Running Head: NARCOLEPSY AND CATAPLEXY NARCOLEPSY AND CARTAPLEXY 6 Study of Narcolepsy and cataplexy Nicole Stallworth Herzing University Study of Narcolepsy and cataplexy Narcolepsy Narcolepsy is a serious cause of chronic sleeplessness. It normally develop in teen period and usually develop for life. It can be described as neurological syndrome that leads to sleepless and other symptoms that come along are short episode of the muscle failure or weakness, dreamlike hallucinations, a short period or episode f paralysis that’s when one is waking up or falling asleep them lastly there is a disjointed nighttime sleep. The disease and its symptoms usually begins at the age of10 to 20 (Schwartz, 2017). However, in other cases it starts late. Both men and women are affected at the same rate. It approximately affects 1 person out of 2,000 people. It’s a disease that is manageable. The following are types of narcolepsy, narcolepsy with cataplexy and then narcolepsy without cataplexy. The only difference is people who has narcolepsy without cataplexy are affected with sleeplessness. However, faces no muscle weakness. They don’t face severe signs. This are the two types that are today recognized by clinicians. Another rare cases arise with the injury to the hypothalamus, this is usually called secondary narcolepsy. Causes Narcolepsy The exact cause of narcolepsy, but researchers and scientist has identified genes that are associated with the condition. This type of gene are specifically in control of the production or yield of the chemicals founded in brain that signals sleep or awake routine or cycles. In other discussion some scientists argue that narcolepsy comes with the deficiency in secretion of the chemical hypocretin in the brain (Schwartz, 2017). In other cases some feel that it due to abnormalities in certain parts of the brain that regulate REM sleep. Then as a result these abnormalities influence the development of those symptoms. Experts feels that narcolepsy is enhanced by varied factors that comes together or relate to cause neurological disorder. Symptoms of Narcolepsy Excessive daytime sleepiness, this in many cases interrupt the normal happenings on a regular basis. Most people who suffers from narcolepsy has reported, memory lapse, depressed moods, mental cloudiness, and lastly lack of concentration and also energy. Cataplexy, loss of muscle tone that makes one too weak and also reduced muscle control. Certain part are interfered with such as speech and o can collapse at a given chance. It perhaps depend on the type of muscle as most of the time the act is triggered by different emotions or behaviour such as laughter and surprise. Sleep paralysis, this symptom is accompanied by one not being able to speak in the process of falling asleep or even waking up (Bassetti, 2018)). However, this type of episode are always brief and people recover very first. Hallucination, one experiences lot of delusion and they are.

1. Running Head: NARCOLEPSY AND CATAPLEXY
NARCOLEPSY AND CARTAPLEXY 6
Study of Narcolepsy and cataplexy
Nicole Stallworth
Herzing University
Study of Narcolepsy and cataplexy
Narcolepsy
Narcolepsy is a serious cause of chronic sleeplessness. It
normally develop in teen period and usually develop for life. It
can be described as neurological syndrome that leads to
sleepless and other symptoms that come along are short episode
of the muscle failure or weakness, dreamlike hallucinations, a
short period or episode f paralysis that’s when one is waking up
or falling asleep them lastly there is a disjointed nighttime
sleep. The disease and its symptoms usually begins at the age
of10 to 20 (Schwartz, 2017). However, in other cases it starts
late. Both men and women are affected at the same rate. It

