发作性嗜睡病

title: 症状和体征.
content: 嗜睡症有两个主要特征:白天过度嗜睡和REM睡眠不正常。第一种,白天过度嗜睡(EDS),即使在足够的夜间睡眠后也会发生。发作性睡病的人可能会变得昏昏欲睡,或者常常在不适当的时间和地点睡着,或者一整天都很累。 患者无法体验健康人体验到的恢复性深度睡眠 - 它们不是“过度睡眠”。事实上,患者一生都处于极度睡眠不足的状态。  此症的特点是患者会在很短的时间进入看上去像深度睡眠的阶段。一般人需要一个半小时左右从轻度睡眠进入到深度睡眠,而患有此病的人可能只需要一分钟甚至更短。患者睡着的速度跟醒来的速度都可以快得惊人,而醒来几秒钟之内可能会意识模糊不清。白天小睡可能会发生,几乎没有警告,并可能是身体不可抗拒的。这些小睡可能会每天发生几次。它们通常令人耳目一新,但只有几个小时或更少。而且大部分患者即使在非常短暂的小睡期间,也可以定期体验到生动的梦想,而且自己会记得多数的梦。甚至可以在睡着几秒钟之内就做一个梦,所以也有人称之为梦境一般的幻觉。困倦可能会持续很长时间或保持不变。另外,夜间睡眠可能是分散的,经常觉醒,所以大脑才会在白天自动进入睡眠状态。发作性睡病的第二个主要症状是REM睡眠异常。 患者的独特之处在于它们在睡眠开始时即进入睡眠的REM阶段,即使在白天睡觉时也是如此。  经常被称为“嗜睡症四分体症”的典型症状是猝倒症,睡眠瘫痪,幻觉幻觉和白天过度嗜睡。其他症状可能包括自动行为和夜间觉醒,这些症状可能不会在所有患者中发生。  猝倒是一种肌肉功能的短暂性缺失,包括轻微的软弱,如颈部或膝盖的软弱,面部肌肉松弛,膝盖无力,通常称为“膝关节屈曲”,或无法清晰说话,完全身体崩溃。突发情绪反应可能会引发情节,如笑声,愤怒,惊讶或恐惧,并可能持续几秒到几分钟。这个人在整个剧集中都保持清醒。在某些情况下,猝倒可能类似于癫痫发作。[来源请求]言语不清,视力受损(双重视力,无法聚焦),但听力和意识仍然正常。猝倒症对嗜睡症也有严重的情绪影响,因为它会引起极度的焦虑,恐惧和避免可能引发发作的人或情况。[来源请求]猝倒症一般被认为是嗜睡症所特有的,与睡眠瘫痪类似因为在睡眠期间发生的通常保护性瘫痪机制被不恰当地激活。与这种情况相反(不能激活这种保护性麻痺)发生在快速眼动行为障碍中。  在大多数情况下,嗜睡症出现的第一个症状是过度和压倒性的白天嗜睡。其他症状可以单独开始,或者在白天发作后的数月或数年内开始。个体的猝倒,睡眠瘫痪和幻觉幻觉的发展,严重程度和出现顺序存在很大差异。只有大约20%到25%的嗜睡患者经历了所有四种症状。白天过度嗜睡通常会持续一生,但睡眠瘫痪和幻觉幻觉可能不会。一种罕见的嗜睡症亚类也经历了被称为超级过敏现象的高度味觉和嗅觉  许多发作性睡病的人也会长时间失眠。日间过度嗜睡和猝倒常常变得严重到足以在一个人的社交,个人和职业生活中造成严重问题。通常,当一个人清醒时,脑电波显示出规律的节奏。当一个人第一次入睡时,脑电波变得更慢,更不规则,这就是所谓的非快速眼动(NREM)睡眠。大约一个半小时 的NREM睡眠后,当大多数记忆中的梦出现时,脑电波又开始显示更加活跃的模式,称为REM睡眠(快速眼动睡眠)。在REM睡眠期间与EEG观察波相关联,肌肉萎缩症目前称为REM atonia。

Summary: 发作性嗜睡症(narcolepsy,又名 猝睡症、渴睡症)是长期的神经失调,其调节睡眠-觉醒周期的能力下降。症状包括白天过度嗜睡,通常持续数秒至数分钟,且随时可能发生。大约70%的受影响者也经历肌肉突然无力的情况,称为猝倒。这些经历可以通过强烈的情绪触发。也有可能在睡着或醒来时无法移动或形成幻觉,不过较不常见。发作性嗜睡症患者每天的睡眠时间与没有此病症的人相同,但睡眠品质往往更差。

Narcolepsy: Narcolepsy is a long-term neurological disorder that involves a decreased ability to regulate sleep-wake cycles. Symptoms often include periods of excessive daytime sleepiness and brief involuntary sleep episodes. About 70% of those affected also experience episodes of sudden loss of muscle strength, known as cataplexy. These experiences can be brought on by strong emotions. Less commonly, there may be vivid hallucinations or an inability to move (sleep paralysis) while falling asleep or waking up. People with narcolepsy tend to sleep about the same number of hours per day as people without, but the quality of sleep tends to be lessened. The exact cause of narcolepsy is unknown, with potentially several causes. In up to 10% of cases, there is a family history of the disorder. Often, those affected have low levels of the neuropeptide "orexin", which may be due to an autoimmune disorder. In rare cases, narcolepsy can be caused by traumatic brain injury, tumors, or other diseases affecting the parts of the brain that regulate wakefulness or REM sleep. Diagnosis is typically based on the symptoms and sleep studies, after ruling out other potential causes. Excessive daytime sleepiness can also be caused by other sleep disorders such as sleep apnea, major depressive disorder, anemia, heart failure, drinking alcohol and not getting enough sleep. Cataplexy may be mistaken for seizures. While there is no cure, a number of lifestyle changes and medications may help. Lifestyle changes include taking regular short naps and sleep hygiene. Medications used include modafinil, sodium oxybate and methylphenidate. While initially effective, tolerance to the benefits may develop over time. Tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) may improve cataplexy. 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 motor vehicle collisions and falls.