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Ed Yong As the H1N1 swine flu pandemic swept the world in 2009, China saw a spike in cases of narcolepsy — a mysterious disorder that involves sudden, uncontrollable sleepiness. Meanwhile, in Europe, around 1 in 15,000 children who were given Pandemrix — a now-defunct flu vaccine that contained fragments of the pandemic virus — also developed narcolepsy, a chronic disease. Immunologist Elizabeth Mellins and narcolepsy researcher Emmanuel Mignot at Stanford University School of Medicine in California and their collaborators have now partly solved the mystery behind these events, while also confirming a longstanding hypothesis that narcolepsy is an autoimmune disease, in which the immune system attacks healthy cells. Narcolepsy is mostly caused by the gradual loss of neurons that produce hypocretin, a hormone that keeps us awake. Many scientists had suspected that the immune system was responsible, but the Stanford team has found the first direct evidence: a special group of CD4+ T cells (a type of immune cell) that targets hypocretin and is found only in people with narcolepsy. “Up till now, the idea that narcolepsy was an autoimmune disorder was a very compelling hypothesis, but this is the first direct evidence of autoimmunity,” says Mellins. “I think these cells are a smoking gun.” The study is published today in Science Translational Medicine1. Thomas Scammell, a neurologist at Harvard Medical School in Boston, Massachusetts, says that the results are welcome after “years of modest disappointment”, marked by many failures to find antibodies made by a person's body against their own hypocretin. “It’s one of the biggest things to happen in the narcolepsy field for some time.” It is not clear why some people make these T cells and others do not, but genetics may play a part. In earlier work2, Mignot showed that 98% of people with narcolepsy have a variant of the gene HLA that is found in only 25% of the general population. © 2013 Nature Publishing Group

Related chapters from BP7e: Chapter 14: Biological Rhythms, Sleep, and Dreaming; Chapter 15: Emotions, Aggression, and Stress
Related chapters from MM:Chapter 10: Biological Rhythms and Sleep; Chapter 11: Emotions, Aggression, and Stress
Link ID: 19055 - Posted: 12.19.2013

By JANE E. BRODY Clea Howard is hardly a tuned-out, disinterested high school student. She likes to be busy: In addition to maintaining an excellent scholastic record at a demanding high school an hour from her Brooklyn home, she studies art, takes dance classes and plays soccer. Yet during her freshman and sophomore years, she was always tired, no matter how much she slept at night. She often fell asleep in class, on the subway, while doing homework or talking to her boyfriend. Even on vacation, when she logged 10 or 11 hours of sleep at night, Clea said, “I was still very tired during the day. I made excuses for myself — maybe I just need more sleep than other teenagers, or maybe I don’t feel any more tired than other people.” Her pediatrician unearthed no medical reason or aberrant sleep habits to explain her extreme fatigue and tendency to doze off at the drop of a hat. An endocrinologist could not find any hormonal or diet-related abnormality. Perhaps, her pediatrician said, a sleep study might show if Clea was getting the kind of rest at night that restores body and mind. At the Sleep Disorders Institute in New York, Clea met with a sleep specialist. It did not take long for Dr. Maha Ahmad to zero in on a possible diagnosis: narcolepsy. © 2012 The New York Times Company

Related chapters from BP7e: Chapter 14: Biological Rhythms, Sleep, and Dreaming
Related chapters from MM:Chapter 10: Biological Rhythms and Sleep
Link ID: 16482 - Posted: 03.08.2012

by Sujata Gupta In spring last year, the number of narcolepsy cases in Beijing, China, multiplied threefold. Now, it looks like the swine flu pandemic of the previous winter was to blame. Previously, similar rises in cases of narcolepsy – a disorder that causes sleepiness at inappropriate times – have been linked to use of a swine flu vaccine. The cause was presumed to lie in the drug's adjuvants – additives that boost the immune response to the vaccine. The claim puzzled researchers who saw a concurrent rise in narcolepsy cases in China, where few people had opted to get vaccinated and those who did received a vaccine without adjuvants. Could the flu itself be to blame? To find out, Fang Han and his colleagues at Beijing University People's Hospital studied the medical profiles of 906 people who had come to the hospital with narcolepsy since 1998. The group found that, even in the years before the vaccine was introduced in October 2009, the number of narcolepsy cases followed a seasonal pattern – cases dropped significantly around November and spiked in April. The peak was higher than normal in the spring after the swine flu pandemic (Annals of Neurology, DOI: 10.1002/ana.22587). The idea that flu causes narcolepsy fits in with the theory that narcolepsy is triggered by the immune system's response to airway infections. © Copyright Reed Business Information Ltd.