2. approximately affects 1 person out of 2,000 people. It’s a
disease that is manageable. The following are types of
narcolepsy, narcolepsy with cataplexy and then narcolepsy
without cataplexy. The only difference is people who has
narcolepsy without cataplexy are affected with sleeplessness.
However, faces no muscle weakness. They don’t face severe
signs. This are the two types that are today recognized by
clinicians. Another rare cases arise with the injury to the
hypothalamus, this is usually called secondary narcolepsy.
Causes Narcolepsy
The exact cause of narcolepsy, but researchers and scientist has
identified genes that are associated with the condition. This
type of gene are specifically in control of the production or
yield of the chemicals founded in brain that signals sleep or
awake routine or cycles. In other discussion some scientists
argue that narcolepsy comes with the deficiency in secretion of
the chemical hypocretin in the brain (Schwartz, 2017). In other
cases some feel that it due to abnormalities in certain parts of
the brain that regulate REM sleep. Then as a result these
abnormalities influence the development of those symptoms.
Experts feels that narcolepsy is enhanced by varied factors that
comes together or relate to cause neurological disorder.
Symptoms of Narcolepsy
Excessive daytime sleepiness, this in many cases interrupt the
normal happenings on a regular basis. Most people who suffers
from narcolepsy has reported, memory lapse, depressed moods,
mental cloudiness, and lastly lack of concentration and also
energy. Cataplexy, loss of muscle tone that makes one too weak
and also reduced muscle control. Certain part are interfered
with such as speech and o can collapse at a given chance. It
perhaps depend on the type of muscle as most of the time the
act is triggered by different emotions or behaviour such as
laughter and surprise. Sleep paralysis, this symptom is
accompanied by one not being able to speak in the process of
falling asleep or even waking up (Bassetti, 2018)). However,
this type of episode are always brief and people recover very

3. first. Hallucination, one experiences lot of delusion and they are
always clear or vivid.
Narcolepsy Diagnosis
A proper way to diagnose narcolepsy is by following ones
medical history and physical exam. However some specialized
tests are always done in the lab clinics before the process of
diagnosis is initiated (Bassetti, 2018). The two texts that a very
necessary in this process are, polysomnogram (PSG), and then
multiple sleep latency test (MSLT). The overnight test I
normally PSG as its done when the client r patient is sleeping.
This help in identifying if the REM sleep happens at abnormal
time or not at the sleep routine or cycle. The other type of test
MSLT is always done at daytime so that they measure one’s
probability or tendency to sleep. This help by gauging the
isolated features of REM sleep interrupt at inappropriate
periods at the time of awakening hours.
Narcolepsy treatment
As I have said earlier on there is no treatment for the disorder,
most of the disabling symptoms such as cataplexy can be
managed or controlled by use of drugs. Amphetamine like
stimulant is used to treat sleeplessness. And in the cases of
abnormality in REM sleep antidepressant medicine or drugs are
given. In recent happening new drugs has been approved for
those people who suffers from both cataplexy and narcolepsy.
Xylem medication is administered. This has helped the patient
by having less at the day and good sleep at night. The other
lifestyle adjustment are as follow: avoiding the use of caffeine,
nicotine alcohol, creating schedules for meals and seep and
finally no having heavy meals.
Cataplexy
This disorder can be described as a sudden and brief loss of
deliberate muscle tone that is related to robust emotions such s
surprise or anger. This disorder has been associated to the
narcolepsy. It mostly happens during the time when one wakes
up. In the process of the attack the muscle becomes so weak
such that there is drooping eyelids (Tafti, 2015). Then the worst

4. scenario is the total body failure. There has never been a cue for
the disorder but it can only be controlled by drugs. As I have
stated before, the disorder is associated with narcolepsy
however, it carries other rare disorders including: Niemann-pick
type C diseases, Wilson’s illness and prader-Will syndrome. In
other are cases cataplexy has been seen in stroke, injuries in the
head, multiple sclerosis, and encephalitis.
Causes
The REM sleep disassociation proposition argue that cataplexy
is the paralysis in the muscle which happens when REM sleep
interrupt or intrude into the waking hours. However, the exact
cause is not known. The factor that has been identified is
hypocretin. Those with cataplexy has had the following
behaviour and disorders, variation in T-cells and leukocyte
antigen, this has made some exert to term it as an autoimmune
disorder. However, it’s still remain a topic of debate.
Symptoms and diagnosis
The symptoms are known to be either severe or just mild (Tafti,
2015). They are a follow: unusual tongue movement, jaw
tremor, drooping eyelid, difficulty in speech, knee buckling and
lastly facial flickering. The personal can collapse and the
movement remain standstill. The diagnosis with narcolepsy and
catalepsy is normal done on the foundation of patient’s medical
history. Most of the complaints are related to daytime
sleepiness and also during the time he wakes up. EDS has been
always he first symptom of narcolepsy and ones it’s tested and
found in cataplexy, it justify the presence of narcolepsy. In this
case the test method used will be MSLT which will be
accompanied by five naps routine or schedule.
Treatment and prevention
Since the cure for the disorder has never been found, the disease
is only managed. the prioritize measures are better sleep
hygiene exercise and then the use of drugs or medication. Some
other measures are not being exposed to too much light,
relaxing bed, avoid alcohol and caffeine. Sodium oxybate has
been authorized and approved by U.S Food and Drug

