sleep disorder and ncs...

[jan]

I have been diagnosed with neurocardiogenic syncope, my symptoms are tiredness and dizziness. I have never actually fainted from this, but on the tilt table my blood pressure and heart rate made the classic drop. My neuro agrees with this diagnosis, but he also thinks I have a sleep disorder - possibly narcolepsy,(2 failed sleep studies).  What are the chances that my tiredness and dizziness are from that? My cardio has been making changes in my doses to attempt to get rid of these symptoms and is now talking about changing my med, currently I am on a beta blocker. Yes , the beta blocker has "helped", but never totally. Can these symptoms be from a sleep disorder or some other neurological problem? Maybe we are changing my medicine all the time and the ncs isn't the problem. I will be seeing my neuro Mon., are there any questions I should ask him? What else can we do? I have read about an infrared light that can measure your pupil and about a genetic blood test that measures certain antigens, what do you think?  Thank you for your time once again.

[CCF Neuro[P] MD, RPS]

Dear Me Again:

There is no known chemical test for narcolepsy in humans.  It is mostly a clinical diagnosis expressing daytime sleepiness, rapid onset sleep/dreaming, maybe cataplexy, and sleep paralysis in some.  We diagnose this entity by a sleep study, MSLT, or sleep onset latency.  Whether you have narcolepsy I can't tell from what you indicated over the internet.  

Beta blockers have a known side effect of tiredness or a fatigue.  Whether this is the cause or simply adding to your sleep disease is currently unknown without knowing more, your neurologist should be able to answer this for you.

There are also other sleep disorders that give you daytime sleepiness, but whether you have one of these is for your neurologist to work out as I have no history etc. A good sleep diary, sleep history, neurological exam, should help clear the picture.  Bring a diary of when you went to sleep, woke up in the night, length of sleep, quality of sleep, etc over the last 4 weeks or so before the examination.  A knowledge of the medications your on, history of snoring, movement during sleep, medical problems, etc are also important.

Sincerely,

CCF Neuro MD

[jan]

Because I have ncs and IST the beta blockers actually help me to feel less tired. I slept long enough during my 2nd sleep study (2 hrs.)to show I don't have apnea and that I have alphawaves at inappropriate times. I don't snore and I wake up briefly through out the night. I do have periods where I feel I just have to sleep and yet if I can't I can fight it ,miserably. I've only had one occurrence of what might have been cataplexy 20 years ago! I also have had 3 episodes of what I think was fainting,, but my neuro thinks maybe muscle weakness or periodic paralysis. With these episodes I all of the sudden realize that my head is tilted fully back, my eyes are shut and it takes a little bit to bring it upright and then I open my eyes. I do have hallucinations at waking from time to time.  This is very frustrating! It's not so much that I care if I have narcolepsy or not. It's just that I am concerned about attributing the tiredness and dizziness to ncs when it may be a sleep disorder or something.  I don't want to keep changing my med. I remember my mom, who had asthma and chf and she always went for her inhaler when it was frequently her chf.  I don't want to do the same thing. I want to know what it is that needs treating. Does this info. help bring anything to your mind?