Related chapters from BP7e: Chapter 14: Biological Rhythms, Sleep, and Dreaming
Related chapters from MM:Chapter 10: Biological Rhythms and Sleep
Link ID: 15711 - Posted: 08.23.2011

A swine flu jab has been linked to rare cases of a sleeping disorder and should be the last line of protection for young people, European regulators say. The European Medicines Agency (EMA) said Pandemrix should only be given to children and teenagers at risk of H1N1 flu if other jabs are unavailable. More than six million doses of the vaccine have been given in the UK. Ten suspected cases of narcolepsy linked to the vaccine have been reported to the UK's drug regulator. Pandemrix, made by GlaxoSmithKline (GSK), was the most widely used in the UK during the 2009/10 flu pandemic. However, the vaccine is no longer in use and the remaining stocks will be destroyed this autumn. The EMA's investigation followed reports, mainly from Finland and Sweden but also from Iceland and the UK, of children and adolescents suffering the sleep disorder narcolepsy, which causes people to fall asleep suddenly and unexpectedly. It said studies had shown a six to 13-fold increased risk of narcolepsy in children and adolescents vaccinated with Pandemrix compared with unvaccinated children. In a statement, the EMA said it had "noted that the vaccine is likely to have interacted with genetic or environmental factors which might raise the risk of narcolepsy, and that other factors may have contributed to the results." BBC © 2011

Related chapters from BP7e: Chapter 14: Biological Rhythms, Sleep, and Dreaming
Related chapters from MM:Chapter 10: Biological Rhythms and Sleep
Link ID: 15600 - Posted: 07.26.2011

By INGFEI CHEN Scientists have begun to pull back the veil of mystery that has surrounded narcolepsy since it was first described more than 125 years ago. In 2000, investigators reported that a lack of a neurochemical called hypocretin is a prime culprit in the sleep disorder. Patients with classic narcolepsy — a combination of irresistible sleepiness and sudden collapses from muscle weakness — are missing most of the brain cells that make the wakefulness-promoting protein. But high expectations for a therapeutic payoff have since flagged. While narcoleptic patients have gained two helpful new medications in the last decade, they are still waiting for a cure to correct their hypocretin deficiency. Meanwhile, researchers remain flummoxed by the underlying question: What destroys the hypocretin-producing neurons in the first place? “A few years ago we were all sort of proudly crowing about how now we knew what was happening in narcolepsy,” said Dr. Thomas Scammell, a neurologist at Harvard Medical School. “And yeah, now we know what the cellular abnormality is, but we still don’t know what causes it.” As a result, he said, “we can’t stop or reverse the cell loss.” Copyright 2008 The New York Times Company

Related chapters from BP7e: Chapter 14: Biological Rhythms, Sleep, and Dreaming
Related chapters from MM:Chapter 10: Biological Rhythms and Sleep
Link ID: 11337 - Posted: 06.24.2010

By LISA SANDERS, M.D. The middle-aged woman perched on the edge of a plastic chair as the doctor explained his thoughts on why her son was having persistent headaches. Suddenly, she toppled forward, collapsing onto the linoleum floor. Dr. Philip Ledereich hurried over to the woman. “Call 911,” he shouted to his nurse. “The patient’s mother has fainted.” Was the fainting brought on simply by stress? Or could there be an underlying neurological problem? Ledereich, an ear, nose and throat specialist in Clifton, N.J., first met the mother a couple of weeks before, when she herself came in as a patient. She was fainting several times a day, and no one knew why. Ledereich hadn’t been able to figure it out, either. Despite that, she took her son to see him for the treatment of a chronic sinus infection. Ledereich was describing various treatment alternatives when the woman pitched to the floor. She had been having these spells almost daily for the past several months, she told him at their first appointment. She was 49, a nurse, and she considered herself pretty healthy until one Saturday nearly three months earlier. That day she had just put on her shoes to go to a bar mitzvah, and as she straightened up she felt a fluttering sensation in her stomach. The next minute she was on the floor. Her husband rushed to her side. She could hear him calling her name, but she couldn’t answer him; she couldn’t even open her eyes. Copyright 2010 The New York Times Company

