What up? Hello. Hello. How's it going?
I had a Sambazon energy drink from Whole Foods. It was really good, but it gave me the jitters
because it's basically an energy drink and I've only been drinking Yerba mate. I've been
trying to stay away from coffee. I feel like my eyes are shaking. Welcome back to diagnosing
a killer. Mental breakdown. Oh yeah, this looks like I'm so ready to do the case. I'm
Kenna. I'm Koelle. And we actually have had kind of a little bit of a hiatus. I think
that you guys have been patiently waiting for a new episode. It's finals week. I'm
getting very close to graduating and so I had a lot going on this week with school and
I know you did too and worked on it. Thanksgiving. So busy. Yeah, thanksgiving. So thank you
guys for patiently waiting for this new episode. But the good news is that you're going to
get three episodes this week. You're going to get this mental breakdown. You're going
to get Koelle's case and then on Sunday you're going to get my mental breakdown. So be lookout.
I think by the time this is posted you'll have two and then in two days you'll have
another one. That's exciting. We're going to bombard you with our voices. So this week's
mental breakdown is... I'm excited. Narcolepsy. Oh my gosh. I don't know. I know what I think
I know a lot about narcolepsy and what comes to mind immediately is that one episode of
A Thousand Ways to Die, this guy fell asleep in a freezer and he died because he had narcolepsy.
See I don't... Okay. What? Alright. I'll buy that but maybe after this you won't. Okay.
So narcolepsy is described as recurrent periods of an irrepressible need to sleep and it's
lapsing into sleep or napping occurring within the same day. They must be occurring in at
least three times per week over the past three months. Okay. So it just described what the
first half of narcolepsy is and then the second half is the presence of at least one of the
following. So it's episodes of cataplexy which is the sudden loss of muscle tone. Okay. So
basically when your whole body just relaxes. Oh that sounds scary. And so it does kind
of sound scary but I think it's more of like, do you ever get that moment like right before
you fall asleep at night and you feel your body like go there? Like you're like, ugh.
No. No. No? Like a thousand times. I lay down and I'm like, poof. Like I can feel my whole
body just like not tense. It must be like that but it's sudden. My falling asleep pattern
usually involves me jolting awake. You know what that is though right? That's your equilibrium
not catching up with the rest of your body. So when you get that feeling motion it's your
equilibrium trying to regulate. That's so. But it doesn't so quickly that you feel like
you're falling. Yeah. Like you're losing your balance while you're not moving. Yeah,
that's really weird. So A is an individuals with longstanding disease brief seconds to
minute episodes of sudden bilateral loss of muscle tone with maintained consciousness
that are precipitated by laughter or joking. Oh, that's kind of scary. That's a little
scary and not to like, okay, so this one time when I was a kid, mom heard me laughing from
the bathroom and I was like in elementary school and I had gotten up in the middle of
the night to use the bathroom and I was just sitting on the toilet laughing but I couldn't
catch my breath. Yeah. But then it reminds me of that Grey's Anatomy episode where that
guy had like. He was having seizures. He was having seizures. There's a kid. Oh my gosh.
And then knowing that camera has seizures. Yeah. So it's like, maybe it's a little weird.
So in children or in individuals within six months of onset spontaneous grimaces or jaw
opening episodes with tongue thrusting or in a global hypotonia without any obvious
emotional triggers. Okay. So in children, it'll manifest with like moving your mouth
a lot or your jaw or open. Yeah. Like constantly opening your mouth. There's a and then there's
B and then under B is one and then under one is A and B. Oh my gosh. So now we're going
back to two. Okay. If that makes any sense. Yeah. So again, this is narcolepsy is recurrent
periods of needing to sleep and with the presence of at least the cataplexy or again, the cataplexy
is in children with the jaw and then in individuals with muscle tone loss with laughing and joking.
And so going back to B, which is presence of at least one of the following in two. So
another indication is that if you have low measures of CSF, which is cerebral spinal
fluid, it's hard to say. Yes. That is not caused by an acute brain injury, inflammation
or infection. Okay. So and then the third under that little second part of causation
is that your nocturnal sleep polysynom or stenography, which is like a sleep study.
If it shows abnormal rapid eye movement or REM sleep latency, diagnostic features are
the essential features of sleepiness or in narcolepsy are recurrent daytime naps or lapses
into sleep kind of like uncontrollably. So sleepiness typically occurs daily, but must
occur at a minimum of three times a week for at least three months, which we talked about
earlier. Cataplexy should not be confused with weakness in the muscles. So like in the
context of athletic activities, like that's physiologically, it's not like a brain thing.