5. Administration (FDA) for cataplexy treatment (Lammers, 2017).
The safety measures are as follow, being aware of the danger
e.g. glass and also sharp ages, stress management, don’t deprive
yourself sleep, then make sure to evens that can prove strong
emotions don’t drive heavy vehicles or machines and always
teach others about the disease.
References
Lammers, G. J. (2017). Narcolepsy with cataplexy. Oxford
Textbook of Sleep Disorders, 119.
Liblau, R. S., Vassalli, A., Seifinejad, A., & Tafti, M. (2015).
Hypocretin (orexin) biology and the pathophysiology of
narcolepsy with cataplexy. The Lancet Neurology, 14(3), 318-
328.
Sturzenegger, C., Baumann, C. R., Lammers, G. J., Kallweit,
U., van der Zande, W. L., & Bassetti, C. L. (2018). Swiss
Narcolepsy Scale: A simple screening tool for hypocretin-
deficient narcolepsy with cataplexy. Clinical and Translational
Neuroscience, 2(2), 2514183X18794175.

6. Szakacs, Z., Dauvilliers, Y., Mikhaylov, V., Poverennova, I.,
Krylov, S., Jankovic, S., ... & Schwartz, J. C. (2017). Safety
and efficacy of pitolisant on cataplexy in patients with
narcolepsy: a randomised, double-blind, placebo-controlled
trial. The Lancet Neurology, 16(3), 200-207.
Running Head: CLINICAL EVIDENCE BASED PRACTICE
1
CLINICAL EVIDENCE BASED PRACTICE
5
Narcolepsy with Cataplexy
Nicole Stallworth
Herzing University
Clinical Evidence Based Practice.
Narcolepsy with cataplexy is a sleep disorder that affects
about 0.02% of adults in the world. The disorder is
characterized by sleepiness during the daytime, with loss of

7. muscle tone. Narcolepsy on its own is a sleep disorder in which
there is excessive sleepiness and hallucinations. The disorder
occurs in men with an equal chance of occurrence in women.
Symptoms of the disease appear in childhood or during
adolescence. Most people who have the symptoms of the
disorder go for years without getting an appropriate diagnosis.
People with the disorder have an urge to sleep even during
normal activities. Sleep characteristics can even occur while a
person is awake. In cataplexy, there is muscle paralysis of the
Rapid Eye Movement (REM) phase of the sleep cycle, which
occurs during waking hours. It results in loss of muscle tone,
leading to weakness of the trunk, arms and legs. The main cause
of narcolepsy with cataplexy is deficiency of hypocretin, a
hormone from the brain. The hormone alerts systems in the
brain, regulating sleep wake cycles. In the condition, the cells
that produce hypocretin, which are located in the hypothalamus,
are destroyed. There is no cure for the condition at the moment.
However, behavioural treatments and some medications can
help improve symptoms in patients. When well managed,
patients lead normal lives (Dauvilliers et al, 2007). The topic is
important in nursing care due to the several cases of
misdiagnosis of the condition taking place. Notably, the
condition can be diagnosed through physical examinations,
medical history taking and conducting sleep studies on patients.
Based on the nature of diagnosing the condition, nurses are best
suited to diagnose the problem, as they care for the patient
(Rios et al, 2010).
For a nurse to obtain relevant yet sensitive information from a
patient, which can guide them to diagnosing a problem such as
narcolepsy with cataplexy, there is need for a model to guide in
assessing the patient. The PICOT question format is a formula
for developing researchable and answerable questions, which
clinicians can use to ease the evaluation process. Notably, most
nurses fail to understand the real cause of conditions facing a
patient apart from the disease itself, due to lack of the skills
necessary in assessment. They also do not understand that in