Related chapters from BP7e: Chapter 14: Biological Rhythms, Sleep, and Dreaming
Related chapters from MM:Chapter 10: Biological Rhythms and Sleep
Link ID: 13827 - Posted: 06.24.2010

By Carolyn Y. Johnson Research into an unusual sleep disorder is unraveling what goes awry in the brains of people who fall prey to daytime sleep attacks - and shedding light on everything from addiction to appetite. Work that began in sleepy dogs and mice has led to a significant advance in understanding narcolepsy, providing new insight into the ways in which sleep and wakefulness, eating, and addictive behaviors are linked. The work is pointing to potential therapies not only for people who are chronically sleepy, but also for the much larger numbers who have trouble sleeping at all. At the root of this work is a fundamental brain chemical called orexin. Research over the past decade has shown that narcolepsy is caused by the loss of a type of brain cell that produces orexin. Scientists have found that the chemical also helps determine when we are asleep and awake and plays a role in regulating appetite and addiction. Orexin “was only discovered in 1998,’’ said Dr. Tom Scammell, a neurologist at Beth Israel Deaconess Medical Center. “A lot of the work is related to sleep, but it’s also opened up these other areas.’’ His lab teases out the nuances of narcolepsy with some unconventional techniques - including tickling sleepy mice to keep them awake and feeding them Froot Loops. The anticipation of the sugary cereal triggers one of the most striking symptoms of the disease: a temporary loss of muscle control called cataplexy, causing mice to drop in their tracks. Using gene therapy, he restored orexin to the brains of mice who lacked it and found that it improves their ability to stay awake and reduces cataplexy. © 2009 NY Times Co.

Related chapters from BP7e: Chapter 14: Biological Rhythms, Sleep, and Dreaming
Related chapters from MM:Chapter 10: Biological Rhythms and Sleep
Link ID: 13517 - Posted: 06.24.2010

By INGFEI CHEN On a sun-drenched morning this month, a small, black, bushy-haired dog trotted out from the animal care center at Stanford. The Belgian schipperke, Bear, soon veered off to lift a hind leg over a shrub. He was, clearly, oblivious to the gravitas of the day. Bear had spent nearly seven years in the underground kennels as part of a colony of narcoleptic dogs studied by Dr. Emmanuel Mignot, director of the Stanford Center for Narcolepsy. Dr. Mignot had just signed papers to adopt the dog, the last of the colony. Bear’s freedom ended 30 years of investigations that led to the discovery of the importance of a neurochemical called hypocretin in human and animal narcolepsy, and in normal sleep. Bear will now be a pet. And Dr. Mignot has turned to less huggable research subjects, like wet, cold-blooded and, unexpectedly, less cooperative zebrafish. Investigators now understand that narcolepsy arises from a deficiency of the brain cells that make hypocretin, similar to the way that Parkinson’s is caused by the loss of dopamine-producing neurons. Copyright 2007 The New York Times Company

Related chapters from BP7e: Chapter 14: Biological Rhythms, Sleep, and Dreaming
Related chapters from MM:Chapter 10: Biological Rhythms and Sleep
Link ID: 10876 - Posted: 06.24.2010

Health Canada has issued a warning about serious skin and allergic reactions related to Alertec, a drug used to relieve excessive sleepiness due to narcolepsy, obstructive sleep apnea and shift-work sleep disorders. The federal agency said patients taking Alertec (modafinil) should seek immediate medical attention if they have any of the following symptoms: skin rash, hives, sores in the mouth, blisters and skin peeling; swelling of the face, eyes, lips, tongue or throat; trouble swallowing or breathing; or a hoarse voice. Alertec, made by Shire Canada Inc., is not approved in Canada for use in children for any condition. The drug can cause mental problems, such as depression, anxiety, hallucinations, mania and suicidal thoughts, although these events were rare during controlled studies. Health Canada says anyone experiencing such psychiatric conditions should stop taking Alertec and seek medical attention. Those taking the drug should tell their doctor if they have any heart problems, chest pain, have had a heart attack or a history of psychiatric disorders. © The Canadian Press, 2007

Related chapters from BP7e: Chapter 14: Biological Rhythms, Sleep, and Dreaming
Related chapters from MM:Chapter 10: Biological Rhythms and Sleep
Link ID: 11130 - Posted: 06.24.2010

