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Narcolepsy: What Lies Beneath

Narcolepsy is a chronic neurological condition characterized by pervasive, excessive daytime sleepiness, as well as the abnormal intrusion of rapid eye movement sleep into wakefulness. Narcolepsy type I, or hypocretin deficiency syndrome, also includes cataplexy—a sudden loss of skeletal muscle tone during wakefulness—and is often triggered by a strong emotion, such as laughter, surprise, or anger. Other symptoms of narcolepsy include fragmented or disturbed nighttime sleep, sleep paralysis, and hallucinations, either when falling asleep (hypnagogic) or when waking up (hypnopompic). Evaluation requires meticulous clinical history taking, sleep duration and regularity validation, and assessment of patients for conditions that could also present with hypersomnia, such as insufficient sleep and delayed sleep phase disorder, depression, and obstructive sleep apnea. Management includes lifestyle modification, short and strategic shift power naps, and pharmacologic agents to improve daytime sleepiness, episodes of cataplexy, and sleep fragmentation at night.

Things That Go Bump in the Night

Complex nocturnal behaviors are some of the most fascinating sleep disorders in medical practice and often include a variety of conditions that require detective work. Parasomnias can include both simple and complex abnormal behaviors and are defined as abnormal sensory or behavioral phenomena that manifest during sleep-wake transition. Parasomnias are divided into those that occur during rapid eye movement (REM) sleep (including nightmares, isolated sleep paralysis, and REM sleep behavior disorder or RBD) and those occurring during nonrapid eye movement (NREM) sleep (such as sleepwalking, sleep terrors, and confusion on arousal. RBD often precedes the onset of neurodegenerative conditions, particularly α-synucleinopathies, a group of neurodegenerative diseases characterized by abnormal accumulation of insoluble α-synuclein in neurons and glial cells, comprising Parkinson’s disease, dementia with Lewy bodies, and multiple system atrophy. Other forms of complex behaviors include motor behaviors of sleep, such as rhythmic movements disorder, periodic leg moments of sleep, and bruxism. Sleep related epilepsy may resemble parasomnias but tend to be monomorphic and stereotyped.

Sleep As an Intervention for Neurological Conditions and Psychiatric Disorders

How can you help your patients sleep better, especially those who report poor sleep in the context of co-occurring neurological and psychiatric conditions? This session offers evidence based recommendations for improving your patients’ sleep, along with biological reasons to help motivate patients to actually implement the strategies suggested. After this session, attendees will be able to assess how cognitive behavioral therapy for insomnia (CBT-I) fits into the larger category of behavioral sleep medicine (BSM). Also be discussed: the role circadian biology, sleep drive, and stress response play in sleep, and specific sleep and circadian targets for improving sleep in the context of co-occurring neurological conditions and psychiatric disorders.