt great, even if they did not sleep enough. Naturally, the development immediately aroused interest among the military. There is also hope for patients with narcolepsy: perhaps the day is not far off when this disease will no longer be incurable.
Causes of the occurrence and development of the disease
The exact causes of narcolepsy are unknown. Basically, it occurs in people who already had it in one of their relatives.
They have a deficiency of neuropeptides: orexin A and orexin B. These substances are secreted by the cells of the hypothalamus and are responsible for the onset of a state of wakefulness. Their decrease, which occurs suddenly, in an attack, causes severe drowsiness.
Heredity
Disorders of the genetic apparatus lead to non-production or incorrect composition of orexin, which is the cause of narcolepsy.
Synthetic analogues of this neuropeptide are now being actively developed.
With the serial launch of this medicine, narcolepsy can be considered a defeated disease.
Other provoking factors
- Frequent stress.
- Taking certain medications and narcotics.
- Hard long work.
- Hormonal imbalances in chronic diseases, pregnancy.
- Wide range of brain diseases.
- Violations of the daily routine: night work, late falling asleep, short sleep.
Interesting
It recently became known that Leonardo da Vinci suffered from narcolepsy. He developed an irresistible drowsiness after three years spent in the dungeon of the Doge's Palace. The great artist and thinker not only did not allow the disease to break him, but also learned to benefit from it for creativity. To prevent attacks from taking him by surprise, Leonardo invented a wheelchair that was always nearby, and there was also paper and a pencil nearby. As soon as the artist woke up, he immediately captured the visions that visited him during the attacks.
Important
Diagnosis by sleep pattern. Two tests are usually performed to confirm the diagnosis: polysomnography and the MSLT test.
For polysomnography, you must spend the night in a sleep laboratory. You will be asked to sleep in an environment as close to your usual environment as possible. Small electrodes will be attached to the skin using a sticky jelly-like substance. They record brain waves, muscle activity, heart rate and eye movements. The test is necessary to rule out other disorders that have similar symptoms.
The next day, the MSLT test is performed. During the daytime, with the same electrodes, you will be asked to sleep for 20 minutes four to five times at intervals of two hours. The MSLT test examines your sleep pattern. People with narcolepsy have a different sleep pattern from healthy people.
What is narcolepsy
Narcolepsy or Gelineau's disease is an abnormality of the nervous system that relates to hypersomnia and excessive sleep. The term comes from ancient Greek words meaning stupor and attack, thereby reflecting the essence of what is happening to the sick person. During the daytime, a person experiences sudden drowsiness, accompanied by cataplexy, relaxation of muscle tone. The desire to fall asleep appears unexpectedly and irresistibly.
The narcoleptic falls asleep anywhere, in an uncomfortable position. Sleep lasts differently, from a few minutes to 2–3 hours. The person wakes up on his own, feeling rested, but after some time the attack occurs again. This can happen several times a day, which significantly disrupts life. The disease is rare: according to medical data, 20–30 cases per hundred thousand population are recorded. According to statistics, men suffer from it more often and mainly at a young age.
