Narcolepsy - Knowledge

1323:(an antibiotic approved by the FDA for the treatment of infections) was found to return the function of the GABA system to normal in people with primary hypersomnias. Investigators therefore treated a few people with narcolepsy with off-label clarithromycin, and most felt their symptoms improved with this treatment. In order to help further determine whether clarithromycin is truly beneficial for the treatment of narcolepsy and idiopathic hypersomnia, a small, double-blind, randomized, controlled clinical trial was completed in 2012. "In this pilot study, clarithromycin improved subjective sleepiness in GABA-related hypersomnia. Larger trials of longer duration are warranted." In 2013, a retrospective review evaluating longer-term clarithromycin use showed efficacy in a large percentage of people with GABA-related hypersomnia. "It is important to note that the positive effect of clarithromycin is secondary to a 531:. The person remains conscious throughout the episode. In some cases, cataplexy may resemble epileptic seizures. Usually speech is slurred and vision is impaired (double vision, inability to focus), but hearing and awareness remain normal. Cataplexy also has a severe emotional impact on narcoleptics, as it can cause extreme anxiety, fear, and avoidance of people or situations that might elicit an attack. Cataplexy is generally considered to be unique to narcolepsy and is analogous to sleep paralysis in that the usually protective paralysis mechanism occurring during sleep is inappropriately activated. The opposite of this situation (failure to activate this protective paralysis) occurs in 1311:, making them more susceptible to the sleep-inducing effect of GABA. For one person, daily administration of flumazenil by sublingual lozenge and topical cream has proven effective for several years. A 2014 case report also showed improvement in primary hypersomnia symptoms after treatment with a continuous subcutaneous flumazenil infusion. The supply of generic flumazenil was initially thought to be too low to meet the potential demand for treatment of primary hypersomnias. However, this scarcity has eased, and dozens of people are now being treated with flumazenil off-label. 491:. Excessive daytime sleepiness occurs even after adequate night time sleep. A person with narcolepsy is likely to become drowsy or fall asleep, often at inappropriate or undesired times and places, or just be very tired throughout the day. Narcoleptics may not be able to experience the amount of restorative deep sleep that healthy people experience due to abnormal REM regulation – they are not "over-sleeping". Narcoleptics typically have higher REM sleep density than non-narcoleptics, but also experience more REM sleep without 878:, the individual must present with excessive sleepiness despite at least 7 hours of sleep as well as either recurrent lapses into daytime sleep, nonrestorative sleep episodes of 9 or more hours, or difficulty staying awake after awakening. In addition, the hypersomnolence must occur at least three times a week for a period of three months, and must be accompanied by significant distress or impairment. It also cannot be explained by another sleep disorder, coexisting mental or medical disorders, or medication. 1393:

and humans have also revealed that hypocretin is involved in other functions beside regulation of wakefulness and sleep. These functions include autonomic regulation, emotional processing, reward learning behaviour or energy homeostasis. In studies where the concentration of the hypocretin was measured under different circumstances, it was observed that the hypocretin levels increased with the positive emotion, anger or social interaction but stayed low during sleep or during pain experience.

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Doberman pinschers where it was investigated the possibility to inherit this disorder in the autosomal recessive mode. According to a reliable canine model for narcolepsy would be the one in which the narcoleptic symptoms are the result of a mutation in the gene HCRT 2. The animals affected exhibited excessive daytime sleepiness with a reduced state of vigilance and severe cataplexy resulted after palatable food and interactions with the owners or with other animals.

52: 356:. There are two recognized forms of narcolepsy, narcolepsy type 1 and type 2. Narcolepsy type 1 (NT1) can be clinically characterized by symptoms of EDS and cataplexy, and/or will have CSF orexin levels of less than 110 pg/ml. Cataplexy are transient episodes of aberrant tone, most typically loss of tone, that can be associated with strong emotion. In pediatric onset narcolepsy, active motor phenomena are not uncommon. Cataplexy may be mistaken for 582:

occur at other times in people with narcolepsy. For example, the lack of muscular control can occur during wakefulness in a cataplexy episode; it is said that there is an intrusion of REM atonia during wakefulness. Sleep paralysis and vivid dreams can occur while falling asleep or waking up. Simply put, the brain does not pass through the normal stages of dozing and deep sleep but goes directly into (and out of) rapid eye movement (REM) sleep.

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for a few hours or less. Vivid dreams may be experienced on a regular basis, even during very brief naps. Drowsiness may persist for prolonged periods or remain constant. In addition, night-time sleep may be fragmented, with frequent awakenings. A second prominent symptom of narcolepsy is abnormal REM sleep. Narcoleptics are unique in that they enter into the REM phase of sleep in the beginnings of sleep, even when sleeping during the day.

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quickly into what appears to be very deep sleep, and they wake up suddenly and can be disoriented when they do (dizziness is a common occurrence). They have very vivid dreams, which they often remember in great detail. People with narcolepsy may dream even when they only fall asleep for a few seconds. Along with vivid dreaming, people with narcolepsy are known to have audio or visual hallucinations prior to

3000: 645:(HLA) complex. Specific variations in HLA genes are strongly correlated with the presence of narcolepsy (HLA DQB1*06:02, frequently in combination with HLA DRB1*15:01); however, these variations are not required for the condition to occur and sometimes occur in individuals without narcolepsy. These genetic variations in the HLA complex are thought to increase the risk of an 380:). People with narcolepsy tend to sleep about the same number of hours per day as people without it, but the quality of sleep is typically compromised. Narcolepsy is a clinical syndrome of hypothalamic disorder, but the exact cause of narcolepsy is unknown, with potentially several causes. A leading consideration for the cause of narcolepsy type 1 is that it is an 440:

scheduled or strategic naps and maintaining a regular sleep wake schedule. Social support, social networks, and social integration are resources that may lie in the communities related to living with narcolepsy. Medications used to treat narcolepsy are primarily targeting EDS and/or cataplexy. These medications include alerting agents (

1195:, making misdiagnosis likely. While narcolepsy symptoms are often confused with depression, there is a link between the two disorders. Research studies have mixed results on co-occurrence of depression in people with narcolepsy, as the numbers quoted by different studies are anywhere between 6% and 50%. 1405:

Dogs, as well as other species like cats or horses, can also exhibit spontaneous narcolepsy with similar symptoms as the ones reported in humans. The attacks of cataplexy in dogs can involve partial or full collapse. Narcolepsy with cataplexy was identified in a few breeds like Labrador retrievers or

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Animal studies try to mimic the disorder in humans by either modifying the Hypocretin/Orexin receptors or by eliminating this peptide. An orexin deficit caused by the degeneration of hypothalamic neurons is suggested to be one of the causes of narcolepsy. More recent clinical studies on both animals

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activation and consequent injury to orexin producing neurons. Familial trends of narcolepsy are suggested to be higher than previously appreciated. Familial risk of narcolepsy among first degree relatives is high. Relative risk for narcolepsy in a first degree relative has been reported to be 361.8.

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Excessive sleepiness can vary in severity, and it appears most commonly during monotonous situations that do not require much interaction. Daytime naps may occur with little warning and may be physically irresistible. These naps can occur several times a day. They are typically refreshing, but only

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Rat models have been used to demonstrate the association between orexin deficiency and narcoleptic symptoms. Rats who lost the majority of their orexinergic neurons exhibited multiple SOREMPs as well as less wakefulness during nocturnal hours, shortened REM latency, and brief periods of cataplexy.

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receptor antagonist on the market as of January 2013, and it is currently manufactured only as an intravenous formulation. Given its pharmacology, researchers consider it to be a promising medication in the treatment of primary hypersomnias. Results of a small, double-blind, randomized, controlled

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and young adulthood. There is about a ten-year delay in diagnosing narcolepsy in adults. Cognitive, educational, occupational, and psychosocial problems associated with the excessive daytime sleepiness of narcolepsy have been documented. For these to occur in the crucial teen years when education,

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In narcolepsy, the order and length of NREM and REM sleep periods are disturbed, with REM sleep occurring at sleep onset instead of after a period of NREM sleep. Also, some aspects of REM sleep that normally occur only during sleep, like lack of muscular control, sleep paralysis, and vivid dreams,

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While there is no cure, behavioral strategies, lifestyle changes, social support and medications may help. Lifestyle and behavioral strategies can include identifying and avoiding or desensitizing emotional triggers for cataplexy, dietary strategies that may reduce sleep inducing foods and drinks,

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Orexinergic projections in the CNS. Orexin neurons with cell bodies in the lateral hypothalamic area (LHA) and posterior hypothalamus (PH) project throughout the brain (excluding the cerebellum) with dense projections to the noradrenergic locus ceruleus (LC), histaminergic tuberomamillary nucleus

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The multiple sleep latency test is performed after the person undergoes an overnight sleep study. The person will be asked to sleep once every 2 hours, and the time it takes for them to do so is recorded. Most individuals will fall asleep within 5 to 8 minutes, as well as display REM sleep faster

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of less than 8 minutes, and two or more sleep-onset REM periods (SOREMPs), or they must present with a hypocretin-1 concentration of less than 110 pg/mL. A diagnosis of type 2 narcolepsy requires a mean sleep latency of less than 8 minutes, two or more SOREMPs, and a hypocretin-1 concentration of

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An episodic loss of muscle function, known as cataplexy, ranging from slight weakness such as limpness at the neck or knees, sagging facial muscles, weakness at the knees often referred to as "knee buckling", or inability to speak clearly, to a complete body collapse. Episodes may be triggered by

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In many cases, planned regular short naps can reduce the need for pharmacological treatment of the EDS, but only improve symptoms for a short duration. A 120-minute nap provided benefit for 3 hours in the person's alertness whereas a 15-minute nap provided no benefit. Daytime naps are not a

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Polysomnography involves the continuous recording of sleep brain waves and a number of nerve and muscle functions during night time sleep. When tested, people with narcolepsy fall asleep rapidly, enter REM sleep early, and may often awaken during the night. The polysomnogram also helps to detect

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As a consequence night time sleep does not include as much deep sleep, so the brain tries to "catch up" during the day, hence excessive daytime sleepiness. People with narcolepsy may visibly fall asleep at unpredicted moments (such motions as head bobbing are common). People with narcolepsy fall

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ICSD-3 diagnostic criteria posits that the individual must experience "daily periods of irrepressible need to sleep or daytime lapses into sleep" for both subtypes of narcolepsy. This symptom must last for at least three months. For a diagnosis of type 1 narcolepsy, the person must present with

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In most cases, the first symptom of narcolepsy to appear is excessive and overwhelming daytime sleepiness. The other symptoms may begin alone or in combination months or years after the onset of the daytime naps. There are wide variations in the development, severity, and order of appearance of

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cataplexy and displayed brain and muscle electrical activity similar to the activity present during REM and NREM sleep. This cataplexy is able to be triggered through social interaction, wheel running, and ultrasonic vocalizations. Upon awakening, the mice also display behavior consistent with