Heidi Ledford By learning from patients who nod off unexpectedly during the day, researchers have pinpointed a chemical that could help people who can't sleep at night. One out of every 10 people in the United States suffers from chronic insomnia, making for a big sleeping-pill market. The most popular pills work by strengthening the effects of a brain chemical that slows the nervous system and promotes relaxation. But these drugs can also carry unpleasant side effects, including memory loss and grogginess the next day. The race for a better sleeping pill is still on. Now, a new approach targets brain hormones called orexins. Orexins are known to be linked to sleepiness; patients with a sleeping disorder called narcolepsy have low levels of these hormones and are chronically sleepy during the day, sometimes falling asleep on the job or while driving. The new chemical, known as ACT-078573, blocks the action of orexins. When given to dogs, rats and humans, it decreased alertness in all three species, while shortening the time it took for them to fall asleep. Franois Jenck, of the Swiss biotech company Actelion Pharmaceuticals in Allschwil, and his colleagues report the findings in the journal Nature Medicine1. Orexins aren't an obvious target for developing new sleeping pills. Narcoleptics suffer not only from sleepiness, but also from sudden loss of muscle tone that, in extreme cases, can cause them to collapse and remain frozen - fully conscious - for minutes at a time. Laughter often triggers a collapse in human narcoleptics, whereas narcoleptic dogs can crumple from the thrill of dinnertime or being let loose to play in the yard. "They get excited and run out the door and just go 'thump'," says Jerome Siegel, a sleep researcher at the University of California, Los Angeles. ©2007 Nature Publishing Group

Related chapters from BP7e: Chapter 14: Biological Rhythms, Sleep, and Dreaming; Chapter 13: Homeostasis: Active Regulation of the Internal Environment
Related chapters from MM:Chapter 10: Biological Rhythms and Sleep; Chapter 9: Homeostasis: Active Regulation of the Internal Environment
Link ID: 9893 - Posted: 06.24.2010

Paradoxically, a single MHC class II allele, HLA-DQ0602, confers susceptibility to narcolepsy but prevents development of type I diabetes. Clinical immunologist Lars Fugger and structural biologist Yvonne Jones, both at Oxford University, have compared the crystal structure of the allele with those of two similar MHC molecules that respectively predispose to type 1 diabetes and protect against narcolepsy.1 They have identified unique features of several pockets within the peptide-binding groove of HLA-DQ0602 that could explain the contradiction through differential influences on T-cell stimulation. In particular, says Fugger, the extra large P4 pocket selectively accommodates a candidate auto-antigenic peptide that might stimulate autoreactive T cells in narcolepsy, a potential autoimmune disorder. For diabetes, the unusual stability of the P9 pocket could promote development of regulatory T cells able to actively suppress disease-causing T cells. "In many ways," he adds, "I would say that narcolepsy and diabetes could be mirrors of each other." © 2004, The Scientist LLC,

Related chapters from BP7e: Chapter 14: Biological Rhythms, Sleep, and Dreaming
Related chapters from MM:Chapter 10: Biological Rhythms and Sleep
Link ID: 5126 - Posted: 06.24.2010

Copyright © 2002 AP Online By LAURAN NEERGAARD, AP Medical Writer WASHINGTON - The notorious date-rape drug GHB won government approval Wednesday to treat a rare but dangerous complication of the sleep disorder narcolepsy - but it will be sold under some of the most severe restrictions ever imposed on a medicine. The Food and Drug Administration approval puts the chemical in a peculiar position. Throughout the 1990s, the government cracked down on illegal use of GHB - abused as a party drug, sex and athletic enhancer and - because it can knock people out - a date-rape drug. Several dozen deaths are blamed on the chemical's abuse. Now the maker of the only FDA-approved version, Orphan Medical Inc., will have to balance how to get GHB to the relatively few patients who qualify while keeping it from falling into the wrong hands. Copyright © 2001 Nando Media

Related chapters from BP7e: Chapter 14: Biological Rhythms, Sleep, and Dreaming; Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Related chapters from MM:Chapter 10: Biological Rhythms and Sleep; Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Link ID: 2327 - Posted: 06.24.2010