Or exclusively after using emotional triggers like stress or anxiety. So like if you have
a really stressful day, you're going to be tired because your brain was overworked, right?
So episodes lasting hours or days or those not triggered by emotions are unlikely to
be cataplexy, nor is like rolling on the floor while laughing clearly, right? Like you're
having an emotional reaction to something that does not mean that you're laughing or joking
due to your narcolepsy. So in children, close to onset, genuine cataplexy can be atypical
like the relaxing of the muscles, but it affects primarily the face and that presents itself
in grimaces or jaw opening again, like we said. So when sleepiness is severe, automatic
behaviors can occur like the individual continuing his or her activities in a semi automatic
state like autopilot. Yeah. And it's a hate in like a hazelike fashion without memory or
consciousness. So they won't not even remember like what they're doing. So it's like you're
literally sleepwalking in the middle of the day for like a few minutes. Sleep waking. Yeah.
So yeah. So approximately 20 to 60% of individuals experience sleep paralysis upon falling asleep
or waking. So that's leaving them awake but unable to move or speak. However, many normal
sleepers also report sleep paralysis, especially with stress or slept sleep deprivation. So
again, it's not directly linked to narcolepsy, but yeah. Sleep paralysis is one of the things
that I thank the Lord every single day that I've not experienced. I hope I never do because
I have like twice ever. It's so scary. It's so scary. It's mostly like when you when
I have a dream, like I could get over the sleep paralysis because I'm literally like
it's one of those lucid dreams where I'm probably thinking to my head, okay, this is just sleep
paralysis. It's going to go away, you know? Well, the ones that I hate is when I try to
scream and I can't like I try to talk and I can't. That happens to me in my dreams.
But I don't consider that being sleep paralysis. Yeah. I mean, maybe it is and I just never
noticed something else to be anxious about. It does say defining it as leaving them awake
but unable to move or speak. So yeah, but you're not trying to scream in real life.
You're trying to scream in your dream or you're trying to scream in real life. I think it's
both.
Porque no los dos.
This is now a Spanish podcast.
Yeah. So nocturnal eating could occur as well. So it's like sleep eating.
That sounds like funsies.
Nocturnal eating.
That sounds like fun. I want to taste my food. I don't want to like just gain weight. So
obesity is actually common. Wow.
Yeah. So nocturnal sleep disruption with frequent long or short awakenings is common
and can honestly be disabling to the person. Wow.
So individuals may appear sleepy or fall asleep in the waiting area or during a clinical exam.
So during cataplexy, individuals may slump at a chair or have slurred speech or drooping
eyelids. Can you imagine how many people probably think that you are like drunk?
Yeah. You know, that's unfortunate.
It is.
So narcolepsy cataplexy affects.02% to.04% of the general population in most countries.
And I don't know why it denotes most countries. I think maybe the statistic is from most countries.
Yeah. They probably, well, they probably haven't gotten the data from all countries.
All countries.
Yeah. The narcolepsy affects all genders, but it's a little bit more likely in males.
So the onset of narcolepsy can come from certain things like temperamental is one of them.
So that's like disruptive sleep orders like sleepwalking, sleepwalking, sleepwalking,
sleepwaxing, just waxing my legs. Such as sleepwalking, of course, REM sleep behavior
disorders. And they're going to be more common in individuals. That developed narcolepsy,
of course. So people commonly report that they need more sleep than other family members.
That's usually how it manifests. They're like, oh man, I feel like I need more sleep than
they do. So that's usually when you can see it. It can also be environmental, like things
like strep throat, the flu, and other winter infections are likely to trigger an autoimmune
process. And that can produce narcolepsy within a few months.
You can literally get narcolepsy from just getting sick like normal. I can strep every
year, once a year, literally around this time, actually.
That's so weird. It's interesting.
It'll produce it. Yeah. And I guess it's just because of the sleep patterns that you're
not training your brain.
So head trauma and abrupt changes in sleep wake patterns can also be additional triggers.
I think this is if you have narcolepsy and it just, it can trigger episodes of narcolepsy.
I see. So you don't like get narcolepsy just from getting strep.
That's what I thought. No, I think it just exacerbates it. So genetically, identical
twins are 25 to 32% likely to develop narcolepsy. Identical twins.
Huh. Isn't that interesting?
I wouldn't think that that would be an indicator.
Right. That twins. Why do you think that is?
I don't know. So driving and working, so again, effects of narcolepsy. Driving and working
can be impaired. Individuals with narcolepsy should generally avoid jobs that place themselves
or others in danger like working with machinery, driving a bus.
So once the narcolepsy is actually controlled, it can be controlled with therapy. Patients
can usually drive, although rarely long distances alone by themselves.