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have been observed in people with narcolepsy. These same low levels have been associated with primary hypersomnia in general in mouse studies. "Mice with systemic carnitine deficiency exhibit a higher frequency of fragmented wakefulness and rapid eye movement (REM) sleep, and reduced locomotor

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General strategies like people and family education, sleep hygiene and medication compliance, and discussion of safety issues for example driving license can be useful. Potential side effects of medication can also be addressed. Regular follow-up is useful to be able to monitor the response to

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transgene via gene editing restored normal function in mice models by making other neurons produce orexin after the original set have been destroyed, or replacing the missing orexinergic neurons with hypocretin stem cell transplantation, are both steps in that direction for fixing the biology

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As described above, medications used to treat narcolepsy primarily target EDS and/or cataplexy. Internationally there are differences in the availability of medications as well as guidelines for treatment. The alerting agents are medications typically used to improve wakefulness and include

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that acts within the brain to regulate appetite and wakefulness as well as a number of other cognitive and physiological processes. Loss of these orexin-producing neurons causes narcolepsy and most individuals with narcolepsy have a reduced number of these neurons in their brains. Selective

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is a new molecule indicated for narcolepsy of type 1 and 2. Solriamfetol works by inhibiting the reuptake of the monoamines via the interaction with both the dopamine transporter and the norepinephrine transporter. This mechanism differs from that of the wake-promoting agents modafinil and

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DSM-5 narcolepsy criteria requires that the person to display recurrent periods of "an irrepressible need to sleep, lapsing into sleep, or napping" for at least three times a week over a period of three months. The individual must also display one of the following: cataplexy, hypocretin-1

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Genes associated with narcolepsy mark the particular HLA heterodimer (DQ0602) involved in presentation of these antigens and modulate expression of the specific T cell receptor segments (TRAJ24 and TRBV4-2) involved in T cell receptor recognition of these antigens, suggesting causality.

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Some researches indicated that people with type 1 narcolepsy (narcolepsy with cataplexy) have a lower level of orexin (hypocretin), which is a chemical contributing to the regulation of wakefulness and REM sleep. It also acts as a neurotransmitter to enable nerve cells to communicate.

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cataplexy, sleep paralysis, and hypnagogic hallucinations in individuals. Only about 20 to 25 percent of people with narcolepsy experience all four symptoms. The excessive daytime sleepiness generally persists throughout life, but sleep paralysis and hypnagogic hallucinations may not.

629:) after being stimulated by infection with H1N1 influenza. In addition to genetic factors, low levels of orexin peptides have been correlated with a history of infection, diet, contact with toxins such as pesticides, and brain injuries due to head trauma, brain tumors or strokes. 544:

Vivid, often frightening, dreamlike experiences that occur while dozing or falling asleep, known as hypnagogic hallucinations. Hypnopompic hallucinations refer to the same sensations while awakening from sleep. These hallucinations may manifest in the form of visual or auditory

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In up to 10% of cases there is a family history of the disorder. Family history is more common in narcolepsy with cataplexy. There is a strong link with certain genetic variants, which may make T-cells susceptible to react to the orexin-releasing neurons

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Ollila, H.M., Sharon, E., Lin, L., Sinnott-Armstrong, N., Ambati, A., Yogeshwar, S.M., Hillary, R.P., Jolanki, O., Faraco, J., Einen, M. and Luo, G., 2023. Narcolepsy risk loci outline role of T cell autoimmunity and infectious triggers in narcolepsy.

1071:, twice nightly mixed salts oxybate and once nightly extended release sodium oxybate). This class of medication is taken once or twice during the night, as opposed to other medications for EDS and cataplexy that are typically taken during the day. 886:

Diagnosis is relatively easy when all the symptoms of narcolepsy are present, but if the sleep attacks are isolated and cataplexy is mild or absent, diagnosis is more difficult. Three tests that are commonly used in diagnosing narcolepsy are

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Many medications are used in treating adults and may be used to treat children. These medications include central nervous system stimulants such as methylphenidate, modafinil, amphetamine, and dextroamphetamine. Other medications, such as

368:. Narcolepsy type 2 (NT2) does not have features of cataplexy and CSF orexin levels are normal. Sleep related hallucinations, also known as hypnogogic (going to sleep) and hypnopompic (on awakening) are vivid hallucinations that can be 2494:

the loss of orexin neurons raise the interesting possibility that narcolepsy may be caused by an autoimmune mediated destruction of these neurons in analogy with the autoimmune destruction of insulin-secreting β-islet cells in type I

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armodafinil. These are thought to bind primarily at the dopamine transporter to inhibit the reuptake of dopamine. Solriamfetol also differs from amphetamines as it does not promote the release of norepinephrine in the brain.Uniquely,

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The most reliable and valid animal models developed are the canine (narcoleptic dogs) and the rodent (orexin-deficient mice) ones which helped investigating the narcolepsy and set the focus on the role of orexin in this disorder.

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destruction of the HCRT/OX neurons with preservation of proximate structures suggests a highly specific autoimmune pathophysiology. Cerebrospinal fluid HCRT-1/OX-A is undetectable in up to 95% of patients with type 1 narcolepsy.

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Boscolo-Berto R, Viel G, Montagnese S, Raduazzo DI, Ferrara SD, Dauvilliers Y (October 2012). "Narcolepsy and effectiveness of gamma-hydroxybutyrate (GHB): a systematic review and meta-analysis of randomized controlled trials".

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for extended periods of time. The excessive daytime sleepiness and cataplexy often become severe enough to cause serious problems in a person's social, personal, and professional life. Normally, when an individual is awake,

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neuronal loss. T-cells have been demonstrated to be cross-reactive to both a particular piece of the hemagglutinin flu protein of the pandemic 2009 H1N1 and the amidated terminal ends of the secreted hypocretin peptides.

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Estimates of frequency range from 0.2 to 600 per 100,000 people in various countries. The condition often begins in childhood, with males and females being affected equally. Untreated narcolepsy increases the risk of

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receptors in the primary hypersomnias (narcolepsy and idiopathic hypersomnia), medications that could counteract this activity are being studied to test their potential to improve sleepiness. These currently include

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development of self-image, and development of occupational choice are taking place is especially devastating. While cognitive impairment does occur, it may only be a reflection of the excessive daytime somnolence.

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effectively permanently once applied in humans. Additionally effective ideal non-gene editing and chemical-drug methods involve hypocretin treatments methods such as future drugs like hypocretin agonists (such as

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Trotti LM, Saini P, Freeman AA, Bliwise DL, García PS, Jenkins A, Rye DB (July 2014). "Improvement in daytime sleepiness with clarithromycin in patients with GABA-related hypersomnia: Clinical experience".

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The neural control of normal sleep states and the relationship to narcolepsy are only partially understood. In humans, narcoleptic sleep is characterized by a tendency to go abruptly from a waking state to

777:. In narcoleptic individuals, these systems are all associated with impairments due to a greatly reduced number of hypothalamic orexin projection neurons and significantly fewer orexin neuropeptides in 541:

The temporary inability to talk or move when waking (or less often, when falling asleep), known as sleep paralysis. It may last a few seconds to minutes. This is often frightening but is not dangerous.

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Narcolepsy generally occurs anytime between early childhood and 50 years of age, and most commonly between 15 and 36 years of age. However, it may also rarely appear at any time outside of this range.

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Trotti LM, Saini P, Freeman AA, Bliwise D, Jenkins A, Garcia P, Rye D (June 2013). "Clarithromycin for the Treatment of Hypersomnia: A Randomized, Double-Blind, Placebo-Controlled, Crossover Trial".

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Mice that are genetically engineered to lack orexin genes demonstrate many similarities to human narcolepsy. During nocturnal hours, when mice are normally present, those lacking orexin demonstrated

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was shown to improve these symptoms in mice. A subsequent human trial found that people with narcolepsy given L-carnitine spent less total time in daytime sleep than people who were given a placebo.

3526: 1179:, narcolepsy is estimated to affect as many as 200,000 Americans, but fewer than 50,000 are diagnosed. The prevalence of narcolepsy is about 1 per 2,000 persons. Narcolepsy is often mistaken for 4293:

Rye DB, Bliwise DL, Parker K, Trotti LM, Saini P, Fairley J, et al. (November 2012). "Modulation of vigilance in the primary hypersomnias by endogenous enhancement of GABAA receptors".

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clinical trial were published in November 2012. This research showed that flumazenil provides relief for most people whose CSF contains the unknown "somnogen" that enhances the function of

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may help in diagnosing narcolepsy, with abnormally low levels serving as an indicator of the disorder. This test can be useful when MSLT results are inconclusive or difficult to interpret.

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recommended that Pandemrix vaccinations be suspended pending further investigation into narcolepsy. In 2018, it was demonstrated that T-cells stimulated by Pandemrix were cross-reactive by

495:. Many narcoleptics have sufficient REM sleep, but do not feel refreshed or alert throughout the day. This can feel like living their entire lives in a constant state of sleep deprivation. 785:

stage of sleep within five minutes of falling asleep, while people who do not have narcolepsy (unless they are significantly sleep deprived) do not experience REM until after a period of

3700: 853:(DSM-5) uses the diagnosis of narcolepsy to refer to type 1 narcolepsy only. The DSM-5 refers to narcolepsy without cataplexy as hypersomnolence disorder. The most recent edition of the 1172:

Estimates of frequency range from 0.2 per 100,000 in Israel to 600 per 100,000 in Japan. These differences may be due to how the studies were conducted or the populations themselves.

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Narcolepsy is a neurological disorder characterized by excessive daytime sleepiness, cataplexy, hypnagonic hallucinations, sleep paralysis, and disturbed nocturnal sleep patterns.

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replacement for night time sleep. Ongoing communication between the health care provider, person, and their family members is important for optimal management of narcolepsy.

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However, it is important to note that there is a spectrum of symptoms found in this study, including asymptomatic abnormal sleep test findings to significantly symptomatic.

400:. Secondary narcolepsy can occur as a consequence of another neurologic disorder. Secondary narcolepsy can be seen in some individuals with traumatic brain injury, tumors, 514:, and excessive daytime sleepiness. Other symptoms may include automatic behaviors and night-time wakefulness. These symptoms may not occur in all people with narcolepsy. 1756:

Wing, Y.K., Chen, L., Lam, S.P., Li, A.M., Tang, N.L., Ng, M.H., Cheng, S.H., Ho, C.K., Mok, V., Leung, H.W. and Lau, A., 2011. Familial aggregation of narcolepsy.

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Wing, Y.K., Chen, L., Lam, S.P., Li, A.M., Tang, N.L., Ng, M.H., Cheng, S.H., Ho, C.K., Mok, V., Leung, H.W. and Lau, A., 2011. Familial aggregation of narcolepsy.

963:(sprayed through the nose), the latter being low in efficacy, at the low amount used in current experiments but may be effective at very high doses in the future. 910:

The Epworth Sleepiness Scale is a brief questionnaire that is administered to determine the likelihood of the presence of a sleep disorder, including narcolepsy.

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Kelty E, Martyn V, O'Neil G, Hulse G (July 2014). "Use of subcutaneous flumazenil preparations for the treatment of idiopathic hypersomnia: A case report".