8. clinical care, there is need to focus on a multi-sectorial
approach in order to understand what really intensifies the
conditions patients face. What is more, nurses need to
understand the importance of using an integrated approach to
patient care, which is preventive and promotive oriented, rather
than just a curative and rehabilitative one. The PICO(T) format
therefore is necessary in evaluating a patient to diagnose the
underlying factors, which may have led to the problem, away
from the clinical setting (Indicators, 2003).
P: A 21-year-old AA female diagnosed with narcolepsy with
cataplexy without a family history of narcolepsy.
I: Adding altered eating patterns reduction of daily stress and
daily naps.
C: Methylphenidate alone.
O: Reduction of daytime sleepiness and cataplexy.
In A 21 year-old AA female diagnosed with narcolepsy with
cataplexy without a family history of narcolepsy will Adding
altered eating patterns, reduction in daily stress and daily naps
versus Methylphenidate alone lead to a Reduction of daytime
sleepiness and cataplexy?
A good question that the nurse should frame to the patient
should be simple to understand, answerable and realistic. In the
model, “P” stands for population or patient, whereby the
question the nurse should ask should focus mainly on the
ethnicity, gender and age of the patient with the disorder in
question. The “I” in the format stands for intervention or
indicator, whereby the question of interest should be geared
towards discovering the exposure to the disease, the prognostic
factor and the risk behaviour that may have led to the disorder.
The “C” in the model stands for comparison or control, whereby
the nurse should frame the question to inquire the state of the
patient while normal. It could be a placebo or business as usual
question, in the absence of symptoms in the patient. The “O” in
the model stands for the outcome, whereby the nurse should
focus the question on understanding the rate of occurrence of
the condition and the risk of the disease. It is in this stage that

9. the nurse should also make an accurate diagnosis of the
condition. Finally, the “T” in the model stands for time,
whereby the clinician should focus on understanding the
duration of time the clinical procedure on the patient, geared
towards intervention may take, as well as the period of time to
observe the patient. Essentially, every question should have an
intervention (Riva et al, 2012).
The PICO(T) framework not only helps the clinician make an
accurate diagnosis to a condition, but also helps in carrying out
the right intervention on patients. Quality of care is dependent
on the ability to formulate a good action plan with proven
efficacy. Besides, the clinician should understand that self-care
for patients while way from the hospital setting is important in
preventing recurrence of conditions. To achieve this, there is
need to understand the background information concerning a
patient, so that the clinician can give appropriate advice to the
patient after the clinical procedure. The advice will guide the
patient in developing primary healthcare goals for themselves,
while away from the clinic, which will reduce revisits to the
clinic. Most patients however find some questions that
clinicians ask a bit personal. They may end up giving wrong
answers to avoid disclosing information they may deem
embarrassing. The feedback obtained may therefore be
subjective, which may lead to wrong decision-making by the
clinician. In order to receive objective responses from patients,
the clinician needs a model to guide them in asking clear
questions and also help in receiving answers easily. The
PICO(T) format is essential in this scope, as its efficacy is
research based and proven to be essential to clinical care.
References
Indicators, A. Q. (2003). Guide to patient safety

10. indicators. Rockville, MD: Agency for Healthcare Research and
Quality.
Riva, J. J., Malik, K. M., Burnie, S. J., Endicott, A. R., &
Busse, J. W. (2012). What is your research question? An
introduction to the PICOT format for clinicians. The Journal of
the Canadian Chiropractic Association, 56(3), 167.
Rios, L. P., Ye, C., & Thabane, L. (2010). Association between
framing of the research question using the PICOT format and
reporting quality of randomized controlled trials. BMC medical
research methodology, 10(1), 11.
Dauvilliers, Y., Arnulf, I., & Mignot, E. (2007). Narcolepsy
with cataplexy. The Lancet, 369(9560), 499-511.