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Narcolepsy and the Risk of Addiction

Narcolepsy is a rare disorder characterized by periods of extreme daytime sleepiness. It may contribute to muscle weakness.

The risk of addiction is low among people who have narcolepsy. If substance abuse issues are present, specialized addiction treatment is needed.

Symptoms of Narcolepsy

People who have narcolepsy have difficulty sleeping at night. They may struggle with sleep disorders before narcolepsy itself becomes apparent.

The symptoms of narcolepsy can occur when the person is in the middle of activities like talking, eating, or driving.

The Sleep Cycle

During a normal sleep cycle, the brain cycles through rapid eye movement (REM) and non-rapid eye movement (NREM) sleep. Typically, you will fall asleep and stay in NREM for up to 90 minutes and then cycle into REM sleep, which is the dream state.

People with narcolepsy fall directly into REM sleep without cycling through other important stages first, and they usually wake directly from REM sleep. This leads to experiencing intense hallucinations from the REM cycle during periods of wakefulness or semi-wakefulness.

To approach a normal sleep cycle, people who have narcolepsy must take certain medications on a very rigid, regular schedule. These include stimulants and relaxants at different times of the day. 

This regulates a neurotransmitter called hypocretin, which promotes wakefulness in an average brain. The brains of those with narcolepsy typically have low hypocretin.

Issues and Causes

This sleep disorder may include other issues associated with sleep and consciousness. 

This is sudden muscle weakness while awake. It can affect certain muscle groups or limbs, or it can affect the whole body at once, leading to falling or slumping. Strong emotions typically trigger the loss of muscle activation, which can last for a few seconds to several minutes

These are vivid images that may occur during wakefulness or while asleep. They are not real, but the brain interprets them as reality

As you fall asleep, your brain paralyzes your body so you will not thrash around and react to your dreams as though you are awake. Sometimes, the brain wakes up before the body does, and the body cannot move. The sleep paralysis condition may be accompanied by hallucinations.

There are several potential causes or triggers of narcolepsy.

  • Heredity
  • Infections
  • Low levels of histamine in the blood
  • Brain injuries
  • Autoimmune disorders

Difficult to Diagnose

Narcolepsy

People who develop narcolepsy often struggle during their teenage or young adult years, as symptoms begin to manifest. They may begin to have trouble at work or school, at home, or in social situations due to low physical and mental energy and excessive tiredness.

Narcolepsy is a difficult condition to diagnose. It can take as much as 10 to 15 years from the onset of symptoms until a diagnosis is achieved. The condition is often misdiagnosed as a learning disorder, laziness, depression, or a seizure disorder.

To diagnose narcolepsy, a doctor will perform a thorough physical and examine both family and medical history. Then, the individual will be referred to a sleep clinic for a sleep test.

There is no cure for narcolepsy since it is a chronic condition. However, there are several approaches to treatment, including medications and lifestyle changes.

Medications used to treat narcolepsy include:

  • Stimulant drugs, such as amphetamines like Adderall.
  • Hypocretin-controlling medications.
  • Sedatives to sleep at night
  • Antidepressants, which prevent cataplexy, hallucinations, and sleep paralysis by aiding in the regulation of serotonin and dopamine.

Along with prescribed medications, your doctor may recommend avoiding certain medications, like antihistamines, because they can interfere with the delicate balance of prescription medicine required to ease a narcoleptic brain into a stable circadian rhythm.

Narcolepsy is rare, but the condition often involves several intoxicating substances, which may be addictive. Understanding the risk of addiction associated with prescription medications for narcolepsy can help you recognize how severe the risks are to you or a loved one.

What Is Addiction?  

Like narcolepsy, addiction is a chronic condition; however, it is a more common chronic illness than narcolepsy.

People who struggle with addiction perform compulsive behaviors to trigger a flood of neurotransmitters, mostly dopamine, which triggers the reward center in the brain, elevates mood, and makes the body feel better. Most addictions are associated with substances like alcohol, cocaine, marijuana, or opioids. Some behaviors are addictive, like shopping or gambling.

People who develop addictions often start by abusing substances for fun, to get high, to relieve stress, because of peer pressure, out of curiosity, or to feel better. When the person no longer has control over consuming the substance or how much they consume, they may be addicted. 