A Mayo Clinic study reports that narcolepsy, a sleep disorder, is more common in men and originates in their 20s. The study, which appeared in a recent edition of the journal Sleep, also found that narcolepsy without cataplexy -- a sudden loss of muscle tone -- is an important subgroup, warranting further study. Narcolepsy is a sleep disorder associated with excessive daytime sleepiness, involuntary daytime sleep episodes, disturbed nocturnal sleep and cataplexy (weakness with emotions such as laughter). Narcolepsy affects over 100,000 people in the United States. Copyright © 1995-2002 ScienceDaily Magazine

Related chapters from BP7e: Chapter 14: Biological Rhythms, Sleep, and Dreaming
Related chapters from MM:Chapter 10: Biological Rhythms and Sleep
Link ID: 1977 - Posted: 06.24.2010

About 50,000 people have been diagnosed with narcolepsy in the U.S, but there may be as many as 2.4 million people unknowingly living with it. Narcolepsy causes excessive daytime sleepiness, fatigue and even sudden muscular weakness, known as cataplexy. Here, six men and women speak about living with narcolepsy. Copyright 2009 The New York Times Company

Related chapters from BP7e: Chapter 14: Biological Rhythms, Sleep, and Dreaming
Related chapters from MM:Chapter 10: Biological Rhythms and Sleep
Link ID: 13214 - Posted: 08.27.2009

Scientists have uncovered genetic evidence suggesting the sleep disorder narcolepsy is linked to a fault in the immune system's "foot soldier" cells. It suggests these T-cells may cause the condition by attacking cells in the sleep centres of the brain. Narcolepsy, which causes extreme daytime sleepiness and sudden muscle weakness, has previously been linked to a malfunctioning immune system. The Stanford University research appears in the journal Nature Genetics. Narcolepsy is a mysterious, uncommon condition that can be very distressing for those who have it. It can trigger "sleep attacks" without any warning during any normal activity. In addition, some people can experience "cataplexy", where strong emotions such as anger, surprise, or laughter can trigger an instant loss of muscle strength, which, in some cases, can cause collapse. There is currently no cure for narcolepsy, only ways to minimise symptoms such as taking frequent, brief naps evenly spaced throughout the day. The condition has previously been linked to depletion of cells deep in the regulatory regions of the brain. But lead researcher Dr Emmanuel Mignot said while previous research had only suggested a link with a fault in the immune system, the latest study provided firm evidence. The Stanford team carried out an extensive genetic analysis to identify specific areas of the genome which appeared to be linked to the condition. They pinpointed three specific genetic variants in the same gene in people with European and Asian ancestry that appeared to be associated with an increased susceptibility for narcolepsy. The gene in question plays a key role in the functioning of an important receptor used by T-cells to recognise foreign proteins in the body. (C)BBC

Related chapters from BP7e: Chapter 14: Biological Rhythms, Sleep, and Dreaming; Chapter 15: Emotions, Aggression, and Stress
Related chapters from MM:Chapter 10: Biological Rhythms and Sleep; Chapter 11: Emotions, Aggression, and Stress
Link ID: 12822 - Posted: 05.05.2009

Genetic research could shed light on what is happening in people with the mysterious sleep disorder narcolepsy. The condition causes extreme daytime sleepiness, and sudden muscle weakness. Japanese researchers found a genetic variant linked to a much higher risk of narcolepsy, publishing their results in the journal Nature Genetics. It is linked to genes involved in regulating sleep, and the scientists say their finding could help unravel narcolepsy's causes. The condition is an uncommon and distressing one - people with it can suffer "sleep attacks" without any warning during any normal activity. In addition, some people can experience "cataplexy", where strong emotions such as anger, surprise, or laughter can trigger an instant loss of muscle strength, which, in some cases, can cause collapse. The causes are still not completely clear, although some scientists believe they revolve around a shortage of a chemical called hypocretin which sends signals to the brain about sleeping and waking up. There is strong evidence that the condition can run in families, so the University of Tokyo team are looking for the genetic differences which may be involved. They looked at the genetic code of hundreds of volunteers, some with narcolepsy, some without, to look for differences. The variant they found was linked to an 79% higher chance of narcolepsy in Japanese people, and a 40% increased chance in other ethnic groups. It is found close to two genes, CPT1B, and CHKB, which have already been singled out as candidates for involvement in the disorder - as they both have a role in regulating sleep. (C)BBC

Related chapters from BP7e: Chapter 14: Biological Rhythms, Sleep, and Dreaming
Related chapters from MM:Chapter 10: Biological Rhythms and Sleep
Link ID: 12086 - Posted: 09.29.2008