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People with narcolepsy can be substantially helped, but not cured currently. However, the technology exists in early form such as experiments in using the

4185: 2846: 733: 2941:(TMN), serotonergic raphe nuclei, cholinergic laterodorsal and pedunculopontine nuclei (LDT and PPT), and the dopaminergic ventral tegmental area (VTA). 601:; children can gain 20 to 40 pounds (9.1 to 18.1 kg) when they first develop narcolepsy; in adults the body-mass index is about 15% above average. 3873: 4651:"Polymorphism located between CPT1B and CHKB, and HLA-DRB1*1501-DQB1*0602 haplotype confer susceptibility to CNS hypersomnias (essential hypersomnia)" 4406: 4388: 2924:

Malenka RC, Nestler EJ, Hyman SE (2009). "Chapter 6: Widely Projecting Systems: Monoamines, Acetylcholine, and Orexin". In Sydor A, Brown RY (eds.).

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Other medications that suppress REM sleep may also be used for the treatment of cataplexy as well as potentially other REM dissociative symptoms.

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The autoimmune process is thought to be triggered in genetically susceptible individuals by an immune provoking experience, such as infection with

3701:"Recommendation for maintenance of orphan designation at the time of marketing authorisation: Wakix (pitolisant) for the treatment of narcolepsy" 1496: 846: 562:

show a regular rhythm. When a person first falls asleep, the brain waves become slower and less regular, which is called non-rapid eye movement (

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The system which regulates sleep, arousal, and transitions between these states in humans is composed of three interconnected subsystems: the

4124: 849:(ICSD-3) differentiates between narcolepsy with cataplexy (type 1) and narcolepsy without cataplexy (type 2), while the fifth edition of the 1018:, which promotes the release of the wakefulness-promoting molecule amine histamine. It was initially available in France, United Kingdom's ( 4106: 4920:

Baker TL, Foutz AS, McNerney V, Mitler MM, Dement WC (March 1982). "Canine model of narcolepsy: genetic and developmental determinants".

4710:"Effects of oral L-carnitine administration in narcolepsy patients: a randomized, double-blind, cross-over and placebo-controlled trial" 3983:

Postiglione E, Antelmi E, Pizza F, Lecendreux M, Dauvilliers Y, Plazzi G (April 2018). "The clinical spectrum of childhood narcolepsy".

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Postiglione, E.; Antelmi, E.; Pizza, F.; Lecendreux, M.; Dauvilliers, Y.; Plazzi, G. The clinical spectrum of childhood narcolepsy.

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Ruoff C, Rye D (October 2016). "The ICSD-3 and DSM-5 guidelines for diagnosing narcolepsy: clinical relevance and practicality".

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is correlated with narcolepsy. Mice whose orexin neurons have been ablated have shown sleep fragmentation, SOREMPs, and obesity.

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IDs rs1154155, rs12587781, and rs1263646). A 2013 review article reported additional but weaker links to the loci of the genes

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The exact cause of narcolepsy is unknown, and it may be caused by several distinct factors. The mechanism involves the loss of

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Common behavioral treatments for childhood narcolepsy include improved sleep hygiene, scheduled naps, and physical exercise.

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treatment, to assess the presence of other sleep disorders like obstructive sleep apnea, and to discuss psychosocial issues.

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more than 110 pg/mL. In addition, the hypersomnolence and sleep latency findings cannot be better explained by other causes.

3019:"REM sleep deprivation during 5 hours leads to an immediate REM sleep rebound and to suppression of non-REM sleep intensity" 857:, ICD-11, currently identifies three types of narcolepsy: type 1 narcolepsy, type 2 narcolepsy, and unspecified narcolepsy. 532: 3210: 810:

systems during REM sleep have been studied in both human and animal models. During normal REM sleep, spinal and brainstem

5400: 5012: 2507: 1246: 566:) sleep. After about an hour and a half of NREM sleep, the brain waves begin to show a more active pattern again, called 4279: 4253: 1225:

medication at a cost of £12,000 a year for 80 people who are taking legal action over problems linked to the use of the

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will be found and developed for the treatment of hypersomnia. One such agent which is currently in clinical trials is

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Iranzo A (2011). "Current Diagnostic Criteria for Adult Narcolepsy". In Baumann CR, Bassetti CL, Scammell TE (eds.).

2933: 2487: 1919: 1536: 1230: 1110:(NRI), which has no addiction liability or recreational effects has been used with variable benefit. Other NRIs like 1107: 4543:

Jacobson LH, Hoyer D, de Lecea L (January 2022). "Hypocretins (orexins): The ultimate translational neuropeptides".

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Guilleminault C, Fromherz S (2005). "Narcolepsy: Diagnosis and Management". In Kryger MH, Roth T, Dement WC (eds.).

5278: 5273: 5245: 3326:"Orexin peptides prevent cataplexy and improve wakefulness in an orexin neuron-ablated model of narcolepsy in mice" 3834: 1576:

Moscovitch, A.; Partinen, M.; Guilleminault, C. The positive diagnosis of narcolepsy and narcolepsy’s borderland.

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The primary genetic factor that has been strongly implicated in the development of narcolepsy involves an area of

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as of September 2016) after being given marketing authorisation by European Commission on the advice of the

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genes such as HLA-DQA1*01:02 have been linked. A 2009 study found a strong association with polymorphisms in the

5089: 3966: 1675: 1212: 774: 4181: 3682: 3234:"The role of cerebrospinal fluid hypocretin measurement in the diagnosis of narcolepsy and other hypersomnias" 2757:

Sarkanen T, Alakuijala A, Julkunen I, Partinen M (June 2018). "Narcolepsy Associated with Pandemrix Vaccine".

5705: 5513: 5375: 3866: 3602:"Living with Narcolepsy: Current Management Strategies, Future Prospects, and Overlooked Real-Life Concerns" 5385: 5313: 5158: 4402: 4380: 1357: 1064: 1027: 781:

and neural tissue, compared to non-narcoleptic individuals. Those with narcolepsy generally experience the

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Zorick FJ, Salis PJ, Roth T, Kramer M (April 1979). "Narcolepsy and automatic behavior: a case report".

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Malenka RC, Nestler EJ, Hyman SE (2009). "Chapter 12: Sleep and Arousal". In Sydor A, Brown RY (eds.).

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hypocretin-1) has been shown to be strongly wake-promoting in animal models, but it does not cross the

448:, twice nightly mixed salts oxybate and once nightly extended release sodium oxybate), and stimulants ( 384:. Proposed pathophysiology as an autoimmune disease suggest antigen presentation by DQ0602 to specific 5596: 5405: 5353: 5328: 1188: 1023: 511: 421: 401: 340:, and specifically impacts REM (rapid eye movement) sleep. The pentad symptoms of narcolepsy include 243: 5835: 5153: 5023: 4874: 3660: 3475:"The alerting effects of short and long naps in narcoleptic, sleep deprived, and alert individuals" 1135: 1075: 1067:

associated with narcolepsy. There are now three formulations of oxybate medications (twice nightly

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Thorpy MJ, Krieger AC (May 2014). "Delayed diagnosis of narcolepsy: characterization and impact".

4120: 460:(SSRIs), and selective norepinephrine reuptake inhibitors (SNRIs) for the treatment of cataplexy. 5693: 5474: 5283: 1349: 669: 642: 574:

occurs. Associated with the EEG-observed waves during REM sleep, muscle atonia is present called

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Narcolepsy can occur in both men and women at any age, although typical symptom onset occurs in

5830: 5789: 5338: 5173: 1697: 369: 259: 234: 5063: 3867:"FDA Approval Letter for Xyrem; Indication: Cataplexy associated with narcolepsy; 17 Jul 2002" 3721: 3232:

Mignot E, Lammers GJ, Ripley B, Okun M, Nevsimalova S, Overeem S, et al. (October 2002).

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Miyagawa T, Miyadera H, Tanaka S, Kawashima M, Shimada M, Honda Y, et al. (March 2011).

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Luo G, Ambati A, Lin L, Bonvalet M, Partinen M, Ji X, Maecker HT, Mignot EJ (December 2018).

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with part of the hypocretin peptide, the loss of which is associated with type I narcolepsy.

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Miyagawa T, Honda M, Kawashima M, Shimada M, Tanaka S, Honda Y, Tokunaga K (30 April 2009).

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Kim H, Ayele GM, Atalay RT, Hussien S, Tewoldemedhin B, Michael MB, Scharf SM (July 2022).

1118:

have also been used in the treatment of narcolepsy. Additional related medications include

833:

involved in this pathway. In narcolepsy, the reflex inhibition of the motor system seen in

766: 654: 614: 502:

The classic symptoms of the disorder, often referred to as the "tetrad of narcolepsy", are

2051: 2044: 1356:, has been found to interact indirectly with the orexin system. It is also likely that an 1001:. In late 2007, an alert for severe adverse skin reactions to modafinil was issued by the 8: 5815: 5760: 5750: 5216: 5116: 5001: 1229:

swine flu vaccine. Sodium oxybate is not available to people with narcolepsy through the

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showing sleep latency of less than 8 minutes and two or more SOREMPs. For a diagnosis of

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antagonist-like effect, not its antibiotic effects, and treatment must be maintained."

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Miyagawa T, Kawamura H, Obuchi M, Ikesaki A, Ozaki A, Tokunaga K, et al. (2013).

3410: 3352: 3325: 2636: 2619: 870:

concentration of less than 110 pg/mL, REM sleep latency of less than 15 minutes, or a

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Holm A, Lin L, Faraco J, Mostafavi S, Battle A, Zhu X, et al. (November 2015).

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Nevsimalova S (August 2014). "The diagnosis and treatment of pediatric narcolepsy".

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Kantor S, Mochizuki T, Lops SN, Ko B, Clain E, Clark E, et al. (August 2013).

3245: 3174: 3164: 3087: 3053: 3033: 2979: 2969: 2893: 2885: 2774: 2766: 2729: 2721: 2680: 2672: 2631: 2587: 2540: 2438: 2430: 2372: 2364: 2314: 2276: 2225: 2184: 2176: 2133: 2014: 2006: 1956: 1948: 1814: 1804: 1640: 1630: 1304: 830: 389: 337: 80: 4875:"Hypocretin (orexin) biology and the pathophysiology of narcolepsy with cataplexy" 3091: 2850: 2811:"The MPA investigates reports of narcolepsy in patients vaccinated with Pandemrix" 2212:

Barateau, Lucie; Pizza, Fabio; Plazzi, Giuseppe; Dauvilliers, Yves (August 2022).

1488: 5646: 5573: 5551: 5498: 5258: 5163: 5028: 4734: 4675: 4306: 3449: 1336: 1152:, may also be used to counteract sleepiness. Medications such as sodium oxybate, 1038: 922: 888: 875: 822: 786: 725: 507: 449: 377: 349: 298: 177: 4159: 3397:

Dauvilliers Y, Arnulf I, Mignot E (February 2007). "Narcolepsy with cataplexy".

