She is also the editor for the Clinical TMS Society newsletter, on their Board of Directors, and the chairman of the TMS and Sleep Disorders Affinity Group. With a special interest in Narcolepsy, she treats a variety of sleep disorders and psychiatric issues. She is board certified in psychiatry, sleep medicine, and behavioral sleep medicine. She completed a residency in psychiatry and a fellowship in child and adolescent psychiatry through West Virginia University at their Charleston Division through Charleston Area Medical Center in Charleston, West Virginia. Dr Stultz earned her medical degree from Marshall University School of Medicine in Huntington, West Virginia. Over the past 12 months (January 2020 - December 2020), Dr Stahl has served as a consultant to Acadia, Alkermes, Allergan, AbbVie, Arbor Pharmaceuticals, Axovant, Axsome, Celgene, Concert, Clearview, EMD Serono, Eisai Pharmaceuticals, Ferring, Impel NeuroPharma, Intra-Cellular Therapies, Ironshore Pharmaceuticals, Janssen, Karuna, Lilly, Lundbeck, Merck, Otsuka, Pfizer, Relmada, Sage Therapeutics, Servier, Shire, Sunovion, Takeda, Taliaz, Teva, Tonix, Tris Pharma, and Viforpharma he is a board member of Genomind he has served on speakers bureaus for Acadia, Lundbeck, Otsuka, Perrigo, Servier, Sunovion, Takeda, Teva, and Vertex and he has received research and/or grant support from Acadia, Avanir, Braeburn Pharmaceuticals, Eli Lilly, Intra-Cellular Therapies, Ironshore, ISSWSH, Neurocrine, Otsuka, Shire, Sunovion, and TMS NeuroHealth Centers.ĭr Debra Stultz is the Director and Owner of Stultz Sleep and Behavioral Health in Barboursville, West Virginia. You’ve got to tease out these symptoms.ĭr Stephen Stahl is clinical professor of psychiatry and neuroscience at the University of California Riverside, adjunct professor of psychiatry at the University of California San Diego, and honorary fellow in psychiatry at the University of Cambridge. They’re used to not sleeping well, and they focus on just the hypersomnia. Maybe the cataplexy doesn’t present for several years. The thing about narcolepsy is that this is usually developed over a number of years, with the sleep problem starting first. Once you start losing that, I would say all hell breaks loose.ĭebra Stultz, MD: Right. Then during sleep you have rhythms within sleep. You’ve got to be awake, and then you have to be asleep. Stephen Stahl, MD, PhD: They’ve got to have a rhythm. Even though they’re asleep, they’re not sleeping right, and they’re not sleeping deep. Obviously, we need that for the diagnosis. They may go to sleep quickly, but they don’t stay asleep. People who have narcolepsy have decreased sleep efficiency. The same way the light flickers during the day with REM phenomenon, wake flickers into sleep. I had a patient tell me that once, but that’s just not true. There have been reports of a doctor saying you can’t have narcolepsy if you have insomnia. That brings up the next point: insomnia, or disrupted nocturnal sleep. Stephen Stahl, MD, PhD: Maybe it’s something that’s frightening, and they don’t want to go to sleep then.ĭebra Stultz, MD: Right, it can contribute. Sometimes they’re very surprised when I ask them about it. Patients are very frustrated when they have these symptoms, and they don’t necessarily link it with the sleepiness or even the cataplexy. These symptoms, although not necessary for the diagnosis of narcolepsy present, can be quite disturbing. I thought that was a great description.ĭebra Stultz, MD: Hypnagogic hallucinations are abnormal sensations: hearing voices, seeing things, sensing a presence when you’re going to or coming from sleep. He said, “Have you ever been right under the water, and you’re trying to get up but you can’t?” That’s exactly what it’s like. One of my patients had a particularly good description of this. When they say they have panic attacks at nighttime, I’ll start thinking could it be sleep paralysis because they wake up, and their heart is racing. Stephen Stahl, MD, PhD: Yeah, it scares the heck out of people.ĭebra Stultz, MD: Right. There’s even a familial form of sleep paralysis, but narcolepsy patients get this 1 commonly, and it’s very frightening. Doctors and residents have had it, shift workers have had it. Now, sleep paralysis can occur with anybody who has severe sleep deprivation. With sleep paralysis, the brain wakes up and the body is still paralyzed. All these symptoms occur with REM abnormalities. During REM sleep, your brain is very active. The problem with narcolepsy is REM sleep. Debra Stultz, MD: There are other symptoms of narcolepsy, and that’s sleep paralysis and hypnagogic hallucinations.
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