Signs of addiction include: 

  • Impaired control of cravings and urges, including the desire to quit and attempts to quit but failing
  • Risky use, including driving while intoxicated, consuming drugs throughout the day, and risky sexual behaviors
  • Social problems like skipping work or school to get high, harming relationships with loved ones, and failing to meet family responsibilities
  • Drug effects, such as physical tolerance, or needing more to achieve the original high, and dependence, or needing the drug to feel normal

Also, like narcolepsy, addiction treatment requires ongoing medical interventions — mostly counseling and lifestyle changes, but for some drugs, prescription medications to ease the body off dependence on the substance or medications to manage co-occurring mental health conditions like depression or anxiety.

Narcolepsy and Addiction Not Closely Associated

Addiction and narcolepsy both impact the hypocretin system, which enhances signaling between the mesolimbic pathways involved in the brain’s reward center.

A study published in 2011 suggested that people with narcolepsy, particularly narcolepsy in which cataplexy is a symptom, may be less susceptible to addictive behaviors due to lower amounts of hypocretin in the brain. However, the study found that narcolepsy patients, both with and without cataplexy, displayed normal rates of risk-taking behaviors. Patients with cataplexy were more prone to binge eating behaviors.

People with narcolepsy also had higher rates of depression and anxiety than those without narcolepsy. Both depression and anxiety are closely tied to increased risk of addiction.

However, studies have reported that people with narcolepsy have lower rates of addiction to substances due to absent or low levels of orexin (both A and B), which is a neuropeptide also involved in regulating sleep cycles.

Another medical study published in 2016 reported a low frequency of drug abuse among those with narcolepsy and idiopathic hypersomnia, whether they were hypocretin-deficient or not. Heavy drinkers were rare in the narcolepsy group during the study, but they appeared at the same rate as in the overall population with different hypersomnias, which are similar to narcolepsy but do not involve hypocretin secretion problems.

Like other mental or behavioral conditions, people who have narcolepsy are not considered to be at risk of abusing the drugs they are prescribed. When taken as prescribed, daytime stimulants and nighttime sedatives moderate the brain’s activity. The person feels normal or better than they would without medical intervention. 

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hypocretin production

The Reward System and Hypocretin Production 

Studying hypocretin-secreting neurons has been a boon to understanding addiction. For example, a study of lab rats found that a less-sensitive hypocretin receptor, which had a weaker response to the neuropeptide, was associated with less motivation to seek cocaine (a potent stimulant that releases a lot of dopamine into the brain).

Elevated levels of hypocretin neurons in people struggling with heroin and opioid addiction, in particular, were higher compared to both the general population and those with narcolepsy. People struggling with opioid abuse had 54 percent more hypocretin-producing neurons, on average, compared to healthy controls.

Follow-up studies on mice injected with morphine found that the presence of the opioid increased the number of hypocretin-producing neurons in the brain. In narcoleptic mice injected with morphine, symptoms disappeared.

The findings suggest that treating some forms of narcolepsy with opioids may be a new form of managing the condition. However, it will slightly increase the rates at which opioids are prescribed, which escalates the risk that these drugs will be diverted for abuse.

Treatment for Addiction With a Sleep Disorder

While it is unlikely that someone with narcolepsy will need addiction treatment, it is a possibility.

Finding a treatment program that manages underlying medical conditions, including mental illnesses like depression and anxiety, sleep disorders like narcolepsy, and the associated effects of these issues, may take some time, but it is worth finding a program that allows prescription drug treatments for sleep disorders.

Although stimulants and sedatives are potent, addictive drugs, people with narcolepsy need them. Treatment programs will devise a plan to keep them on a regular schedule and avoid a relapse into other addictive substances.

Sources

(November 9, 2011). Narcolepsy. National Heart, Lung, and Blood Institute (NHLBI) from https://www.nhlbi.nih.gov/health-topics/narcolepsy

(January 2017). What is Addiction? American Psychiatric Association (APA) from https://www.psychiatry.org/patients-families/addiction/what-is-addiction

(June 15, 2011). Reward-Seeking Behavior in Human Narcolepsy. Journal of Clinical Sleep Medicine from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3113969/

(March 1, 2016). Smoking, Alcohol, Drug Use, Abuse and Dependence in Narcolepsy and Idiopathic Hypersomnia: A Case-Controlled Study. Sleep Research Society from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4763360/

(June 27, 2018). A Brain Chemical Tied to Narcolepsy May Play a Role in Opioid Addiction. Science News from https://www.sciencenews.org/article/brain-chemical-narcolepsy-role-opioid-addiction

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