3250: 3233: 2843:"Terveyden ja hyvinvoinnin laitos suosittaa Pandemrix-rokotusten keskeyttämistä" 2591: 444:, armodafinil, pitolisant and solriamfetol), Oxybate medications (twice nightly 404:

or other diseases affecting the parts of the brain that regulate wakefulness or

5720: 5591: 5533: 5236: 5136: 5109: 3996: 3904: 3330:

Proceedings of the National Academy of Sciences of the United States of America

3202: 3004: 2676: 2434: 2368: 2010: 1789:

Proceedings of the National Academy of Sciences of the United States of America

1324: 1320: 1283: 1250: 1222: 1145: 1068: 1052: 900: 807: 445: 433: 413: 397: 310: 290: 255: 137: 5039: 4991: 4511: 4271: 4245: 3946: 3752: 2770: 2544: 2318: 1785:"Autoimmunity to hypocretin and molecular mimicry to flu in type 1 narcolepsy" 732:

and narcolepsy has been found in both children and adults. In 2010, Finland's

668:

was reported in more than 90% of people with narcolepsy, and alleles of other

5809: 5698: 5546: 5503: 5453: 5448: 5221: 4617: 4461: 4349: 3568: 3491: 3474: 3324:

Mieda M, Willie JT, Hara J, Sinton CM, Sakurai T, Yanagisawa M (March 2004).

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Gottlieb, B.H. and Bergen, A.E., 2010. Social support concepts and measures.

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and may occur independent of or in combination with an inability to move (

361: 4941: 4496:"A practical guide to the therapy of narcolepsy and hypersomnia syndromes" 3500: 3473:

Helmus T, Rosenthal L, Bishop C, Roehrs T, Syron ML, Roth T (April 1997).

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Klein J, Sato A (September 2000). "The HLA system. Second of two parts".

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can be used, but are commonly considered second or third line therapy.

1042: 990: 952: 818: 685: 646: 598: 591: 492: 417: 302: 239: 211: 3618: 2779: 2725: 5784: 5730: 5710: 5508: 5484: 5415: 5226: 5196: 5191: 5181: 4556: 3291: 3169: 2974: 1287: 1157: 1123: 1115: 1111: 1083: 1011: 994: 960: 697: 673: 587: 575: 294: 281: 51: 4974: 3140:(5th ed.). Arlington, Virginia: American Psychiatric Association. 2912:

The analgesic properties of orexin peptides have been well-established

2889: 2482:(2nd ed.). New York: McGraw-Hill Medical. pp. 294–296, 303. 2229: 5794: 5745: 5740: 5606: 5568: 5305: 5211: 5201: 5186: 5069: 1907: 1567:, 3rd ed.; American Academy of Sleep Medicine: Darien, CT, USA, 2014. 1353: 1226: 1060: 986: 834: 799: 782: 729: 567: 503: 452:

and amphetamines). There is also the use of antidepressants, such as

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Mouse models have also been used to test whether the lack of orexin

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other possible sleep disorders that could cause daytime sleepiness.

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Molecular Neuropharmacology: A Foundation for Clinical Neuroscience

2480:

Molecular Neuropharmacology: A Foundation for Clinical Neuroscience

1993:

Wise MS, Arand DL, Auger RR, Brooks SN, Watson NF (December 2007).

1341: 1184: 1119: 1094:(SSRIs), and selective norepinephrine reuptake inhibitors (SNRIs) ( 1031: 665: 554: 520: 60: 4602:"Abnormally low serum acylcarnitine levels in narcolepsy patients" 2756: 2620:"A commentary on the neurobiology of the hypocretin/orexin system" 1995:"Treatment of narcolepsy and other hypersomnias of central origin" 5688: 5683: 5678: 5673: 5656: 5561: 5395: 5295: 5253: 5206: 3982: 1415: 1360: 365: 30:

This article is about the medical condition. For other uses, see

5017: 4239: 4237: 4182:"DH funds private prescriptions for drug denied to NHS patients" 4018:

Peterson PC, Husain AM (November 2008). "Pediatric narcolepsy".

3135: 5755: 5641: 4986: 4599: 4329: 3739:

Syed YY (September 2016). "Pitolisant: First Global Approval".

2416: 1934: 1423: 789:, which lasts for about the first hour or so of a sleep cycle. 762: 713: 689: 681: 661: 650: 610: 425: 247: 203: 2211: 5651: 5469: 5132: 4872: 4707: 4648: 4234: 3828: 3826: 3791:"Narcolepsy: current treatment options and future approaches" 3003:

Text was copied from this source, which is available under a

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Primary Care Companion to the Journal of Clinical Psychiatry

4873:

Liblau RS, Vassalli A, Seifinejad A, Tafti M (March 2015).

4774:"Etiopathogenesis and neurobiology of narcolepsy: a review" 3599: 3472: 2417:

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may be prescribed if the child presents with cataplexy.

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National Institute of Health and Care Excellence (NICE)

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was previously used but was withdrawn due to toxicity.

4292: 3377:"OX2R Agonists for the Treatment of Narcolepsy Type I" 3005:

Creative Commons Attribution 4.0 International License

2707: 4542: 4395: 4269: 4246:"Flumazenil for the Treatment of Primary Hypersomnia" 4243: 4060: 3442:

Narcolepsy: Pathophysiology, Diagnosis, and Treatment

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Diagnostic and Statistical Manual of Mental Disorders

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and then in the United States by the approval of the

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Diagnostic and Statistical Manual of Mental Disorders

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has features normally seen only in normal REM sleep.

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via an inhibitory descending reticulospinal pathway.

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Electroencephalography and Clinical Neurophysiology

