There are many reasons why you may be sleepy during the daytime while you’re pregnant. One common reason is that pregnancy disrupts your physiology as well as the shape of your body, such that you find it difficult to fall asleep, or to remain asleep throughout the night. There is also a fairly common condition called circadian sleep phase disorder, delayed type, in which your brain simply is not ready for sleep at an hour by which most people in your time zone are asleep, so you go to sleep late and wake up late. You are a night owl. This is a condition that exists outside of pregnancy, but pregnancy can exacerbate it, and if you must wake up early anyway to get children ready for school, or to get to a job or school, then of course you will feel sleepy. In such cases, you may become drowsy, particularly if you are sitting for a long time and not consuming caffeine. However, narcolepsy is a much more severe condition. Rather than merely being sleepy during the day, people with narcolepsy are at risk of simply falling asleep all of a sudden, no matter what they are doing, even if they are standing up. This poses a particular danger, if you are also pregnant, since you can fall, injuring not just yourself, but also your fetus, putting the pregnancy at risk.
Classification of narcolepsy
As with other conditions involving the brain, narcolepsy is classified into different types. In type 1 narcolepsy, the person’s sleep attacks consist of what’s called cataplexy, which is a loss of muscle tone that typically lasts around two minutes and that is stimulated by strong emotions. In type 2 narcolepsy, instead of cataplexy, the problem is that your body does not make enough orexin A, which is a chemical that is needed in the cerebral spinal fluid (CSF), the fluid that bathes the brain and spinal cord.
Frequency of narcolepsy
Narcolepsy afflicts 25 – 50 per 100,000 people. This may not sound like a lot, but your chances of being a narcoleptic increase if you have siblings, parents, or children with narcolepsy. Furthermore, since narcolepsy tends to strike during late teenage years and during one’s twenties, it is not uncommon for pregnant women to be narcoleptic. Since various conditions can account for daytime sleepiness in pregnancy, however, it is important that you receive a proper neurological examination and evaluation for sleep conditions, leading to an accurate diagnosis.
Evaluation of narcolepsy
Evaluation begins with your medical history, which your doctor will obtain through an interview. The presence of excessive daytime sleepiness is the main clue to possible narcolepsy. If you report such sleepiness, your doctor may order a couple of different tests. One is called a polysomnogram and the other a multiple sleep latency test. Additionally, a procedure will be performed called a lumbar puncture in which a sample of CSF is drawn through a needle inserted through your lower spine. The CSF sample will be tested for levels of orexin A. Together with the presence or absence of cataplexy, the level of orexin A in your CSF will allow the doctor to tell the difference between type 1 and type 2 narcolepsy. Your doctor also may order genetic testing.
The risks of narcolepsy during pregnancy
Along with the possibility of falls, narcolepsy also puts you and your fetus at risk, if you drive, due to the possibility that you will fall asleep while driving. Since the consequences of falling asleep at the wheel are severe, you should avoid driving completely if you are narcoleptic, unless the condition is brought under control with treatment.
Treatment for narcolepsy
Whether you are pregnant or not, treatment for narcolepsy consists of sleep hygiene and medication. As part of sleep hygiene, you should avoid alcohol at all times, plus you should eat a few light meals during the day time in order to avoid one big meal that will put you to sleep, although you may have a bigger meal at night. You should sleep seven to nine hours at night, going to bed the same time night after night awakening the same time after day. If sleep hygiene does not eliminate the daytime sleepiness, or does not reduce the sleepiness enough, most sleep specialists will recommend medications, which can be either stimulants such as methylphenidate and dextroamphetamine, or non-stimulant, wakefulness promoting medications, such as modafinil, or armodafinil. Other drugs given for narcolepsy include venlafaxine, fluoxetine, and sodium oxybate. Although these drugs are not thought to cause birth defects, more study is needed to be certain that they are safe to be used during pregnancy. Furthermore, since some research studies have suggested that modafinil might carry some danger during pregnancy, some specialists have suggested that this medication should be tapered off particularly near the end of pregnancy, although this practice is controversial, given the extreme danger surrounding the possibility that a pregnant woman will fall asleep on her feet.
When it comes to taking medications for narcolepsy while you are breastfeeding, the level of caution is even higher than it is during pregnancy, since virtually all narcolepsy medications have been shown to enter breast milk. Additionally, these medications all affect the brain; the whole point is to affect the mother’s brain, so that she won’t fall asleep, but there is concern that drugs consumed in mild can affect the newborn brain as well. This means that, if sleep hygiene alone cannot control your narcolepsy, then to be on the safe side you should avoid breastfeeding and give your newborn formula instead.