Narcolepsy and hallucinations in the spectrum of its manifestations. Clinical сase

Abstract

Narcolepsy is a rare chronic disorder characterized by impaired regulation of the sleep-wake cycle, which significantly worsens the quality of life of patients but is often diagnosed with considerable delay. Increasing physician awareness of this pathology can contribute to its earlier diagnosis and therapy optimization. A description and discussion of a clinical case of narcolepsy type 1 in a 22-year-old man. The development of narcolepsy type 1 in the patient was preceded by long-term sleep-wake disorders associated with addiction to computer games, and that the clinical manifestations of narcolepsy type 1 was provoked by emotional stress. The patient eventually developed all the classic signs of narcolepsy type 1, including visual, tactile, and auditory hallucinations upon awakening. Although the patient's quality of life had deteriorated dramatically, he did not seek medical attention for over a year, fearing that he would be considered mentally ill because of hallucinations. After the diagnosis, therapy led to rapid and significant improvement in the patient's condition. In the context of the clinical case, current pathogenic concepts of narcolepsy and its clinical manifestations are discussed. Particular attention is paid to hypnagogic and hypnopompic hallucinations and their differences from 'daytime hallucinations,' which is important for preventing the stigmatization of patients as 'mentally ill' individuals. The diagnostic criteria update for narcolepsy type 1, that was made in the International Classification of Sleep Disorders, Third Edition, Text Revision of 2023, is provided and the treatment of this disease is discussed.