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United States Food and Drug Administration. 3557:Therapeutic Advances in Neurological Disorders 3151:Akintomide GS, Rickards H (8 September 2011). 2126: 1666: 1664: 67:of narcoleptic individuals is usually very low 5131: 5117: 4701: 4642: 4593: 4145: 3644: 3553:"Recent advances in treatment for narcolepsy" 2951: 2949: 1778: 1776: 1774: 1772: 1770: 4831: 4536: 4276:Emory University – Georgia Research Alliance 4250:Emory University – Georgia Research Alliance 3775: 3195: 2871: 2571: 2350: 1269: 1245:. The French term was first used in 1880 by 947:) or hypocretin replacement, in the form of 753:Orexin, otherwise known as hypocretin, is a 700:that has been associated with narcolepsy is 4778:Journal of Clinical and Diagnostic Research 4771: 4484: 4286: 4121:"Link Between Narcolepsy and Mental Health" 3650: 2659:Singh AK, Mahlios J, Mignot E (June 2013). 2304: 2267:Scammell TE (December 2015). "Narcolepsy". 1988: 1986: 1984: 1982: 1980: 1661: 1610: 1352:. The first line treatment for narcolepsy, 1330: 1098:) are used for the treatment of cataplexy. 5439:Rapid eye movement sleep behavior disorder 5124: 5110: 4205: 4203: 3925: 3123:"International Classification of Diseases" 2946: 2917: 2759:Current Neurology and Neuroscience Reports 2346: 2344: 2307:Current Neurology and Neuroscience Reports 1767: 1483: 1481: 1479: 1477: 1475: 1473: 1471: 1469: 1467: 1465: 1463: 1217:In 2015, it was reported that the British 50: 4849: 4797: 4767: 4765: 4763: 4743: 4733: 4684: 4674: 4625: 4519: 4063:Principles and Practice of Sleep Medicine 3919: 3806: 3627: 3617: 3576: 3546: 3544: 3490: 3351: 3341: 3300: 3290: 3249: 3178: 3168: 3136:American Psychiatric Association (2013). 2983: 2973: 2897: 2778: 2733: 2684: 2635: 2613: 2611: 2609: 2577: 2442: 2376: 2188: 2165:"Narcolepsy presenting as pseudoseizures" 2018: 1960: 1818: 1808: 1644: 1634: 1520: 1518: 1516: 1514: 1461: 1459: 1457: 1455: 1453: 1451: 1449: 1447: 1445: 1443: 1241:The term "narcolepsy" is from the French 899:. These tests are usually performed by a 792: 4184:. 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Archived from 2351:Sehgal A, Mignot E (July 2011). 1409: 1387: 1037:Traditional stimulants, such as 273:Medication, regular short naps, 79: 5434:Periodic limb movement disorder 5401:Non-24-hour sleep–wake disorder 4218:. Online Etymology Dictionary. 4174: 4139: 4054: 4011: 3976: 3883: 3859: 3732: 3714: 3693: 3675: 3593: 3507: 3466: 3433: 3390: 3368: 3317: 3266: 3225: 3144: 3129: 3114: 2878:British Journal of Pharmacology 2835: 2816:Swedish Medical Products Agency 2803: 2750: 2652: 2500: 2423:Current Opinion in Neurobiology 2205: 2156: 2099: 2068: 1928: 1835: 1750: 1733: 1495:. NIH Publication No. 03-1637. 1167: 1063:associated with narcolepsy and 1030:(FDA) as of August 2019. 806:. The changes in the motor and 712:Type 1 narcolepsy is caused by 538:Periods of wakefulness at night 4295:Science Translational Medicine 4071:10.1016/B0-72-160797-7/50072-0 4032:10.1016/j.braindev.2008.02.004 3444:. Springer. pp. 369–381. 3375:Hartman D (14 November 2019). 3207:Stanford Center for Narcolepsy 2138:Stanford Center for Narcolepsy 1715: 1590: 1570: 1557: 1419:excessive daytime sleepiness. 1370: 1247:Jean-Baptiste-Édouard Gélineau 1213:List of people with narcolepsy 979: 897:Epworth Sleepiness Scale (ESS) 802:with little or no intervening 775:ventrolateral preoptic nucleus 613:-releasing neurons within the 158:sudden loss of muscle strength 156:, involuntary sleep episodes, 13: 1: 5706:Biphasic and polyphasic sleep 5514:Nocturnal clitoral tumescence 5376:Advanced sleep phase disorder 5090:"Narcolepsy Information Page" 4891:10.1016/S1474-4422(14)70218-2 4450:Journal of Psychopharmacology 4338:Journal of Psychopharmacology 3411:10.1016/S0140-6736(07)60237-2 3092:10.1080/03007995.2016.1208643 2637:10.1016/S0893-133X(01)00316-5 2075:Cunha JP. Shiel WC Jr (ed.). 1672:"Narcolepsy Information Page" 1433: 1400: 1380:activity." Administration of 1293: 966: 914:than non-narcoleptic people. 5386:Delayed sleep phase disorder 5314:Excessive daytime sleepiness 4934:10.1016/0014-4886(82)90038-3 4735:10.1371/journal.pone.0053707 4676:10.1371/journal.pone.0005394 4545:Journal of Internal Medicine 4307:10.1126/scitranslmed.3004685 3941:(S1): 25–33, quiz 25–7, 34. 3450:10.1007/978-1-4419-8390-9_34 3203:"Narcolepsy Research – FAQs" 3038:10.1016/0013-4694(90)90209-3 2046:Principles of Neural Science 1528:Narcolepsy: A Clinical Guide 1065:excessive daytime sleepiness 1028:Food and Drug Administration 928: 840: 485:excessive daytime sleepiness 342:excessive daytime sleepiness 216:Family history, brain injury 154:Excessive daytime sleepiness 7: 5519:Nocturnal penile tumescence 5391:Irregular sleep–wake rhythm 4790:10.7860/JCDR/2014/7295.4057 4379:Beck M (10 December 2012). 4160:10.1016/j.sleep.2014.01.015 3653:"Pitolisant / Wakix Update" 3606:Nature and Science of Sleep 3251:10.1001/archneur.59.10.1553 2962:Nature and Science of Sleep 2592:10.1056/NEJM200009143431106 1698:"Narcolepsy with cataplexy" 1298:Flumazenil is the only GABA 1264: 1129: 955:(injected into the veins), 771:reticular activating system 632: 32:Narcolepsy (disambiguation) 10: 5852: 5381:Cyclic alternating pattern 4494:Mignot EJ (October 2012). 3997:10.1016/j.smrv.2017.04.003 3905:10.1016/j.smrv.2011.09.001 2677:10.1016/j.jaut.2013.02.003 2618:Mignot E (November 2001). 2435:10.1016/j.conb.2013.04.013 2369:10.1016/j.cell.2011.07.004 1334: 1210: 1133: 653:-releasing neurons in the 226:Based on the symptoms and 29: 5821:Ailments of unknown cause 5624: 5597:Behavioral sleep medicine 5584: 5532: 5462: 5414: 5406:Shift work sleep disorder 5362: 5354:Sleep state misperception 5304: 5244: 5235: 5172: 5143: 5049: 4968: 4512:10.1007/s13311-012-0150-9 3947:10.1017/S1092852914000583 3835:"XYREM® (sodium oxybate)" 3753:10.1007/s40265-016-0620-1 3708:European Medicines Agency 3687:European Medicines Agency 3651:O'Neill M (23 May 2016). 2771:10.1007/s11910-018-0851-5 2545:10.1038/nature.2013.14413 2319:10.1007/s11910-014-0469-1 2218:Journal of Sleep Research 1375:Abnormally low levels of 1270:GABA-directed medications 1076:Tricyclic antidepressants 1024:European Medicines Agency 861:either cataplexy, a mean 845:The third edition of the 817:produces almost complete 604: 512:hypnagogic hallucinations 454:Tricyclic antidepressants 422:major depressive disorder 316: 280: 269: 244:major depressive disorder 233: 220: 210: 199: 191: 183: 167: 147: 131: 71: 58: 49: 44: 5154:Rapid eye movement (REM) 4462:10.1177/0269881113515062 4350:10.1177/0269881114523865 3789:Billiard M (June 2008). 3569:10.1177/1756286419875622 2011:10.1093/sleep/30.12.1712 1331:Orexin receptor agonists 1136:Narcolepsy in Pediatrics 881: 876:hypersomnolence disorder 617:(about 70,000 neurons). 466:motor vehicle collisions 174:Motor vehicle collisions 5475:Exploding head syndrome 5284:Obstructive sleep apnea 4385:The Wall Street Journal 4020:Brain & Development 3343:10.1073/pnas.0400590101 2665:Journal of Autoimmunity 2624:Neuropsychopharmacology 2533:"Narcolepsy Fact Sheet" 2181:10.4088/PCC.09l00793whi 1810:10.1073/pnas.1818150116 1702:Autoimmune Registry Inc 1674:. NINDS. Archived from 1489:"Narcolepsy Fact Sheet" 1236: 1231:National Health Service 1055:, also known as sodium 643:human leukocyte antigen 5790:Sleeping while on duty 5339:Idiopathic hypersomnia 4922:Experimental Neurology 4618:10.1093/sleep/34.3.349 4278:. ClinicalTrials.gov. 4252:. ClinicalTrials.gov. 3985:Sleep Medicine Reviews 3893:Sleep Medicine Reviews 3492:10.1093/sleep/20.4.251 3153:"Narcolepsy: a review" 2956:Chow M, Cao M (2016). 1953:10.1093/sleep/30.7.844 1319:In a test tube model, 1059:(GHB) can be used for 793:Disturbed sleep states 320:0.2 to 600 per 100,000 260:idiopathic hypersomnia 235:Differential diagnosis 5612:Neuroscience of sleep 5344:Night eating syndrome 5329:Kleine–Levin syndrome 4879:The Lancet. Neurology 3519:Postmarketing Reviews 3238:Archives of Neurology 2281:10.1056/NEJMra1500587 1795:(52): E12323–E12332. 1724:Nature communications 1193:recreational drug use 1057:gamma-hydroxybutyrate 889:polysomnography (PSG) 765:projections from the 696:(rs2305795). Another 402:Prader–Willi syndrome 344:(EDS), sleep related 334:neurological disorder 63:neuropeptides in the 59:The concentration of 5766:Sleep and creativity 4838:Comparative Medicine 4405:. Emory University. 4403:"Hypersomnia Update" 3563:: 1756286419875622. 1636:10.7759/cureus.27287 1261:) meaning "attack". 