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Sleep–Wake Disorders
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Margaret Kay-Stacey, Eunice Torres-Rivera, Phyllis C. Zee
During transitions from wakefulness to sleep (hypnagogic events) or from sleep to wakefulness (hypnopompic events), vivid dream-like hallucinations that are thought to be related to sleep-onset REM sleep occur repeatedly in 40–80% of patients with narcolepsy with cataplexy. These are distinguished from hallucinations in other psychotic states by their exclusive association with sleep–wake transitions. Similar to sleep paralysis, hypnagogic hallucinations also occur sporadically in the normal population.
Parasomnias
Published in Stanley R. Resor, Henn Kutt, The Medical Treatment of Epilepsy, 2020
Sleep paralysis is phenomenologically similar to cataplexy but is limited to brief occurrences at transitions between sleep and wakefulness (18). Hypnagogic or hypnopompic hallucinations often accompany sleep paralysis and the clinical significance of these symptoms is similar, i.e., they are intrinsically benign but may indicate the presence of narcolepsy. In addition, a familial syndrome of sleep paralysis has rarely been described. Specific therapy for sleep paralysis is virtually never necessary.
ILF Neurofeedback and Alpha-Theta Training in a Multidisciplinary Chronic Pain Program
Published in Hanno W. Kirk, Restoring the Brain, 2020
Evvy J. Shapero, Joshua P. Prager
In their ground-breaking book, Beyond Biofeedback, Alyce and Elmer Green showed that theta training made material from the unconscious accessible. Falling into a theta-dominant state can produce detached thoughts or a stream of vague images that are not necessarily connected. They may not make immediate sense in the prevailing narrative of the conscious life. Nevertheless, there is typically a sense of connection to these experiences. The closest one comes to having experiences such as this in ordinary life is during the transition from wakefulness to sleep, where it is referred to as hypnagogia. Typically, this state in transition is very brief, but with the reinforcements involved in Alpha-Theta training the hypnagogic state can be sustained. The client typically migrates between alpha-dominated and theta-dominated states throughout the session, with the respective states of consciousness each contributing to the experience.45
Narcolepsy Treatment: Voices of Adolescents
Published in Behavioral Sleep Medicine, 2022
Lena Xiao, Anna Chen, Arpita Parmar, Lucy Frankel, Alene Toulany, Brian J. Murray, Indra Narang
Narcolepsy is a debilitating lifelong sleep disorder that is increasingly recognized in the pediatric population. The overall estimated incidence of narcolepsy in Europe is 0.93 per 100,000 person-years and approximately 0.83 per 100,000 person-years in the adolescent population (Wijnans et al., 2013). There is frequently a delay between symptom onset and diagnosis with a median interval of 10.5 years (Morrish et al., 2004). The median age of symptom onset is 18 years and age at diagnosis is 35 years (Morrish et al., 2004). The classic clinical syndrome consists of excessive daytime sleepiness, cataplexy, hypnagogic hallucinations and sleep paralysis. The symptomatology is mediated by the hypothalamic loss of the excitatory neuropeptide hypocretin which is responsible for sleep-wake regulation and wake promotion (Houghton et al., 2004; Thannickal et al., 2000).
Dissociative Symptoms are Highly Prevalent in Adults with Narcolepsy Type 1
Published in Behavioral Sleep Medicine, 2022
Laury Quaedackers, Hal Droogleever Fortuyn, Merel Van Gilst, Martijn Lappenschaar, Sebastiaan Overeem
Dissociative symptoms are not limited to dissociative disorders, but can occur in a variety of mental health problems such as post-traumatic stress disorder (PTSD) and schizophrenia. Often, dissociation in these other conditions has been found to be related to traumatic experiences. Because of the presence of hypnagogic hallucinations, narcolepsy patients have been misdiagnosed with schizophrenia or other psychotic disorders (Plazzi et al., 2015). However, a role for trauma in the emergence of dissociation in narcolepsy patients has not been established, nor have there been reports of an overrepresentation of PTSD in narcolepsy patients. So, although there seems to be some overlap in symptoms between schizophrenia and narcolepsy, phenotypically the hypnagogic hallucinations in narcolepsy have been shown to be different from hallucinations of schizophrenic patients. Moreover, delusions are exceptional in narcolepsy patients, but hallmarks in schizophrenic patients (Fortuyn et al., 2009).
Emerging therapeutic targets for narcolepsy
Published in Expert Opinion on Therapeutic Targets, 2021
Marieke Vringer, Birgitte Rahbek Kornum
Narcolepsy has two subtypes: Patients with Narcolepsy type 1 (NT1) have cataplexy and hypocretin (Hcrt, also known as orexin) deficiency, while Narcolepsy type 2 (NT2) patients have neither cataplexy nor Hcrt deficiency [4,9,18]. Cataplexy attacks are brief episodes of muscle atonia during wake typically triggered by strong, mainly positive emotions. Other symptoms are sleep paralysis, hypnagogic, and hypnopompic hallucinations, and disturbed nocturnal sleep. These symptoms can be experienced by both NT1 and NT2 patients, but not every patient experience all the symptoms. Diagnosis requires nighttime and day-time polysomnography to rule out other sleep-wake disorders, objectify a short latency to fall asleep, and document at least two sleep onset REM (SOREM) periods [18]. Diagnosing NT2 can be challenging. This requires the presence of EDS and two SOREM periods but cataplexy and Hcrt deficiency should be absent. Due to the lack of clear biomarkers, diagnosis is mainly based on the exclusion of other sleep disorders [3,18,19].