FDA approved Sodium Oxybate for Narcolepsy starts affecting muscle tone

Believe it or not, Narcoleptic patients have slept in many awesome places than normal people have ! Guess why ? 

Existing Drug treatment for narcolepsy generally treats by increasing the daytime alertness, cataplexy, sleep paralysis and hypnagogic/hypnopompic hallucination which are the charactersitics of Narcolepsy.Sodium Oxybate (brand name: Xyrem,Alcover,Somsanit) has its name as "date rape drug" when treated with alcohol beverages.It is an illegal form of "Sodium salt of Gamma-hydroxy butyrate" used illicitly typically at parties and nightclubs. The FDA (Food and drug administration) approval was done on recent years to reduce the daytime sleepiness and cataplexy by generally improving the night time sleep in the patients of narcolepsy. From New york (Reuters health),according to the Germen researchers some new analysis of data from a manufacturer-funded study throws some light on the effect with this Sodium Oxybate or Xyrem. Dr.Geert Mayer of Hephata Klinik,in Schwalmstadt passed an email to Reutres health by mentioning that

Besides the effect on sleep ,it also has an impact on the chin muscle tone during the phases of sleep cycle studies and this lead to a significant dose-dependent reduction of the REM sleep duration and further increase of the sleep stage N3

Using some of the semi-automatic analysis for this issue, the team found that the chin muscles activity decreased significantly during the light sleep while the long muscle activity remained stable in all of the active treatment groups during the slow-wave sleep or deep sleep stage but decreased during the REM sleep. Sleep specialist Dr,Lois Krahn of the Mayo Clinic in Phoenix,Arizona even messaged Reuters Health that : They have faced some very hard situations to manage the patients with the incidence of the parasomnia behavior with narcolepsy which has no much of the positive benefits from the published data. These patients tend to have relatively high incidence of the REM parasomniac behaviour which must be reconciled and restore with the observations that the treatment of narcolepsy increases the NREM parasomnia.As added by Dr.Krahn, he collected some polysomnographic data during the miltisite clinical trial in measurement of REM atonia. The findings he did and came to the conclusion that the sodium oxybate affecting chin muscle in a dose-dependent manner greatly verifies the contradiction that at high doses this compound reduces the dream staging behavior in REM sleep . But in the lower dose, rises the usual sleep behaviours in NREM sleep.

Generally how does a Narcolepsy elicit ? 

You may have felt sleepy during the long drive, long lecture, long awake where you control your sleep-wake cycle. When this gets uncontrolled or say a disabling disorder of the brain that affects in controlling of sleep and wakefulness is termed as "Narcolepsy". Some people tend to have some sort of sleep while awake. In the brain, there is some special group of neurons that helps in increasing the state of wakefulness by releasing some chemical messenger like neurotransmitter. There is a special group of neurons which make a connection between lateral hypothalamus and RAS (Reticular Activating System). In the brain of narcolepsy patient, there are less no of these neurons and connections too . Ultimately, there is fewer neuropeptide release i.e (OREXIN A also called as hypocretin 1 and OREXIN B also called as hypocretin 2) in the cerebro-spinal fluid.These neuropeptide  regualtes the arousal, wakefulness and appetite. So, when these neuro-peptide gets to lower concentration, there is decreased activity of the wake-promoting region of brain leading to commitment of inappropriate transitions to sleeping stage. There is also some auto-immune process and direct injury cases that can damage the neuron. These cause lesser amount of neuropeptides OREXIN A and OREXIN B which causes a sleep related symptoms intruding into wakefulness. These illict during the adolescents or adulthood . Narcolepsy is associated with mainly 4 key Symptoms: 

Orexin Hypocretin disorders   (credit)

• Daytime sleepiness : 

People doze off too quickly with little warning of sleepiness. People feel chronically sleepy but dont sleep more than other healthy people compared in 24 hour cycle.In some patients , a 15 min nap can improve the alertness which suggests the problems with the brain connection and circuits that prevents full alertness but not the quality of sleep .Healthy people go to sleep and have sleep cycle which reach REM (Rapid eye movenment ) consisting of dreaming characteristics sleep after 1 hour . But, in the Narcolepsy patients, they feel asleep quickely .About 5 minute is needed to reach the REM stage of sleep but these include the vivid dreams and of short time. 

• Cataplexy 

Patients tend to have a transient muscle weakness during the triggering of strong emotional condition.Strong emotion include the laughter having positive emotion whereas anger as the negative emotion.  Trasient muscel weakness classified as the partial (face,neck,hand,knee)and Complete severe (total body, weakness/paralysis) leading to collapse . People tend to have some consciousness during the cataplexy. The weakness of the muscels resolves within a minute. Ultimately, these kind of symptoms tend to have a severe impact on the life of people of narcolepsy both from 

1. Physical forms like HURT ( when these people tend to collapse) 
2. Psychological forms like fear of suffering of cataplexy and episode in public causing anxiety. People tend to avoid certain situations that might trigger an episode of cataplexy. 

• Hypnogogic / Hypnopompic hallucination : 

The hypnogogic hallucination are generally vivid and frightening. These includes the visual , tactile, auditory hallucination which happens during the people falling asleep. It is probably caused by mixing of the wakefullness and dreaming during REM sleep.

The hypnopompic hallucination are usually less common which can happen with narcolepsy. These hallucination happen during the wake up stage or during awake. 

Lastly,  

• Sleep paralysis: 

There is the inability of movement after waking or before falling asleep. Understandably, In the REM sleep, the brain becomes active and the voluntary muscles are paralyzed to avoid injury by running or falling during dream. In this case, these activities subsides and sometimes regain the consciousness during the paralysis. There is the frightening stage accompanied by the hypnopompic hallucination or sensation of suffocation ..

Chart showing symptoms of narcolepsy  (credit)

According to some studies, minor people affected with all the four symptoms which is difficult to diagnosed and is confused with other diseases  but major faces all symptoms except cataplexy.

The Polysomnography and multiple sleep latency test can be done as a part of physiological measurenment by ECG and EEG .

So this all for today steemians, Hope to see you on other health post . 

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khatisam4

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Reference Used: 

(1) http://www.medscape.com/viewarticle/879324

(2)http://emedicine.medscape.com/article/1188433-overview

(3)https://sleepfoundation.org/sleep-disorders-problems/narcolepsy-and-sleep

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