Narcolepsy: Awakening in Between Sleeping Routines

Narcolepsy is Genetic, your Child is at a 40-times Higher Risk of Acquiring the Disease

Sleeping during the Day: Unusual for Others but a Daily Routine for Narcoleptics

History or Geography classes invoke sleep in most students, a post-lunch session by our professors is just like a lullaby song, office presentations sometimes transport us to a dream land and even while at work our eyes droop and we fall asleep for a minute or two in between. Such occurrences have happened in all of our lives sometime or the other and if in case you are one of those who hasn’t experienced it you must be a genius indeed. Sleep is a hobby for many, a passionate way to spend our time during weekends (getting up at 11 or 12 in the morning is not a rarity during holidays) and a relief from all the stress and anxiety we experience through the day. Sleep is an act that is dreaded by small kids, loved by teens and younger adults, wished for by middle-aged people and yearned for by older adults. The quality and duration of sleep decrease as we grow old in the case of most people.
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Are you one of those who goes to sleep as soon as you instantly hit the pillow? Of course, you are blessed! In this world where peace has become a rarity, happiness a commodity and good sleep a dream-come-true, getting to sleep in a matter of few minutes is never possible for most people-blame it on smartphones, television series or unending thoughts about life’s complications we keep staring at the ceiling or rolling back and forth in our beds wide awake without sleep. Amongst all this chaos, can you imagine that some people get to sleep during morning hours, while standing in a queue, while waiting for a bus or even in the middle of talking to someone about something important! Yes, these people are not blessed nor are they normal as they are characterized by a chronic debilitating sleep disorder narcolepsy, that’s characterized by excess daytime sleepiness, sleep paralysis, hallucinations and rarely by episodes of cataplexy (partial or total loss of muscle control occurring due to emotional triggers such as laughter, joke, surprise or anger).

Narcolepsy
Narcolepsy is a debilitating condition that ruins the quality of life of those individuals experiencing it. Occurring equally in both men and women it affects 1 in 2000 people as early as during childhood or adolescence but rarely diagnosed immediately. There is no definite boundary between awake and asleep state in these people which causes bouts of sleep in people while they are doing daily activities. Narcolepsy cataplexy (NC) is due to the absence of chemicals called hypocretin in the brain which is duly responsible for keeping us awake and regulating sleep-wake cycles. The cells responsible for producing the chemical is destroyed in narcolepsy and without this chemical the individual experiences troubles staying awake. NC is the muscle paralysis of REM sleep occurring during waking hours.

REM Sleep
Sleep has four phases of which the REM phase is the last one and the other three are non-REM phases. Rapid eye movement (REM) sleep typically happens some 90 minutes after you fall asleep with the first period lasting for about 10 minutes. Other successive stages last longer and the final one might last for as long as an hour. Most of our dreams occur in this stage of sleep and the brain becomes active. REM is critical to learning and memory as this is the time during which the brain processes information from our previous day storing what’s needed and discarding the rest. While non-REM stages occur early during the night it’s the REM stage that prolongs during the latter part of your sleep. Maybe that’s why we get up in the morning right out of a dream when woken up!

Creativity and dreaming have always been interrelated to each other and we do have evidences supporting it-many people have reported scientific and artistic discoveries during dreams and one classic example is that of the periodic table of Mendeleev. Creativity ratio is linked to the number of dreams experiences and the complexity of the dream too. We have also had cases of finding solutions to problems in dreams when the individuals stored these problems in their brain right before falling asleep. There are studies supporting REM sleep’s advantage on anagram solving and creative problem solving and association between distant memories but their association with creativity isn’t proven completely. Are we saying here that naps and sleeps increase a person’s creativity? This is impractical and probably the development of creativity happens over the years over many sleep periods. So, when scientists wanted to examine the role of REM sleep over such long years their first pick was patients with narcolepsy as these individuals were often transported from wakefulness to a REM sleep termed as sleep onset in REM periods (SOREMs). These individuals experience frequent naps and more importantly, repeated periods of REM in comparison to normal individuals who rarely reach REM stage during their short naps. They remember their dreams better and also experience a greater number of dreams, lucid dreams that makes them excellent candidates for displaying versatile creative skills. So, a group of researchers tested upon the creative skills of people with narcolepsy to those of controls with the help of questionnaires and tests.