A chemical found naturally in the brain could be used to treat the sleep disorder narcolepsy, US scientists say. Researchers at the University of Texas said injecting a chemical called orexin stopped symptoms in mice with narcolepsy. They found the treatment made the mice more alert and reduced other narcoleptic symptoms, such as muscle weakness, called cataplexy. The study appeared in the Proceedings of the National Academy Sciences. Dr Masashi Yanagisawa, professor of molecular genetics, and colleagues studied genetically modified mice which lacked the ability to naturally produce orexin. Orexin are small chains of molecules, produced by nerve cells in the area of the brain called the hypothalamus. (C) BBC

Related chapters from BP7e: Chapter 14: Biological Rhythms, Sleep, and Dreaming
Related chapters from MM:Chapter 10: Biological Rhythms and Sleep
Link ID: 5143 - Posted: 03.16.2004

New Haven, Conn. -- A Yale researcher has received a $1.4 million grant to study a neurotransmitter whose loss in the brain is believed responsible for narcolepsy, an often misunderstood disease marked by an uncontrollable desire to sleep. "It's profoundly debilitating," said Anthony van den Pol, professor of neurosurgery at Yale School of Medicine . "For example, narcoleptics may go to work and, despite their best intentions to the contrary, spontaneously fall asleep, raising the ire of their employer. Then at night they may have trouble sleeping, and may suffer from hallucinations when falling asleep or waking." Van den Pol's laboratory, in collaboration with colleagues at Stanford and the Scripps Research Institute, first described the hypothalamic neurotransmitter, hypocretin, in 1998. Later studies showed that patients with narcolepsy did not have any neurons in the brain to make hypocretin. More recently, van den Pol and other researchers also found that hypocretin appears to be linked to pain modulation in the spinal cord.

Related chapters from BP7e: Chapter 14: Biological Rhythms, Sleep, and Dreaming; Chapter 8: General Principles of Sensory Processing, Touch, and Pain
Related chapters from MM:Chapter 10: Biological Rhythms and Sleep; Chapter 5: The Sensorimotor System
Link ID: 1509 - Posted: 02.09.2002

CHAPEL HILL - A brain protein linked to narcolepsy, the sudden, uncontrollable and inexplicable onset of sleep, helps regulate bodily sensations . Exactly how that protein, hypocretin-2, is involved in narcolepsy remains unclear. Indications are that people and animals exhibiting narcoleptic symptoms are deficient in this protein or the molecular receptor to which it attaches. But the new findings by neuroscientists at the University of North Carolina at Chapel Hill and Yale University may open a door to the answer. Their report is the cover story for the January 15 issue of the Journal of Physiology. According to Dr. Edward R. Perl, professor of cell and molecular physiology at UNC-Chapel Hill School of Medicine and the report's corresponding author, hypocretin peptides are distributed widely throughout the brain. They arise from part of the hypothalamus, a region prominently involved in regulation of the autonomic nervous system, endocrine activity, and mood and motivational states. Recently, these proteins have been implicated in the regulation of behaviors associated with arousal such as feeding and sleep.

Related chapters from BP7e: Chapter 14: Biological Rhythms, Sleep, and Dreaming; Chapter 13: Homeostasis: Active Regulation of the Internal Environment
Related chapters from MM:Chapter 10: Biological Rhythms and Sleep; Chapter 9: Homeostasis: Active Regulation of the Internal Environment
Link ID: 1301 - Posted: 01.11.2002

By DAVID TULLER Robert Cloud, a lawyer in Cincinnati, has fallen asleep while talking to clients, while eating dinner, even while meeting with a judge. Mr. Cloud, 58, has suffered for much of his adult life from narcolepsy, a little-understood sleep disorder that afflicts as many as 100,000 to 200,000 Americans. People with the condition are prone to sudden, uncontrollable attacks of intense sleepiness. They feel exhausted most of the time, and many also experience cataplexy, brief episodes of loss of muscle control that may occur for no apparent reason or be brought on by laughter, anger, embarrassment, excitement or other strong emotions, as well as physical exertion and sexual stimulation. Copyright 2002 The New York Times Company

Related chapters from BP7e: Chapter 14: Biological Rhythms, Sleep, and Dreaming
Related chapters from MM:Chapter 10: Biological Rhythms and Sleep
Link ID: 1284 - Posted: 01.08.2002