1219:Department of Health 767:lateral hypothalamus 728:'s H1N1 flu vaccine 655:lateral hypothalamus 615:lateral hypothalamus 27:Human sleep disorder 5761:Sleep and breathing 5217:Sensorimotor rhythm 4726:2013PLoSO...853707M 4667:2009PLoSO...4.5394M 3689:. 20 November 2015. 3619:10.2147/NSS.S162762 2726:10.1038/ejhg.2015.4 1801:2018PNAS..11512323L 1350:blood–brain barrier 1207:Society and culture 919:cerebrospinal fluid 779:cerebrospinal fluid 382:autoimmune disorder 65:cerebrospinal fluid 5771:Sleep and learning 5524:Nocturnal emission 5424:Nightmare disorder 5289:Periodic breathing 5050:External resources 4557:10.1111/joim.13406 3292:10.5665/sleep.2870 3170:10.2147/ndt.s23624 2975:10.2147/NSS.S76711 2819:. 18 August 2010. 2630:(5 Suppl): S5–13. 2163:Dunham CK (2010). 2134:"About Narcolepsy" 1912:Palgrave Macmillan 1382:acetyl-L-carnitine 934:Orexin replacement 829:may be one of the 812:alpha motor neuron 688:(rs34593439), and 599:gain excess weight 479:Signs and symptoms 5803: 5802: 5781:Sleep deprivation 5620: 5619: 5084: 5083: 4500:Neurotherapeutics 4301:(161): 161ra151. 4210:Harper D (2010). 4080:978-0-7216-0797-9 3747:(13): 1313–1318. 3459:978-1-4419-8390-9 3405:(9560): 499–511. 3086:(10): 1611–1622. 2890:10.1111/bph.12415 2230:10.1111/jsr.13631 2061:978-0-8385-7701-1 1764:(10), pp.947-951. 1747:(10), pp.947-951. 1678:on 7 January 2017 1047:dextroamphetamine 831:neurotransmitters 815:hyperpolarization 738:molecular mimicry 714:hypocretin/orexin 597:Narcoleptics can 338:sleep–wake cycles 324: 323: 264:Sleep deprivation 222:Diagnostic method 39:Medical condition 16:(Redirected from 5843: 5776:Sleep and memory 5716:Circadian rhythm 5463:Benign phenomena 5365:Circadian rhythm 5242: 5241: 5126: 5119: 5112: 5103: 5102: 5093: 4966: 4965: 4954: 4953: 4917: 4911: 4910: 4870: 4864: 4863: 4853: 4829: 4812: 4811: 4801: 4769: 4758: 4757: 4747: 4737: 4705: 4699: 4698: 4688: 4678: 4646: 4640: 4639: 4629: 4597: 4591: 4590: 4583: 4577: 4576: 4540: 4534: 4533: 4523: 4491: 4482: 4481: 4444: 4438: 4437: 4425: 4419: 4418: 4416: 4414: 4399: 4393: 4392: 4376: 4370: 4369: 4333: 4327: 4326: 4290: 4284: 4283: 4267: 4258: 4257: 4241: 4232: 4231: 4229: 4227: 4207: 4198: 4197: 4195: 4193: 4178: 4172: 4171: 4143: 4137: 4136: 4134: 4132: 4117: 4111: 4110: 4099: 4093: 4092: 4058: 4052: 4051: 4015: 4009: 4008: 3980: 3974: 3973: 3971: 3965:. Archived from 3932: 3923: 3917: 3916: 3887: 3881: 3880: 3878: 3871: 3863: 3857: 3856: 3854: 3852: 3846: 3839: 3830: 3821: 3820: 3810: 3786: 3773: 3772: 3736: 3730: 3729: 3728:. 14 March 2017. 3718: 3712: 3711: 3710:. 19 April 2016. 3705: 3697: 3691: 3690: 3679: 3673: 3672: 3670: 3668: 3659:. Archived from 3648: 3642: 3641: 3631: 3621: 3597: 3591: 3590: 3580: 3548: 3539: 3538: 3536: 3534: 3525:(1). Fall 2007. 3511: 3505: 3504: 3494: 3470: 3464: 3463: 3437: 3431: 3430: 3394: 3388: 3387: 3381: 3372: 3366: 3365: 3355: 3345: 3321: 3315: 3314: 3304: 3294: 3270: 3264: 3263: 3253: 3229: 3223: 3222: 3220: 3218: 3199: 3193: 3192: 3182: 3172: 3148: 3142: 3141: 3133: 3127: 3126: 3125:(11th ed.). 3118: 3112: 3111: 3075: 3058: 3057: 3023: 3014: 3008: 3002: 2997: 2987: 2977: 2953: 2944: 2943: 2921: 2915: 2914: 2901: 2869: 2863: 2862: 2860: 2858: 2839: 2833: 2832: 2830: 2828: 2807: 2801: 2800: 2782: 2754: 2748: 2747: 2737: 2705: 2699: 2698: 2688: 2656: 2650: 2649: 2639: 2615: 2604: 2603: 2575: 2569: 2568: 2566: 2564: 2529: 2523: 2522: 2520: 2518: 2504: 2498: 2497: 2475: 2460: 2459: 2446: 2414: 2391: 2390: 2380: 2348: 2339: 2338: 2302: 2293: 2292: 2264: 2258: 2257: 2209: 2203: 2202: 2192: 2160: 2154: 2153: 2151: 2149: 2130: 2124: 2123: 2103: 2097: 2096: 2094: 2092: 2072: 2066: 2065: 2049: 2039: 2033: 2032: 2022: 1990: 1975: 1974: 1964: 1932: 1926: 1925: 1898:Green S (2011). 1895: 1878: 1877: 1875: 1873: 1859: 1850: 1849:(5), pp.511-520. 1839: 1833: 1832: 1822: 1812: 1780: 1765: 1754: 1748: 1737: 1731: 1719: 1713: 1712: 1710: 1708: 1694: 1688: 1687: 1685: 1683: 1668: 1659: 1658: 1648: 1638: 1614: 1608: 1594: 1588: 1574: 1568: 1561: 1555: 1554: 1552: 1550: 1522: 1509: 1508: 1506: 1504: 1485: 1347: 901:sleep specialist 823:skeletal muscles 123: 122: 119: 118: 115: 112: 109: 106: 103: 100: 97: 94: 91: 88: 85: 54: 42: 41: 21: 5851: 5850: 5846: 5845: 5844: 5842: 5841: 5840: 5836:Sleep disorders 5806: 5805: 5804: 5799: 5694:Procrastination 5647:Four-poster bed 5616: 5580: 5574:Polysomnography 5552:Sleep induction 5528: 5499:Sleep paralysis 5458: 5410: 5369: 5366: 5358: 5300: 5259:Mouth breathing 5237:Sleep disorders 5231: 5168: 5159:Quiescent sleep 5139: 5137:sleep disorders 5130: 5088: 5085: 5080: 5079: 5045: 5044: 4977: 4963: 4958: 4957: 4918: 4914: 4871: 4867: 4830: 4815: 4770: 4761: 4706: 4702: 4647: 4643: 4598: 4594: 4585: 4584: 4580: 4541: 4537: 4492: 4485: 4445: 4441: 4426: 4422: 4412: 4410: 4401: 4400: 4396: 4377: 4373: 4334: 4330: 4291: 4287: 4268: 4261: 4242: 4235: 4225: 4223: 4208: 4201: 4191: 4189: 4180: 4179: 4175: 4144: 4140: 4130: 4128: 4119: 4118: 4114: 4101: 4100: 4096: 4081: 4059: 4055: 4016: 4012: 3981: 3977: 3972:on 9 July 2020. 3969: 3930: 3924: 3920: 3888: 3884: 3876: 3869: 3865: 3864: 3860: 3850: 3848: 3844: 3837: 3831: 3824: 3787: 3776: 3737: 3733: 3720: 3719: 3715: 3703: 3699: 3698: 3694: 3681: 3680: 3676: 3666: 3664: 3649: 3645: 3598: 3594: 3549: 3542: 3532: 3530: 3513: 3512: 3508: 3471: 3467: 3460: 3438: 3434: 3395: 3391: 3379: 3373: 3369: 3336:(13): 4649–54. 3322: 3318: 3271: 3267: 3244:(10): 1553–62. 3230: 3226: 3216: 3214: 3201: 3200: 3196: 3149: 3145: 3134: 3130: 3119: 3115: 3076: 3061: 3021: 3015: 3011: 2954: 2947: 2936: 2922: 2918: 2870: 2866: 2856: 2854: 2853:on 20 July 2011 2841: 2840: 2836: 2826: 2824: 2809: 2808: 2804: 2755: 2751: 2720:(11): 1573–80. 2706: 2702: 2657: 2653: 2616: 2607: 2576: 2572: 2562: 2560: 2531: 2530: 2526: 2516: 2514: 2506: 2505: 2501: 2490: 2476: 2463: 2415: 2394: 2349: 2342: 2303: 2296: 2275:(27): 2654–62. 2265: 2261: 2210: 2206: 2161: 2157: 2147: 2145: 2132: 2131: 2127: 2104: 2100: 2090: 2088: 2073: 2069: 2062: 2040: 2036: 2005:(12): 1712–27. 1991: 1978: 1933: 1929: 1922: 1896: 1881: 1871: 1869: 1861: 1860: 1853: 1840: 1836: 1781: 1768: 1755: 1751: 1738: 1734: 1720: 1716: 1706: 1704: 1696: 1695: 1691: 1681: 1679: 1670: 1669: 1662: 1615: 1611: 1598:Sleep Med. Rev. 1595: 1591: 1575: 1571: 1562: 1558: 1548: 1546: 1539: 1523: 1512: 1502: 1500: 1487: 1486: 1441: 1436: 1412: 1403: 1390: 1373: 1358:orexin receptor 1339: 1337:Orexin receptor 1333: 1317: 1308: 1301: 1296: 1280: 1272: 1267: 1249:, who used the 1239: 1221:was paying for 1215: 1209: 1170: 1138: 1132: 1039:methylphenidate 982: 969: 936: 931: 884: 843: 795: 787:slow-wave sleep 751: 749:Loss of neurons 746: 744:Pathophysiology 726:GlaxoSmithKline 724:A link between 710: 635: 607: 527:, surprise, or 508:sleep paralysis 481: 450:methylphenidate 432:, and drinking 414:sleep disorders 378:sleep paralysis 350:sleep paralysis 311:antidepressants 299:methylphenidate 127: 82: 78: 40: 35: 28: 23: 22: 15: 12: 11: 5: 5849: 5839: 5838: 5833: 5828: 5823: 5818: 5801: 5800: 5798: 5797: 5792: 5787: 5778: 5773: 5768: 5763: 5758: 5753: 5748: 5743: 5738: 5733: 5728: 5723: 5721:Comfort object 5718: 5713: 5708: 5703: 5702: 5701: 5696: 5686: 5681: 5676: 5671: 5670: 5669: 5664: 5659: 5654: 5649: 5644: 5639: 5628: 5626: 5622: 5621: 5618: 5617: 5615: 5614: 5609: 5604: 5599: 5594: 5592:Sleep medicine 5588: 5586: 5582: 5581: 5579: 5578: 5577: 5576: 5566: 5565: 5564: 5559: 5549: 5544: 5538: 5536: 5530: 5529: 5527: 5526: 5521: 5516: 5511: 5506: 5501: 5496: 5491: 5482: 5477: 5472: 5466: 5464: 5460: 5459: 5457: 5456: 5451: 5446: 5441: 5436: 5431: 5426: 5420: 5418: 5412: 5411: 5409: 5408: 5403: 5398: 5393: 5388: 5383: 5378: 5372: 5370: 5363: 5360: 5359: 5357: 5356: 5351: 5346: 5341: 5336: 5331: 5326: 5321: 5316: 5310: 5308: 5302: 5301: 5299: 5298: 5293: 5292: 5291: 5286: 5281: 5276: 5271: 5261: 5256: 5250: 5248: 5239: 5233: 5232: 5230: 5229: 5224: 5219: 5214: 5209: 5204: 5199: 5194: 5189: 5184: 5178: 5176: 5170: 5169: 5167: 5166: 5161: 5156: 5150: 5148: 5141: 5140: 5129: 5128: 5121: 5114: 5106: 5100: 5099: 5094: 5082: 5081: 5078: 5077: 5066: 5054: 5053: 5051: 5047: 5046: 5043: 5042: 5031: 5020: 5009: 4994: 4978: 4973: 4972: 4970: 4969:Classification 4962: 4961:External links 4959: 4956: 4955: 4928:(3): 729–742. 4912: 4865: 4813: 4784:(2): 190–195. 4759: 4700: 4641: 4612:(3): 349–53A. 4592: 4578: 4551:(5): 533–556. 4535: 4506:(4): 739–752. 4483: 4456:(7): 697–702. 4439: 4420: 4394: 4371: 4344:(7): 703–706. 4328: 4285: 4259: 4233: 4216:Dictionary.com 4199: 4173: 4154:(5): 502–507. 4148:Sleep Medicine 4138: 4112: 4094: 4079: 4053: 4026:(10): 609–23. 4010: 3975: 3918: 3899:(5): 431–443. 