Creativity-linked REM Study
The study was carried out in two centers in Italy and France on individuals classified as suffering from narcolepsy based on different criteria. Each of them was categorized as suffering from type 1 or type 2 narcolepsy based on whether they had frank cataplexies and hypocretin-1 deficiency or not respectively. Though these participants had a brain MRI the results were normal as expected in patients suffering from this disorder. The team also picked 30 healthy controls from both countries who experienced no sleep disorders matched the sex, age and education of the participants. All the participants completed a formal test of creativity, a questionnaire asking questions on the participants’ sleep paralysis, hallucinations and presence of cataplexy, Epworth Sleepiness Scale and the Hospital Anxiety and Depression Rating scale.

The participants filled 2 creative questionnaires that include the Test of Creative Profile (TCP) and the Creative Achievement Questionnaire (CAQ). TCP contained 57 yes/no questions that covered various types of creativity including innovation, imagination and researcher profiles. Each positive answer was normalized on a 100-point scale to come to conclusions. CAQ reports achievements across 10 domains including visual arts, music, dance, architectural design, creative writing, humor, inventions, scientific discovery, theatre/film and culinary arts whose scores were from 0 to 7 with 0 representing no expertise in the domain and 7 indicating tremendous expertise. The Evaluation of Potential Creativity (EPoC) is an objective test evaluating creative abilities containing 8 subsets assessing two models of creative thinking which includes divergent-exploratory thinking and convergent-integrative thinking. While participants were asked to generate multiple ideas based on a single stimulus in the former, they were asked to incorporate multiple elements to form a unique production (such as different characters to form a story) in the latter case. 10-15 minutes of time was given based on the task at hand and the total duration of the EPoC test was for 2.30 hours which included a 30-minute break which was used to sleep by 6 of the 30 subjects.

Totally, 185 volunteers (71% had type 1 narcolepsy and 29% had narcolepsy type 2) participated in the study which included 118 from Paris and 67 from Bologna. 126 healthy controls were matched for age, sex and gender. Education levels were lower in the narcolepsy group compared to the control group. 30 subjects each from the narcolepsy and the control group who performed the EPoC test did not differ in age, gender and education while participants with narcolepsy experienced more frequent sleeps, higher levels of daytime sleepiness and depressive symptoms. Results showed that:
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1. Participants with narcolepsy scored higher TCP scores than those in the control group and also on all three creative profiles.
2. CAQ scores were also higher in participants with narcolepsy comparatively
3. While French participants with narcolepsy scored higher both on TCP and CAQ, Italian volunteers with narcolepsy scored higher on the TCP but not CAQ.
4. Among narcolepsy participants those with hallucinations, lucid dreams and sleep paralysis had higher scores on TCP. Lucid dreams paved way for higher scores on imaginative profiles and also innovative profiles but not with the Researcher profile.
5. Cataplexy was not an influential factor for higher creativity but higher sleepiness and depression scores were linked to higher scores on the TCP.
6. Participants in the narcolepsy group scored more than the control group on the Convergent mode of creative thinking and also scored higher on the Divergent dimension.
7. Type 1 and type 2 narcolepsy participants had similar creative performance and these participants did not compensate on integration and elaboration for originality.
8. 43% of 185 subjects with narcolepsy were lucid dreamers compared to 3% of the 126 normal cohorts. While there are still doubts pertaining to whether lucid dreaming motivates creativity this study showed that some of the subjects who were lucid dreamers came up with novel and creative ideas
   
   

This study clearly proves that participants with narcolepsy displayed higher creative thinking than controls. Researchers quote the frequent occurrence of the REM state for creating a positive impact on the creativity quotient as the participants have more time to incubate and associate ideas during sleep and to remember them upon awakening. Thus, while narcolepsy affects day-to-day living these volunteers could be reminded of its creative side when the individuals are depressed and are facing difficulties. Let’s remind ourselves of the renowned biologist, George Church who quotes that all his visionary ideas were formed while he was asleep or quasi asleep, dreaming sometimes at the beginning or end of a narcoleptic nap. His words stating that ‘narcolepsy is a feature, not a bug’ must be a huge inspiration to all those suffering from this chronic sleep condition.
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References
Increased Creative Thinking in Narcolepsy: https://academic.oup.com/brain/article/142/7/1988/5506053
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Narcolepsy: https://www.sleepfoundation.org/articles/narcolepsy

George Church Ascribes his Visionary Ideas to Narcolepsy: https://www.statnews.com/2017/06/08/george-church-narcolepsy/

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