DEAR DR. DONOHUE: Have you addressed narcolepsy and cataplexy? I am asking you to share what you know about them. Perhaps you’re not interested in narcolepsy. Doctors aren’t clamoring to specialize in sleep disorders. Thank you for any information you might have. – C.S.

I am interested in narcolepsy. One in 4,000 people suffers from it. If you divide 4,000 into the combined populations of Canada and the United States, you have a large number of people.

Narcolepsy is the inability to stay awake during the day. Said another way, it’s attacks of irresistible urges to fall asleep at times and in places where it’s inappropriate to do so — while driving a car, listening to the boss speak, talking on the phone or sitting at a desk doing work. Along with sleep attacks, the other signs of this illness are hypnagogic hallucinations, sleep paralysis and cataplexy.

Hypnagogic hallucinations are vivid, frightening, imagined sights of people or things when falling asleep or waking from sleep. Sleep paralysis is the inability to move the body for one to two minutes upon wakening. Cataplexy is muscle weakness that comes on during times of emotional involvement, like laughter, anger or excitement. The muscle weakness might be only the dropping of the jaw, or it can be a total collapse to the floor. The cataplexy episode lasts about two minutes, and the person remains conscious throughout the event. Not all people with narcolepsy have all four signs of it, but having even two puts the diagnosis on firm ground.

Many doctors are involved in the research of narcolepsy. One newer discovery is a deficiency of the brain chemical orexin in people with this condition. Orexin keeps the brain awake and active. Furthermore, people with narcolepsy have disrupted REM sleep, the sleep stage when the eyes are moving rapidly and when most dreaming occurs. These discoveries offer new treatment possibilities.

Twenty-minute naps during the day can lessen the number and intensity of narcolepsy attacks. Provigil, while not the only treatment medicine, is the one most often prescribed. Venlafaxine, an antidepressant, increases the brain’s supply of norepinephrine and serotonin, two brain messenger chemicals that can ease or even abolish cataplexy occurrences.

DEAR DR. DONOHUE: For more than a year, my doctor has been telling me I am anemic, but it’s not due to iron deficiency. My blood ferritin level is high. I have been told that a high iron level is dangerous. Is there no treatment for it or for anemia? – L.O.

“Anemia” – having too few red blood cells – is a word that encompasses many different disorders. Your doctor faces the challenge of finding which kind of anemia you have. Iron deficiency has been eliminated. Lack of vitamin B-12, lack of folic acid (another B vitamin), illnesses that cause the premature death of red blood cells and disorders of the bone marrow have to be explored as possible causes. Only when the cause is found is treatment possible. This year, never stop asking the doctor: Why am I anemic?

Ferritin is a form of stored iron, and it indicates the body’s iron reserves. A high ferritin is seen in a number of illnesses. Some anemias actually cause the ferritin level to rise. Your level is not so high and is not causing any body damage. Still, the reason for its elevation has to be forthcoming. Another question for your doctor.

DEAR DR. DONOHUE: Steroids have a bad name because of their use in the sports world. They helped me cope with multiple sclerosis. They shouldn’t carry such a bum rap. – M.B.

The word “steroids” is misunderstood and misused. It refers to a class of hormones and substances with a similar chemical core but quite different actions. In the sports world, “steroids” refers to the muscle-building male hormones like testosterone. In the medical world, “steroids” most often refers to the cortisone drugs, the drugs that are such wonderful suppressors of inflammation. Prednisone is the most used cortisone drug.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from

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