3882: 3858: 3822: 3801:(3): 557–566. 3774: 3731: 3713: 3692: 3674: 3663:on 7 July 2020 3643: 3592: 3540: 3506: 3465: 3458: 3432: 3389: 3367: 3316: 3285:(8): 1129–38. 3265: 3224: 3194: 3143: 3128: 3113: 3059: 3009: 2945: 2934: 2916: 2864: 2834: 2802: 2749: 2700: 2651: 2605: 2570: 2524: 2499: 2488: 2461: 2392: 2363:(2): 194–207. 2340: 2294: 2259: 2204: 2155: 2125: 2114:(4): 194–197. 2098: 2067: 2060: 2034: 1976: 1927: 1920: 1879: 1851: 1834: 1766: 1758:Sleep medicine 1749: 1741:Sleep medicine 1732: 1714: 1689: 1660: 1609: 1589: 1569: 1556: 1537: 1510: 1438: 1437: 1435: 1432: 1411: 1408: 1402: 1399: 1389: 1386: 1372: 1369: 1332: 1329: 1325:benzodiazepine 1321:clarithromycin 1316: 1315:Clarithromycin 1313: 1306: 1299: 1295: 1292: 1284:clarithromycin 1278: 1271: 1268: 1266: 1263: 1238: 1235: 1223:sodium oxybate 1208: 1205: 1169: 1166: 1146:sodium oxybate 1131: 1128: 1069:sodium oxybate 1053:Sodium oxybate 1016:H3 antagonists 981: 978: 968: 965: 957:intracisternal 935: 932: 930: 927: 883: 880: 842: 839: 808:proprioceptive 794: 791: 750: 747: 745: 742: 709: 708:H1N1 influenza 706: 634: 631: 606: 603: 588:falling asleep 547: 546: 542: 539: 536: 480: 477: 446:sodium oxybate 398:H1N1 influenza 346:hallucinations 322: 321: 318: 314: 313: 291:sodium oxybate 284: 278: 277: 271: 267: 266: 237: 231: 230: 224: 218: 217: 214: 208: 207: 201: 197: 196: 193: 189: 188: 185: 181: 180: 171: 165: 164: 162:hallucinations 151: 145: 144: 138:Sleep medicine 135: 129: 128: 126: 125: 75: 73: 69: 68: 56: 55: 47: 46: 38: 26: 9: 6: 4: 3: 2: 5848: 5837: 5834: 5832: 5831:Rare diseases 5829: 5827: 5824: 5822: 5819: 5817: 5814: 5813: 5811: 5796: 5793: 5791: 5788: 5786: 5782: 5779: 5777: 5774: 5772: 5769: 5767: 5764: 5762: 5759: 5757: 5754: 5752: 5749: 5747: 5744: 5742: 5739: 5737: 5734: 5732: 5729: 5727: 5724: 5722: 5719: 5717: 5714: 5712: 5709: 5707: 5704: 5700: 5697: 5695: 5692: 5691: 5690: 5687: 5685: 5682: 5680: 5677: 5675: 5672: 5668: 5665: 5663: 5660: 5658: 5655: 5653: 5650: 5648: 5645: 5643: 5640: 5638: 5635: 5634: 5633: 5630: 5629: 5627: 5623: 5613: 5610: 5608: 5605: 5603: 5600: 5598: 5595: 5593: 5590: 5589: 5587: 5583: 5575: 5572: 5571: 5570: 5567: 5563: 5560: 5558: 5555: 5554: 5553: 5550: 5548: 5547:Sleep hygiene 5545: 5543: 5540: 5539: 5537: 5535: 5531: 5525: 5522: 5520: 5517: 5515: 5512: 5510: 5507: 5505: 5504:Sleep inertia 5502: 5500: 5497: 5495: 5492: 5490: 5486: 5483: 5481: 5478: 5476: 5473: 5471: 5468: 5467: 5465: 5461: 5455: 5454:Sleep-talking 5452: 5450: 5449:Sleep driving 5447: 5445: 5442: 5440: 5437: 5435: 5432: 5430: 5427: 5425: 5422: 5421: 5419: 5417: 5413: 5407: 5404: 5402: 5399: 5397: 5394: 5392: 5389: 5387: 5384: 5382: 5379: 5377: 5374: 5373: 5371: 5368: 5361: 5355: 5352: 5350: 5347: 5345: 5342: 5340: 5337: 5335: 5332: 5330: 5327: 5325: 5322: 5320: 5317: 5315: 5312: 5311: 5309: 5307: 5303: 5297: 5294: 5290: 5287: 5285: 5282: 5280: 5277: 5275: 5272: 5270: 5267: 5266: 5265: 5262: 5260: 5257: 5255: 5252: 5251: 5249: 5247: 5243: 5240: 5238: 5234: 5228: 5225: 5223: 5222:Sleep spindle 5220: 5218: 5215: 5213: 5210: 5208: 5205: 5203: 5200: 5198: 5195: 5193: 5190: 5188: 5185: 5183: 5180: 5179: 5177: 5175: 5171: 5165: 5162: 5160: 5157: 5155: 5152: 5151: 5149: 5147: 5142: 5138: 5134: 5127: 5122: 5120: 5115: 5113: 5108: 5107: 5104: 5098: 5095: 5091: 5087: 5086: 5076: 5072: 5071: 5067: 5065: 5061: 5060: 5056: 5055: 5052: 5048: 5041: 5037: 5036: 5032: 5030: 5026: 5025: 5021: 5019: 5015: 5014: 5010: 5008: 5004: 5003: 4999: 4995: 4993: 4989: 4988: 4984: 4980: 4979: 4976: 4971: 4967: 4951: 4947: 4943: 4939: 4935: 4931: 4927: 4923: 4916: 4908: 4904: 4900: 4896: 4892: 4888: 4885:(3): 318–28. 4884: 4880: 4876: 4869: 4861: 4857: 4852: 4847: 4844:(2): 91–104. 4843: 4839: 4835: 4828: 4826: 4824: 4822: 4820: 4818: 4809: 4805: 4800: 4795: 4791: 4787: 4783: 4779: 4775: 4768: 4766: 4764: 4755: 4751: 4746: 4741: 4736: 4731: 4727: 4723: 4720:(1): e53707. 4719: 4715: 4711: 4704: 4696: 4692: 4687: 4682: 4677: 4672: 4668: 4664: 4660: 4656: 4652: 4645: 4637: 4633: 4628: 4623: 4619: 4615: 4611: 4607: 4603: 4596: 4588: 4582: 4574: 4570: 4566: 4562: 4558: 4554: 4550: 4546: 4539: 4531: 4527: 4522: 4517: 4513: 4509: 4505: 4501: 4497: 4490: 4488: 4479: 4475: 4471: 4467: 4463: 4459: 4455: 4451: 4443: 4435: 4431: 4424: 4408: 4404: 4398: 4390: 4386: 4382: 4375: 4367: 4363: 4359: 4355: 4351: 4347: 4343: 4339: 4332: 4324: 4320: 4316: 4312: 4308: 4304: 4300: 4296: 4289: 4281: 4277: 4273: 4266: 4264: 4255: 4251: 4247: 4240: 4238: 4221: 4217: 4213: 4206: 4204: 4187: 4183: 4177: 4169: 4165: 4161: 4157: 4153: 4149: 4142: 4126: 4122: 4116: 4108: 4104: 4098: 4090: 4086: 4082: 4076: 4072: 4068: 4064: 4057: 4049: 4045: 4041: 4037: 4033: 4029: 4025: 4021: 4014: 4006: 4002: 3998: 3994: 3990: 3986: 3979: 3968: 3964: 3960: 3956: 3952: 3948: 3944: 3940: 3936: 3935:CNS Spectrums 3929: 3922: 3914: 3910: 3906: 3902: 3898: 3894: 3886: 3875: 3868: 3862: 3843: 3836: 3829: 3827: 3818: 3814: 3809: 3804: 3800: 3796: 3792: 3785: 3783: 3781: 3779: 3770: 3766: 3762: 3758: 3754: 3750: 3746: 3742: 3735: 3727: 3723: 3717: 3709: 3702: 3696: 3688: 3684: 3678: 3662: 3658: 3657:Narcolepsy UK 3654: 3647: 3639: 3635: 3630: 3625: 3620: 3615: 3611: 3607: 3603: 3596: 3588: 3584: 3579: 3574: 3570: 3566: 3562: 3558: 3554: 3547: 3545: 3528: 3524: 3520: 3516: 3510: 3502: 3498: 3493: 3488: 3484: 3480: 3476: 3469: 3461: 3455: 3451: 3447: 3443: 3436: 3428: 3424: 3420: 3416: 3412: 3408: 3404: 3400: 3393: 3385: 3378: 3371: 3363: 3359: 3354: 3349: 3344: 3339: 3335: 3331: 3327: 3320: 3312: 3308: 3303: 3298: 3293: 3288: 3284: 3280: 3276: 3269: 3261: 3257: 3252: 3247: 3243: 3239: 3235: 3228: 3212: 3208: 3204: 3198: 3190: 3186: 3181: 3176: 3171: 3166: 3162: 3158: 3154: 3147: 3139: 3132: 3124: 3117: 3109: 3105: 3101: 3097: 3093: 3089: 3085: 3081: 3074: 3072: 3070: 3068: 3066: 3064: 3055: 3051: 3047: 3043: 3039: 3035: 3032:(2): 114–22. 3031: 3027: 3020: 3013: 3006: 3001: 2995: 2991: 2986: 2981: 2976: 2971: 2967: 2963: 2959: 2952: 2950: 2942: 2937: 2935:9780071481274 2931: 2927: 2920: 2913: 2909: 2905: 2900: 2895: 2891: 2887: 2884:(2): 332–50. 2883: 2879: 2875: 2868: 2852: 2848: 2844: 2838: 2822: 2818: 2817: 2812: 2806: 2798: 2794: 2790: 2786: 2781: 2776: 2772: 2768: 2764: 2760: 2753: 2745: 2741: 2736: 2731: 2727: 2723: 2719: 2715: 2711: 2704: 2696: 2692: 2687: 2682: 2678: 2674: 2670: 2666: 2662: 2655: 2647: 2643: 2638: 2633: 2629: 2625: 2621: 2614: 2612: 2610: 2601: 2597: 2593: 2589: 2586:(11): 782–6. 2585: 2581: 2574: 2558: 2554: 2550: 2546: 2542: 2538: 2534: 2528: 2513: 2509: 2503: 2496: 2491: 2489:9780071481274 2485: 2481: 2474: 2472: 2470: 2468: 2466: 2458: 2454: 2450: 2445: 2440: 2436: 2432: 2429:(5): 767–73. 2428: 2424: 2420: 2413: 2411: 2409: 2407: 2405: 2403: 2401: 2399: 2397: 2388: 2384: 2379: 2374: 2370: 2366: 2362: 2358: 2354: 2347: 2345: 2336: 2332: 2328: 2324: 2320: 2316: 2312: 2308: 2301: 2299: 2290: 2286: 2282: 2278: 2274: 2270: 2263: 2255: 2251: 2247: 2243: 2239: 2235: 2231: 2227: 2224:(4): e13631. 2223: 2219: 2215: 2208: 2200: 2196: 2191: 2186: 2182: 2178: 2174: 2170: 2166: 2159: 2143: 2139: 2135: 2129: 2121: 2117: 2113: 2109: 2102: 2086: 2082: 2078: 2071: 2063: 2057: 2053: 2048: 2047: 2038: 2030: 2026: 2021: 2016: 2012: 2008: 2004: 2000: 1996: 1989: 1987: 1985: 1983: 1981: 1972: 1968: 1963: 1958: 1954: 1950: 1946: 1942: 1938: 1931: 1923: 1921:9780230252653 1917: 1913: 1909: 1905: 1901: 1894: 1892: 1890: 1888: 1886: 1884: 1868: 1864: 1858: 1856: 1848: 1844: 1838: 1830: 1826: 1821: 1816: 1811: 1806: 1802: 1798: 1794: 1790: 1786: 1779: 1777: 1775: 1773: 1771: 1763: 1759: 1753: 1746: 1742: 1736: 1729: 1725: 1718: 1703: 1699: 1693: 1677: 1673: 1667: 1665: 1656: 1652: 1647: 1642: 1637: 1632: 1629:(7): e27287. 1628: 1624: 1620: 1613: 1606: 1602: 1599: 1593: 1586: 1582: 1579: 1573: 1566: 1560: 1544: 1540: 1538:9783319237398 1534: 1530: 1529: 1521: 1519: 1517: 1515: 1498: 1494: 1490: 1484: 1482: 1480: 1478: 1476: 1474: 1472: 1470: 1468: 1466: 1464: 1462: 1460: 1458: 1456: 1454: 1452: 1450: 1448: 1446: 1444: 1439: 1431: 1427: 1425: 1420: 1417: 1410:Rodent models 1407: 1398: 1394: 1388:Animal models 1385: 1383: 1378: 1377:acylcarnitine 1368: 1366: 1362: 1359: 1355: 1351: 1343: 1338: 1328: 1326: 1322: 1312: 1310: 1291: 1289: 1285: 1277: 1262: 1260: 1256: 1252: 1248: 1244: 1234: 1232: 1228: 1224: 1220: 1214: 1204: 1201: 1196: 1194: 1190: 1186: 1182: 1178: 1177:United States 1173: 1165: 1163: 1159: 1155: 1151: 1147: 1141: 1137: 1127: 1125: 1121: 1117: 1113: 1109: 1105: 1104:non-stimulant 1101: 1097: 1093: 1089: 1088:protriptyline 1085: 1081: 1077: 1072: 1070: 1066: 1062: 1058: 1054: 1050: 1048: 1044: 1040: 1035: 1033: 1029: 1025: 1021: 1017: 1013: 1008: 1004: 1000: 996: 992: 988: 977: 973: 964: 962: 958: 954: 950: 946: 941: 940:prepro-orexin 926: 924: 921:sampled in a 920: 915: 911: 908: 904: 902: 898: 894: 890: 879: 877: 873: 867: 864: 863:sleep latency 858: 856: 852: 848: 838: 836: 832: 828: 827:Acetylcholine 824: 820: 816: 813: 809: 805: 804:non-REM sleep 801: 790: 788: 784: 780: 776: 772: 768: 764: 759: 756: 741: 739: 735: 731: 727: 722: 718: 715: 705: 704:(rs3826784). 