Narcolepsy diagnosis

[smhammer]

I'm currently a second year medical student and, to my surprise, I was diagnosed with narcolepsy this year. I'm on medication and it has helped some, but I will always be in a sleep deprived state. I have been able to manage it well thus far because my first 2 years of medical school have been flexible. However, I am very concerned about rotations and residency. I need to have a consistent schedule- that is very important for me to properly function. I have done an overnight shift before and I am DEAD afterwards. I don't think my body can handle doing that very often.

Does anyone have experience with narcolepsy? Any advice on how to deal with this during residency?

---

Members don't see this ad.

 

[operaman]

Sorry to hear you're having to deal with this -- med school is tough enough without adding extra layers of difficulty.

No experience with it personally, but this is something you should probably discuss with your administration so they can make reasonable accommodations. There weren't too many long overnights during M3 at our school -- just on Surgery and OBGYN. IM overnights started at night rather than after a full day, so it was easier. Either way, there may be things your school can do to make things easier for you (scheduling your overnights so you're post-call on weekends, etc.)

It may also impact what careers you can/should chose, so this is definitely something to start talking to people about sooner rather than later.

 

[CrimsonKing]

Discuss this further with your physician before you discuss it with your medical school administration.

I am unsure of what medication you are currently being given, but it is possible that you may need something as an adjunct, possibly a stimulant, to help you get through the rough schedule of the clinical years. Once you have your physicians recommendations, then discuss with your school and come to a solution that works for everyone.

Best of luck.

 

[Doctor Bob]

There weren't too many long overnights during M3 at our school -- just on Surgery and OBGYN. IM overnights started at night rather than after a full day, so it was easier. Either way, there may be things your school can do to make things easier for you (scheduling your overnights so you're post-call on weekends, etc.)

This will be very school dependent, as to how busy (read- time intensive) the rotation is.
Often times the school sets the block schedule, but the individual unit sets the day to day schedule.

So... YMMV

 

[zzxxzz]

I know two people with narcolepsy. One is doing fine and is actually in medical school. The other is completely crippled by the disease. This all depends on how serious your case is. You need to discuss this with your physician, and eventually your medical school. If you have moderate/severe narcolepsy - particularly if you experience sudden sleep episodes - you may need to withdraw from medical school, unfortunately.

 

[smhammer]

I know two people with narcolepsy. One is doing fine and is actually in medical school. The other is completely crippled by the disease. This all depends on how serious your case is. You need to discuss this with your physician, and eventually your medical school. If you have moderate/severe narcolepsy - particularly if you experience sudden sleep episodes - you may need to withdraw from medical school, unfortunately.

I would say I have mild/moderate narcolepsy. If I have a consistent schedule and a 30 minute nap in the afternoon, along with medication, I doubt anyone would be able to tell.

Thank goodness I don't have sudden uncontrollable sleep attacks. Is that the symptom that makes you think withdrawing from medical school might be necessary? Unless things become suddenly and unbearably horrible I am not considering withdrawing. I'm almost halfway through and I have so many loans- just thinking about not finishing with all that debt makes me sick.

 

[smhammer]

Discuss this further with your physician before you discuss it with your medical school administration.

I am unsure of what medication you are currently being given, but it is possible that you may need something as an adjunct, possibly a stimulant, to help you get through the rough schedule of the clinical years. Once you have your physicians recommendations, then discuss with your school and come to a solution that works for everyone.

Best of luck.

I am currently taking a stimulant called Nuvigil. Unfortunately this may be the most awake I will every feel.

 

[Kahreek]

best way to deal with it during residency is to choose a specialty that has a 9 to 5 work schedule.

 

[zzxxzz]

Thank goodness I don't have sudden uncontrollable sleep attacks. Is that the symptom that makes you think withdrawing from medical school might be necessary?

While I'm speculating about having to withdraw from medical school, I can tell you that the person I know with the more serious narcolepsy will fall asleep for short periods (less than a minute) many times throughout the day, at any time, sitting or standing. Sometimes this just seems like a strange, uncomfortable pause in conversation, etc, but sometimes they will collapse.

Obviously this has major life implications. This person cannot operate any motor vehicle or ride the bus (they miss their stop constantly) and has to walk everywhere. This person has significant trouble doing tasks people find "boring" (like cleaning) as those tasks often cause multiple episodes. Also, many people find someone falling asleep while talking to them unsettling, which has limited this person's employment opportunities. They otherwise live a fairly normal - if subdued - life, but can't do too much outside the house without what amounts to a chaperone.