Okay. Sorry, you probably said this or you're going to. Do they get prescribed like a specific
medication to help with it? Like is there something that can help that or?
We'll get there.
So untreated individuals are also likely at risk for social isolation and accidental injury
to themselves or others.
So unfortunate.
Yeah. Social relations may suffer as these individuals strive to avert cataplexy by exerting
control over their emotions. So sometimes like if you're so concentrated on controlling
the way the emotions that you're having in order to avoid an episode, you might not be
able to connect socially as much as you want to.
Yeah. And it actually reminds me, I saw this, this TikTok last night, this girl that has
Tourette syndrome. And she was saying, they were asking her, she was like responding to
a question and someone asked like how she, she's in college. Like how do you go to school?
And she's like, well, I really have to suppress my tics and it's really uncomfortable and it
really feels like an itch that I can't scratch. She's like, but I can't like pull the girl's
hair in front of me in school. Like that's of course like unacceptable. But yeah, I can
see how that can, if you're focused so much on suppressing your symptoms, then it can
in turn, you probably won't talk at all or you probably won't, you know what I mean?
Yeah. It's hard to make friends and, and you know, in social situations, that's, that's
really, yeah.
So the core morbidity of narcolepsy, it can occur with bipolar disorder, depressive and
anxiety disorders and in very rare cases with schizophrenia.
Okay. Narcolepsy is also associated with increased body mass index or obesity, especially when
narcolepsy isn't treated. So rapid weight gain is super common in young children and
with the sudden onset of it.
Cormorabetany is also sleep apnea and sleep apnea should be considered if there's a sudden
aggravation of preexisting narcolepsy.
Okay.
So medications for narcolepsy include stimulants. So drugs that stimulate the central nervous
system are the primary treatment to help people with narcolepsy stay awake during the day.
I mean, that makes perfect sense.
Totally.
It wasn't even on my radar.
Yeah.
So selective serotonin reuptake inhibitors or serotonin and non-reuptanephrin reuptake
inhibitors.
Yeah.
SSRIs and SNRIs.
SNRIs.
SNRIs. Yeah.
So doctors often prescribe these medications which suppress the REM sleep to help alleviate
the symptoms of cataplexy and sleep paralysis.
Okay.
So actually certain types of antidepressants also work.
Huh.
I mean, that would make sense.
Yeah.
Especially with the comorbidity.
Yeah.
That makes sense.
So sodium oxibate, which this medication is actually highly effective for cataplexy,
sodium oxibate helps improve nighttime sleep, which is often poor in narcoleptics.
Lifestyle modifications are also important in managing the symptoms of narcolepsy.
You may benefit from these steps.
So take naps, schedule short naps at regular intervals throughout your day, naps of 20
minutes at strategic times during the day.
It could be refreshing and actually reduce sleepiness for one to three more hours.
Okay.
So you can just kind of postpone it until bedtime.
Unless you literally don't have the time to do that.
Yeah.
That's true.
Because who does?
Well, you know what?
And I thought about that too.
With the weight, look, narcolepsy is covered under HIPAA.
Like it's one of those things that if you, of course, with a doctor's diagnosis, you
can take that information to your employer and you say, look, I have narcolepsy.
I will not be able to function at my job if I don't get X amount or whatever.
And they have to honor it.
Yeah, of course.
They really do.
Of course.
But in certain jobs though, that's just not feasible.
If you're waiting tables or if you're barging in, you can't just check out for three minutes
of the time.
No, but I mean, that's like you're physically doing something.
I'm thinking about like a desk job, something that doesn't require you to walk around a
lot.
Yeah.
So avoid things like nicotine and alcohol.
These substances, especially at night, can worsen your symptoms.
Which is interesting because nicotin is a stimulant.
And they treated it with stimulants, but medication, you know?
That's true.
Yeah.
Alcohol is not.
Alcohol is a depressant.
Yeah.
Oh, I know that for sure.
So get regular exercise.
Moderate regular exercises at least four to five hours before bedtime.
And it can help you feel awake during the day and sleep better at night.
Yes.
And it, I think it increases the search on endopamine in your brain as well when you
exercise.
Yeah.
So although what I wanted to do was put a few cases in here that there's, I haven't
seen any cases of people being murdered with narcoleptic people.
Like narcoleptic killers?
Yeah.
I mean, it kind of just doesn't make sense.
I mean, can't really get much done.
Yeah.
I can just put it.
But there has been.
He falls asleep during the crime.
There has been instances of, so narcolepsy falls under the blanket of sleep-wake disorders.
And that also, and that umbrella has sleepwalking.
And there has been cases of people hurting people while they're well-willed in sleepwalking.
