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Section 10
Narcolepsy Treatment

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How to Overcome Sleep Inertia with Narcoleptic Clients
In the last section, we discussed delayed sleep phase syndrome.  Delayed sleep phase syndrome is a different type of circadian rhythm maladjustment.  Our discussion focused on treating delayed sleep phase syndrome through a three step intervention called phase delay.  The three steps to phase delay are initial phase delays, subsequent phase delays, and maintaining the rhythm.

In this section, we will discuss treating narcolepsy.  We will discuss methods for decreasing narcoleptic occurrences, tips for those who live with a narcoleptic, and sleep inertia.   

First, let’s discuss some behavioral methods for decreasing narcoleptic occurrences. When you diagnosed your client with narcolepsy, you likely found that it has no cure.  However, with, Hugh, age 46, I found that there were some behavioral methods that helped to decrease narcoleptic occurrences. Clearly, as with other sleep disorders, Hugh maximized the efficiency of his nightly sleep by setting a regular sleep schedule. 

4 Methods for Decreasing Narcoleptic Occurrences

Method # 1: Short, Daytime Naps
However, Hugh did not just restrict sleep to the evenings.  I suggested to Hugh, "Use short daytime naps to your advantage."  Hugh responded, "I’ve thought about that, but I kind of feel guilty taking naps in the middle of the day when others are hard at work." 

How might you have responded to Hugh’s feelings of guilt regarding day time naps? 

I stated, "Hugh, haven’t you found that you are more alert following a nap?"  Hugh agreed that he was more alert following a nap.  I continued, "If a regular nap two or three times a day makes you more productive and helps to prevent sleep attacks, you might learn to feel good about naps." 

Method # 2: Be Aware of Low-Alertness Periods
As we discussed on the last track, circadian rhythms can influence times of sleep.  Hugh’s circadian rhythms were measured by a sleep lab. Results indicated that Hugh’s circadian rhythm contained a sleep wake trough between two and four in the afternoon.

After learning of this sleep wake trough, Hugh stated, "Wow. That’s interesting, but it’s really no surprise since that’s when I have the worst attacks." Does your narcoleptic client experience a certain time of day during which he or she experiences the worst narcoleptic attacks? To avoid narcoleptic attacks during periods of low alertness, Hugh increased his physical activity during these times. Hugh stated, "It also helps if I avoid boring or repetitive tasks in mid afternoon." 

Method # 3: Pros & Cons of Caffeine
Clearly, it can be productive for clients like Hugh to avoid alcohol and other sedatives that may aggravate the symptoms of narcolepsy.  Caffeine, however, is sometimes recommended for narcoleptics.  You already know how caffeine works and the benefits of caffeine regarding alertness.  However, when I suggested the use of caffeine to Hugh, I asked him to bear in mind that caffeine may interfere with deep sleep at night if he consumed too much later in the day. 

Could your narcoleptic client benefit from a discussion regarding the pros and cons of caffeine as a method to decrease narcoleptic occurrences?

Method # 4: Deal with Resultant Feelings
Finally, I have found that narcoleptic clients like Hugh are generally faced with feelings of guilt, inadequacy, anger, or depression.  My attempts to address these resultant feelings with Hugh followed standard clinical techniques.  However, Hugh benefited greatly from client education regarding how these feelings were related to his narcolepsy. 

How can you help your narcoleptic client deal with resultant feelings?

Tips for Those Who Live with a Narcoleptic
Next, let’s discuss some tips for those who live with a narcoleptic.  Hugh’s wife, Jeanie, accompanied him to several of our sessions to provide input and gain some insight into her husband’s condition.  In one session, Jeanie asked, "What can I do to help?"  Like Jeanie, the significant other of your narcoleptic client may ask to help.  With what information would you provide your Jeanie? 

I stated, "You have already helped tremendously.  By supporting him to have a consultation and sleep study, you helped Hugh to obtain a definitive diagnosis.  And I’m sure he appreciates you attending these sessions periodically.  Another thing you can do is educate family, friends, and especially employers about narcolepsy, its special needs, and its physical basis.  If you can help Hugh make simple adjustments in his schedule and responsibilities, you will be a big help." 

Jeanie then asked, "Should I wake him when he has an attack?"  I responded, "Yes.  The sleep paralysis of narcolepsy can be quickly reversed simply by touching him."  Are those close to your narcoleptic client unsure if they should wake the client during an attack?  How might you approach the subject?

Sleep Inertia
In addition to methods for decreasing narcoleptic occurrences and tips for those who live with a narcoleptic, let’s discuss sleep inertia. On this track, we decided to relate sleep inertia to narcolepsy because of the recommendation of naps discussed previously. However, sleep inertia is an idea that can be applied to other sleep disorders as well. You might consider asking your sleep disorder client if he or she has ever awakened from a nap feeling as though his or her arms and legs were made of lead. Was your client’s vision bobbing like a keg in a tide?  Did he or she find that focusing on other tasks was difficult? 

If so, your client may be experiencing a phenomenon called sleep inertia.With sleep inertia, a client’s performance following a nap is actually worse than it was before the nap.This decrease normally lasts less than a half hour, but it can be dangerous to do anything that requires alertness and coordination. If your sleep disorder client frequently awakens to this condition, he or she may want to exercise caution. I advise my sleep disorder clients to allow several minutes for the effects of sleep inertia to wear off before driving, operating machinery, or engaging in any hazardous activity. The cause of sleep inertia is unknown.

Are you treating a sleep disorder client who has complained of the effects of sleep inertia?

In this section, we have discussed treating narcolepsy.  We discussed methods for decreasing narcoleptic occurrences, tips for those who live with a narcoleptic, and sleep inertia.  

In the next section, we will discuss four mental imagery techniques.  Four mental imagery techniques that we will discuss are the ‘Float Along,’ ‘Drifting Downward.’ ‘Count Down to Relaxation,’ and the ‘On Vacation’ techniques. 

Peer-Reviewed Journal Article References:
Delazer, M., Högl, B., Zamarian, L., Wenter, J., Gschliesser, V., Ehrmann, L., Brandauer, E., Cevikkol, Z., & Frauscher, B. (2011). Executive functions, information sampling, and decision making in narcolepsy with cataplexy. Neuropsychology, 25(4), 477–487. 

Groeger, J. A., Lo, J. C. Y., Burns, C. G., & Dijk, D.-J. (2011). Effects of sleep inertia after daytime naps vary with executive load and time of day. Behavioral Neuroscience, 125(2), 252–260.

Reznik, D., Gertner-Saad, L., Even-Furst, H., Henik, A., Ben Mair, E., Shechter-Amir, D., & Soffer-Dudek, N. (2018). Oneiric synesthesia: Preliminary evidence for the occurrence of synesthetic-like experiences during sleep-inertia. Psychology of Consciousness: Theory, Research, and Practice, 5(4), 374–383. 

Walker, L. A. S., Bourque, P., Smith, A. M., & Warman Chardon, J. (2017). Autosomal dominant cerebellar ataxia, deafness, and narcolepsy (ADCA-DN) associated with progressive cognitive and behavioral deterioration. Neuropsychology, 31(3), 292–303. 

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