Hard to believe that person could be a physician. My friend in medical school seems more similar to your case. They take medicine, but their main symptom is basically being sleepy all the time. Before getting on the meds, this person would sleep for 12-14 hours a day, and would be constantly "accidentally" falling asleep (e.g. during reading, watching TV...not doing active tasks). They could fall asleep whenever they wanted, which (as an insomniac) I sometimes envied. By keeping a more regular schedule, going to bed and waking up at scheduled times, limiting naps and limiting caffeine (apparently makes a big difference), and taking medicine (I want to say some kind of antidepressant) they have been doing pretty well.

Good luck!

 

[NotAProgDirector]

Narcolepsy will definitely qualify as an ADA qualifying diagnosis. That means that any residency program will need to make "reasonable accommodations". It's unclear what that means but reasonable is defined by the courts not a residency program. A modified schedule, even if it adversely affects others, is usually considered reasonable.

 

[PathoTurnUp1865]

Bump
What specialty did you end up going in to?
Is EM out of the question?
I'm a mild/moderate narcoleptic w/out cataplexy. Tired and have brain fog 24/7. Do well in class, mostly B's and some A's.

 

[michaelrack]

I am currently taking a stimulant called Nuvigil. Unfortunately this may be the most awake I will every feel.

Other options include the traditional stimulants (ritalin, adderall)- more powerful than nuvigil. can also try xyrem with or without a stimulant/nuvigil

 

[KU Brendan]

Bump
What specialty did you end up going in to?
Is EM out of the question?
I'm a mild/moderate narcoleptic w/out cataplexy. Tired and have brain fog 24/7. Do well in class, mostly B's and some A's.

We're all in a fog and grumpy in the ED as it is, so you'd fit right in. 🙂 Seriously, though, every case is different, but the shift work of a typical ED might make a lot of sense for you. Some EDs don't let you choose to stay on days or nights (often having to switch back and forth), so you'd want to be clear about what you were getting into. The big question is if you are able to be mentally awake in critically important times (e.g., codes), or if you need something that would allow you to set your own (slower) pace, such as ambulatory clinical medicine (such as primary care).

 

[PathoTurnUp1865]

We're all in a fog and grumpy in the ED as it is, so you'd fit right in. 🙂 Seriously, though, every case is different, but the shift work of a typical ED might make a lot of sense for you. Some EDs don't let you choose to stay on days or nights (often having to switch back and forth), so you'd want to be clear about what you were getting into. The big question is if you are able to be mentally awake in critically important times (e.g., codes), or if you need something that would allow you to set your own (slower) pace, such as ambulatory clinical medicine (such as primary care).

Thank you for your response. I start third year this upcoming July so I will definitely be paying attention to what I’m able to handle. I have just been worried I’ll be limited on specialties.

 

[KU Brendan]

Thank you for your response. I start third year this upcoming July so I will definitely be paying attention to what I’m able to handle. I have just been worried I’ll be limited on specialties.

Everyone is somewhat "limited" on specialties, be that because of grades, personality, etc. That's what third year is all about: deciding what is going to work for you. If you need special accommodations to make it through, make sure you bring that up sooner than later.

 

[Internist_Sandman]

My wife has narcolepsy without cataplexy. She takes modafinil (generic, I believe) and works as a bartender. Her shifts are analogous to resident shifts, since she can pull 10-12 hours shifts on a weekend till 4am. Her "normal" sleep requirement is 10 hours a day, but she rarely gets that especially since we just had our first kid. All i can say is that narcolepsy is an annoying/frustrating/difficult condition, but not an unbearable one. You'll just need to be honest about your body's needs. She benefits from consistency, so working as an EM doc may not be wise. Similarly, if you have cataplexy, working as a surgeon might not be wise. Narcolepsy, like any diagnosis, can require you to shift your life around to accommodate it, but I promise that you can still be a doctor with narcolepsy. I see the effects it has on my wife and I am a medical student so I can tell you that I understand what effect that it'll have. Best of luck to you - despite narcolepsy you can succeed.

 

[RNtoMD87]

I was diagnosed with narcolepsy, and was prescribed xyrem. Turns out it was major food allergies. No sleeping problems in 6 years.

 

[PathoTurnUp1865]

I was diagnosed with narcolepsy, and was prescribed xyrem. Turns out it was major food allergies. No sleeping problems in 6 years.

How did they determine you had narcolepsy? Just by sx? Or did they give you a poly?
How did you find out it was food allergies?

 

[RNtoMD87]

How did they determine you had narcolepsy? Just by sx? Or did they give you a poly?
How did you find out it was food allergies?

I had many tests that were inconclusive as they tried to work up a syncope diagnosis, eventually I had an MD perform several sleep studies.

I realized it was food allergies over a year later because I started to notice when I ate some foods, I would start sweating profusely, and get VERY hot, and agitated. When I stopped eating these foods, I actually slept to the point of R.E.M. instead of only ever reaching the first couple stages of sleep.