I can believe it.
Yeah.
Wow.
So I didn't put any of those down.
I was like, do you have them?
I don't.
I don't have them only because, again, we're talking about narcolepsy.
Yeah.
I don't have that.
Well, we'll do an episode on sleepwalking too.
Yeah.
Because I mean, I didn't want to bunch the two together.
I feel like they're individual disciplines.
Of course.
Yeah.
But I did get a few celebrities.
I looked so up because I was worried that you didn't have any.
No, I do.
I do.
So the ones that I put down here, I put Sir Winston Churchill, who was the Prime Minister
of the UK.
He was commented on his condition stating, quote, you must sleep sometime between lunch
and dinner.
Take off your clothes and then get into bed.
You get two days and one.
Well, at least one and a half.
Aw.
Cute.
Another one is Jimmy Kimmel, of course, talk show host.
Really?
He was quoted in saying, truth to be told, I'd rather have narcolepsy than not have it.
When I get on a flight to Vegas, I fall asleep before the plane takes off and I wake up right
after it's landed.
And I'm very, I'm always very close to sleep.
So that was really cute.
So one of my favorite people, one of my favorite winners of RuPaul's Drag Race, Jinxmon soon
has introduced himself as quote Seattle's premier Jewish narcoleptic drag queen.
Oh yeah.
They're amazing.
So the last one that I have, and this was incredible to me, Harriet Tubman had narcolepsy.
I'm not going to make an excuse for it.
I wear my narcolepsy as a badge of pride.
Jinxmon soon has introduced themselves as quote Seattle's premier Jewish narcoleptic
drag queen.
Oh yeah.
They're amazing.
So the last one that I have, and this was incredible to me, Harriet Tubman had narcolepsy.
Wow.
And of course she's the famous pioneer for the underground, one of the famous pioneers
for the underground railroad.
Yeah.
Yeah, she began suffering from narcolepsy after a head injury and she actually had epilepsy
too.
Oh wow.
Yeah.
So she had received a head injury of some kind.
Yeah.
But yeah, I just thought that was pretty incredible.
Oh, Lewis Braille.
Who's Lewis Braille?
The inventor of Braille?
The guy that invented Braille?
Wow, that's really interesting.
I hope that you guys love the celebrity thing as much as I do because I was running for
it.
I feel like it's a really good palette cleanser for all of the technical jargon that we throw
out there.
Of course.
And all of the constant true crime, bad stuff.
So it's nice to know.
And it really does shed light on the fact that everyone, it couldn't happen to anybody.
It's nice to know that people that are so successful are also struggling with the same
things that some of us are.
We've said it before.
It's like, if you have a brain, you're capable of this.
Your brain is capable.
We all have brains.
We all are therefore susceptible to developing these disorders.
Yeah, absolutely.
Well, thanks for sharing.
I didn't know you were going to do that one, so I'm glad that we got to do that.
I know.
That makes me like brainstorm for my next one.
I know.
I wanted to do something that was that people don't consider a brain disorder.
And it is.
Yeah, it totally is.
It totally is.
Everybody thinks about OCD or schizophrenia or things like that.
The really big named ones.
Yeah.
But I like to shed light on those other ones that people don't realize that's a disorder.
It's not an efficiency.
Yeah.
I mean, well, it could be because of the C-S-F.
Yeah, and I feel like we kind of take the same approach with our regular cases.
We don't want...
I mean, we will cover the big cases, but I feel like we kind of pepper in some not-so-known
cases every once in a while.
And I think that...
I mean, I hope you guys like that.
I like doing that because I think everyone's story deserves to be told.
Anyway, so that was our mental breakdown.
Mental breakdown.
Sorry, it was so late, but it's here.
And yeah, hope you guys enjoyed it.
And we'll see you...
Yeah, guys.
Probably right after this for the next case, because I'm sure you're listening to both
in a row because y'all are great fans.
In the meantime, you can follow us on Instagram at diagnosingakiller.
We also have Twitter at killerdiagnosis.
You can donate to the Patreon.
We got our third Patreon.
Woo!
Freedah!
Oh my gosh, I'm so excited.
It's not one of us.
Freedah, thank you so much.
I'm so excited she joined and she's one of my classmates and she's just been so supportive
since the beginning, so that's awesome.
And we are also...
Oh, sorry, that's patreon.com slash diagnosingakiller.
We also have an email setup.
It's diagnosingakiller.com if you want to email us.
And we're looking forward to hearing from you.
And I hope everyone had a great Thanksgiving and we're getting close to Christmas.
And I'm going to graduate in a few weeks.
I'm so excited.
All right.
Bye.
Love you.
Bye.
An