The enviable ＂second sleep＂ may also be a disease.

　　You can fall asleep anytime and anywhere, and I’m afraid it will be regarded as "Versailles" by many insomnia patients. But who can understand the troubles of particularly "sleepy" households? Being unnoticed, drowsiness can often delay treatment for 20 or 20 years. September 22nd is the World Narcolepsy Day. Today, the doctor will introduce you to this kind of "sleeping sickness" with 700,000 patients in China.

　　Symptoms vary in severity.

　　This disease harms teenagers.

　　A student who has just entered junior high school goes to sleep as soon as he attends class, falls down when he smiles, and his academic performance drops. Is it laziness or illness … …

　　A strong young man nodded his head frequently while driving, which almost caused a car accident … …

　　A middle-aged uncle was chatting with others when he suddenly became inarticulate, sleepy and even snored … …

　　What are these embarrassing situations? In fact, the culprit that plagues these people is a rare chronic sleep disorder disease called narcolepsy. The incidence of this disease is very low, with only one in every 2,000 people. There are about 3 million narcolepsy patients in the world, and there are about 700,000 narcolepsy patients in China, accounting for a quarter of the world.

　　Every narcolepsy has different manifestations. Some patients have mild clinical manifestations, and only those who are slightly sleepy during the day can be improved by taking a nap. These patients often do not go to see a doctor. Some patients have severe symptoms, which will seriously affect all aspects of life and study.

　　The peak age of narcolepsy is 8 to 15 years old, and about two-thirds of patients will get sick at the age of 7. The second peak onset age is about 40 years old. The youngest onset age can be 3 years old, and the oldest onset age can be 70 years old. Due to the low incidence of narcolepsy, the difference of clinical symptoms, and the public’s general lack of understanding of the disease, many patients who developed narcolepsy in childhood and adolescence were not diagnosed and treated in time. According to foreign research reports, the average delay from onset to diagnosis of narcolepsy was 8 to 22 years. For children and adolescents, this age is a critical period for studying and personality development. If it is not diagnosed and treated in time, it will have a great impact on patients’ lives.

　　Five core symptoms

　　Suggest that sleepiness is "not simple"

　　Narcolepsy was first reported by French doctors in 1880. With the deepening of understanding of the disease, people finally summed up the five core symptoms of narcolepsy, also known as "five signs".

　　Excessive daytime sleepiness is the most common symptom of narcolepsy, which occurs in almost 100% of patients. It is manifested as an irresistible sudden sleep attack, which may sometimes occur when walking, eating or talking, and is more likely to occur when external stimuli are reduced, such as watching TV, reading books or meeting. If you sleep at this time, you will often feel refreshed, but the recovery time of energy is often short.

　　Cataplexy refers to the weakness after laughing or intense emotional stimulation, which makes the patient forced to fall or sit down. This is caused by partial or complete loss of muscle tension in both limbs. Although the duration is short, the patient is at risk of falling when he attacks. The symptoms of cataplexy in children are often atypical, often manifested as bow, tongue sticking out, abnormal facial expression and other symptoms. The time of weakness often ranges from a few seconds to several minutes.

　　Sleep hallucination usually means seeing the shadow of a familiar person, hearing a familiar voice, or feeling touched. This experience is often very real, and it often makes people unable to distinguish between dreams and reality. Most of them occur when they are just about to fall asleep or wake up from sleep, or during a nap.

　　Sleep paralysis patients wake up from sleep as if their bodies are pinned down and unable to move, which is commonly known as "ghost bed". During the attack, the patient is conscious and can perceive the things around him, but he can’t move or talk. He needs someone to push him and soon returns to normal. This situation will last for several seconds to several minutes, and you will feel scared when you first get sick. Although normal people will also have a "ghost bed", patients with narcolepsy appear very frequently.

　　Sleep disorder at night is also one of the chief complaints of patients when they see a doctor. The main manifestations are restless sleep, dreaminess and difficulty in falling asleep after waking up. In addition, there may be periodic limb movements and abnormal behavior during REM sleep.

　　In addition, many patients with narcolepsy will also have other clinical manifestations such as weight gain, precocious puberty, mental disorder and cognitive impairment.

　　Come and answer the question

　　It is recommended to see a doctor if you exceed 10 points.

　　If the above symptoms appear, a small questionnaire can be used to test it. Epworth Sleepiness Scale is a commonly used clinical survey scale, which allows subjects to evaluate their desire to "doze off" in different environments. The total score is 24, and if it is greater than 10, it is drowsiness.

　　According to your situation in the past month, please check the most suitable situation from each question. The scoring criteria are: no or little drowsiness 0, occasional drowsiness 1, frequent drowsiness 2, and drowsiness 3 most or all of the time.

　　1. When sitting reading books and periodicals (in class);

　　2. When watching TV (computer);

　　3. When sitting still in public places;

　　4. Traveling by car lasts for one hour without rest;

　　5. When conditions permit, lie down and rest in the afternoon;

　　6. When sitting and talking to people;

　　7. Don’t drink at lunch and sit quietly after dinner;

　　8. In case of traffic jam, stop within a few minutes.

　　It is suggested that the subjects with a score greater than 10 should go to the sleep specialist in the hospital or the sleep specialist in the department of neurology in time to receive standardized standard polysomnography and multiple snooze latency tests. For accurate diagnosis and differential diagnosis, some patients need to undergo a series of examinations for the first time, including brain magnetic resonance imaging, electroencephalography, detection of orexin in cerebrospinal fluid by lumbar puncture and detection of narcolepsy-related susceptibility genes. These examinations can help improve the accuracy of narcolepsy diagnosis.

　　At present, multiple snooze latency tests and cerebrospinal fluid orexin detection are still recognized as important diagnostic methods for narcolepsy.

　　In addition to taking medicine to drive away the "sleeping god"

　　It is important to adjust living habits.

　　There is no treatment for narcolepsy, and all the treatments are mainly aimed at the core aspects that narcolepsy has the greatest impact on life. The treatment methods include drug treatment and non-drug treatment.

　　Drug therapy is mainly divided into two categories: one is the drugs for treating daytime sleepiness, mainly the drugs for boosting spirits, such as modafinil, tirol, methylphenidate, etc., and some new awakening drugs approved by FDA; The other is drugs for treating cataplexy, sleep paralysis and hallucinations before falling asleep, mainly including venlafaxine, clomipramine and other antidepressants. This requires medication under the guidance of a sleep expert and regular follow-up visits.

　　The positive psychology of patients with non-drug treatment plays a vital role in the cooperation of treatment. What should be done specifically? First of all, we can start with simple changes in daily life habits, such as ensuring adequate sleep at night, arranging regular naps to reduce daytime sleepiness, abstaining from alcohol and smoking, and avoiding excessive eating of high-carbohydrate foods; Avoid driving, working at high altitude and underwater; Keep an optimistic attitude, and seek psychological help or treatment in time when there is inferiority or depression; Don’t get too excited, so as to avoid cataplexy. For adolescent patients, parents and teachers should realize that daytime sleepiness and drowsiness are symptoms of diseases and understand them, so as to assist adolescent patients in psychological construction and long-term disease management. At the same time, patients should go to a regular sleep clinic to receive medication.

　　At present, great progress has been made in the treatment of narcolepsy, and genes, stem cell therapy and orexin agonists are still under experimental study. I believe that more drugs will be put into clinical use in the near future, thus benefiting narcolepsy patients, driving away the sleeping devil and making them regain their energetic day.

　　Text/Zhan Shuqin (xuanwu hospital, Capital Medical University)