703: 699: 695: 691: 687: 684:(rs7553711), 683: 679: 675: 671: 667: 663: 658: 656: 652: 648: 644: 641:known as the 640: 630: 628: 622: 618: 616: 612: 602: 600: 595: 593: 589: 583: 579: 577: 573: 569: 565: 561: 556: 551: 543: 540: 537: 534: 530: 526: 522: 517: 516: 515: 513: 509: 505: 500: 496: 494: 490: 487:and abnormal 486: 476: 473: 471: 467: 461: 459: 455: 451: 447: 443: 437: 435: 431: 430:heart failure 427: 423: 419: 415: 411: 410:sleep studies 407: 403: 399: 394: 391: 388:resulting in 387: 383: 379: 375: 371: 367: 363: 359: 355: 351: 347: 343: 339: 335: 332: 328: 319: 315: 312: 308: 304: 300: 296: 292: 288: 285: 283: 279: 276: 275:sleep hygiene 272: 268: 265: 261: 257: 253: 252:heart failure 249: 245: 241: 238: 236: 232: 229: 228:sleep studies 225: 223: 219: 215: 213: 209: 205: 202: 198: 194: 190: 186: 182: 179: 175: 172: 170: 169:Complications 166: 163: 159: 155: 152: 150: 146: 143: 139: 136: 134: 130: 121: 77: 76: 74: 72:Pronunciation 70: 66: 62: 57: 53: 48: 43: 37: 33: 19: 5667:Sleeping bag 5444:Sleepwalking 5429:Night terror 5333: 5146:sleep cycles 5068: 5057: 5033: 5022: 5011: 4996: 4981: 4925: 4921: 4915: 4882: 4878: 4868: 4841: 4837: 4781: 4777: 4717: 4713: 4703: 4661:(4): e5394. 4658: 4654: 4644: 4609: 4605: 4595: 4581: 4548: 4544: 4538: 4503: 4499: 4453: 4449: 4442: 4433: 4429: 4423: 4411:. 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Retrieved 2511: 2502: 2493: 2479: 2456: 2426: 2422: 2360: 2356: 2310: 2306: 2272: 2268: 2262: 2221: 2217: 2214:"Narcolepsy" 2207: 2172: 2168: 2158: 2146:. Retrieved 2137: 2128: 2111: 2107: 2101: 2089:. Retrieved 2080: 2077:"Narcolepsy" 2070: 2045: 2037: 2002: 1998: 1947:(7): 844–9. 1944: 1940: 1930: 1899: 1870:. Retrieved 1866: 1863:"Narcolepsy" 1846: 1842: 1837: 1792: 1788: 1761: 1757: 1752: 1744: 1740: 1735: 1730:(1), p.2709. 1727: 1723: 1717: 1705:. Retrieved 1701: 1692: 1680:. Retrieved 1676:the original 1626: 1622: 1612: 1604: 1600: 1597: 1592: 1584: 1580: 1577: 1572: 1564: 1559: 1547:. Retrieved 1527: 1501:. Retrieved 1492: 1428: 1421: 1413: 1404: 1395: 1391: 1374: 1365:danavorexton 1340: 1318: 1297: 1273: 1258: 1254: 1242: 1240: 1216: 1197: 1189:side effects 1174: 1171: 1168:Epidemiology 1162:clomipramine 1142: 1139: 1080:clomipramine 1073: 1051: 1036: 1007:Solriamfetol 999:Solriamfetol 983: 974: 970: 949:hypocretin 1 945:danavorexton 937: 916: 912: 909: 905: 885: 868: 859: 844: 796: 760: 755:neuropeptide 752: 723: 719: 711: 676:gene locus ( 659: 649:response to 639:chromosome 6 636: 627:autoimmunity 623: 619: 608: 596: 584: 580: 552: 548: 501: 497: 482: 474: 462: 438: 395: 386:CD4+ T cells 372:, visual or 362:tic disorder 326: 325: 212:Risk factors 36: 5826:Amphetamine 5751:Second wind 5726:Dream diary 5602:Sleep study 5542:Sleep diary 5494:Hypnopompia 5489:Sleep onset 5480:Hypnic jerk 5319:Hypersomnia 5269:Catathrenia 5264:Sleep apnea 5174:Brain waves 5144:Stages of 5059:MedlinePlus 3612:: 453–466. 3163:: 507–518. 2563:25 November 2512:Mayo Clinic 2081:MedicineNet 1910:, England: 1904:Basingstoke 1371:L-carnitine 1243:narcolepsie 1200:adolescence 1154:venlafaxine 1150:atomoxetine 1100:Atomoxetine 1096:Venlafaxine 1043:amphetamine 991:armodafinil 980:Medications 953:intravenous 686:Cathepsin H 647:auto-immune 560:brain waves 545:sensations. 418:sleep apnea 390:CD8+ T-cell 303:amphetamine 254:, drinking 240:Sleep apnea 187:Adolescence 184:Usual onset 18:Narcoleptic 5816:Narcolepsy 5810:Categories 5785:Sleep debt 5731:Microsleep 5711:Chronotype 5625:Daily life 5509:Somnolence 5485:Hypnagogia 5416:Parasomnia 5334:Narcolepsy 5246:Anatomical 5227:Theta wave 5197:Gamma wave 5192:Delta wave 5182:Alpha wave 5035:DiseasesDB 3399:The Lancet 3217:15 January 2313:(8): 469. 2148:15 January 1434:References 1401:Dog models 1335:See also: 1294:Flumazenil 1288:flumazenil 1211:See also: 1181:depression 1158:fluoxetine 1134:See also: 1124:selegiline 1116:reboxetine 1112:viloxazine 1084:imipramine 1012:Pitolisant 995:Pitolisant 967:Behavioral 961:intranasal 923:spinal tap 895:, and the 773:, and the 698:gene locus 590:or before 576:REM atonia 327:Narcolepsy 307:stimulants 295:pitolisant 282:Medication 206:deficiency 45:Narcolepsy 5795:Sleepover 5746:Power nap 5741:Nightwear 5607:Melatonin 5569:Somnology 5534:Treatment 5367:disorders 5306:Dyssomnia 5212:PGO waves 5207:Mu rhythm 5202:K-complex 5187:Beta wave 5164:Slow-wave 5075:neuro/522 5070:eMedicine 4573:248119793 4226:19 August 3991:: 70–85. 2857:24 August 2827:19 August 2765:(7): 43. 2671:: 26–31. 2495:diabetes. 2254:251107306 2238:0962-1105 1908:Hampshire 1682:7 January 1578:Neurology 1549:19 August 1503:19 August 1354:modafinil 1309:receptors 1227:Pandemrix 1061:cataplexy 987:modafinil 929:Treatment 841:Diagnosis 835:cataplexy 800:REM sleep 730:Pandemrix 592:waking up 568:REM sleep 504:cataplexy 489:REM sleep 442:modafinil 406:REM sleep 354:cataplexy 317:Frequency 287:Modafinil 270:Treatment 142:neurology 133:Specialty 5662:Mattress 5637:Bunk bed 5557:Hypnosis 5349:Nocturia 5324:Insomnia 4950:41039138 4907:18455770 4899:25728441 4860:23582416 4808:24701532 4754:23349733 4714:PLOS ONE 4695:19404393 4655:PLOS ONE 4636:21358852 4565:35043499 4530:23065655 4478:13121904 4470:24306133 4413:22 April 4407:Archived 4389:Archived 4366:31846588 4358:24554692 4323:44236050 4315:23175709 4280:Archived 4254:Archived 4220:Archived 4186:Archived 4168:24780133 4125:Archived 4107:Archived 4089:54481723 4040:18375081 4005:28666745 3963:13660411 3955:25403789 3913:22055895 3874:Archived 3851:9 August 3842:Archived 3817:18830438 3769:42684839 3761:27438291 3638:32765142 3587:31632459 3533:15 March 3527:Archived 3427:11041392 3419:17292770 3362:15070772 3311:23904672 3260:12374492 3211:Archived 3189:21931493 3108:19380758 3100:27359185 2994:27051324 2968:: 81–6. 2908:24102345 2821:Archived 2797:46926146 2789:29855798 2744:25669430 2695:23497937 2646:11682267 2600:10984567 2557:Archived 2553:74850662 2539:. 2013. 2517:15 March 2453:23725858 2387:21784243 2335:22408801 2327:24954623 2289:26716917 2246:35624073 2199:20694129 2142:Archived 2091:15 March 2085:Archived 2029:18246981 1971:17682654 1872:15 March 1829:30541895 1655:36043022 1587:, 55–60. 1543:Archived 1497:Archived 1342:Orexin-A 1265:Research 1185:epilepsy 1130:Children 1120:mazindol 1032:Pemoline 666:HLA-DQB1 633:Genetics 572:dreaming 555:insomnia 521:laughter 370:auditory 366:seizures 195:Lifelong 192:Duration 149:Symptoms 61:orexin-A 5689:Bedtime 5684:Bedroom 5679:Bedding 5674:Bed bug 5657:Hammock 5562:Lullaby 5396:Jet lag 5296:Snoring 5254:Bruxism 5029:D009290 4942:7199479 4851:3625050 4799:3972560 4745:3547955 4722:Bibcode 4686:2671172 4663:Bibcode 4627:3041711 4521:3480574 4436:: A248. 4192:20 July 4048:3416096 3808:2526380 3629:7371435 3578:6767718 3501:9231950 3302:3700709 3180:3173034 3054:4548322 3046:1697239 2985:4803263 2899:3904255 2735:4613472 2686:4118764 2444:3848424 2378:3153991 2190:2910991 2020:2276130 1962:1978363 1820:6310865 1797:Bibcode 1707:13 June 1646:9413809 1607:, 70–85 1424:neurons 1361:agonist 1253:νάρκη ( 1175:In the 434:alcohol 374:tactile 358:syncope 331:chronic 256:alcohol 5756:Siesta 5642:Daybed 5470:Dreams 5064:000802 5018:161400 4948: 4940: 4905: 4897: 4858: 4848: 4806: 4796: 4752: 4742: 4693: 4683: 4634: 4624: 4571: 4563: 4528: 4518: 4476: 4468: 4364: 4356: 4321: 4313: 4166: 4131:6 June 4087: 4077: 4046: 4038: 4003: 3961: 3953: 3911: 3815: 3805: 3767: 3759: 3667:5 July 3636: 3626: 3585: 3575: 3499: 3456: 3425: 3417: 3384:Takeda 3360: 3353:384801 3350: 3309: 3299: 3258: 3187: 3177: 3106: 3098: 3052: 3044: 2992: 2982: 2932: 2906: 2896: 2795: 2787: 2742: 2732: 2693: 2683: 2644: 2598: 2551: 2537:Nature 2486: 2451: 2441: 2385: 2375: 2333: 2325: 2287: 2252: 2244: 2236: 2197: 2187: 2120:422531 2118: 2058: 2027: 2017: 1969: 1959: 1918: 1827: 1817: 1653: 1643: 1623:Cureus 1535: 1416:murine 1346:a.k.a. 1259:lepsis 1187:, the 1160:, and 1106:and a 951:given 891:, the 819:atonia 769:, the 763:orexin 690:P2RY11 682:TNFSF4 662:allele 651:orexin 611:orexin 605:Causes 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