Chennai: A disease that mostly goes misdiagnosed | Chennai News

CHENNAI: In classrooms or at conferences, at weddings or in parties, Suresh* (name changed) would fall asleep anywhere and everywhere. While friends teased him, teachers and employers felt he was just lazy. Finally, concerned family members urged him to meet a doctor. After meeting innumerable specialists, he was finally diagnosed with narcolepsy, a neurological disorder that is characterised by excessive daytime drowsiness.
“It is a neurological problem, and is caused when some neurotransmitters in the brain are impaired. The most common symptom is feeling very sleepy. In fact patients have sleep attacks, which they cannot resist so they sleep wherever they are. It can happen anywhere, in school, at college or workplaces, or even while driving,” says Dr N Ramakrishnan, director, Nithra Institute of Sleep Sciences, adding that there are four main symptoms associated with narcolepsy.
“Apart from sleepiness, patients can have cataplexy, ie, when someone is very emotional, they lose complete control of their body and fall down. They can also experience sleep paralysis, where they are aware of their surroundings but cannot move; and also have hypnogogic hallucinations, ie, when they start sleeping, they have some visual or tactile hallucinations,” says Dr Ramakrishnan. Most of these symptoms usually happen when wakefulness and REM sleep overlap.
There is not enough awareness about the disease. That’s why, the world over, September 22 is observed as World Narcolepsy Day. “It’s not very common. It is seen in young adults and patients usually come when they have already had symptoms for three or four years,” says Dr Ramakrishnan. “They are usually labelled as lazy, unproductive, may fail exams or lose jobs and, as a result, get depressed.”
Dr U Meenakshisundaram, director of neurology, SIMS Hospital, says the disease is rare. “The typical full-blown narcolepsy with cataplexy is rare but what goes unrecognised are the milder forms. People do tend to doze off during the daytime, but what should ring the alarm bells is when someone tends to fall asleep in places where you wouldn’t expect them to. For instance, while chatting with a group of friends. I have had patients doze off as the spouse explains the medical history.”
Many cases go undiagnosed or misdiagnosed.
A neurologist or sleep medicine specialist can diagnose the condition with the help of a sleep study. “Patients with narcolepsy will quickly go into REM sleep during daytime. That’s why, to diagnose the condition, we do a full night sleep study to make sure there is no other reason for them to be sleepy. If that is normal, they are allowed to sleep during the day time and they will go to REM sleep in just two or three minutes,” says Dr Ramakrishnan, adding that they also make sure there is no secondary cause for the excessive sleepiness, such as trauma to the brain.
The condition can be very easily treated with medication. “I had a young surgeon come to me who was afraid to work since he was feeling sleepy even in the operating theatre. After being treated, he is now completely normal and back at work,” says Dr Ramakrishnan.

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