Editor's note: This is part five of a seven-part series on sleep disorders

Onset and Diagnosis
A child with narcolepsy does not act sleepy -- they may in fact have the some of the same signs and symptoms of hyperactivity while others often present as suffering from depression, again, leading to often misdiagnosed children. "The symptoms that narcoleptic children present with most commonly are hyperactivity, attention span problems, social isolation, withdrawal, school learning problems and behavior problems," says Sheldon. "Many of them -- especially those who have cataplexy -- are diagnosed as being depressed because they are not real happy kids. The reason is because if they laugh and are happy, they fall. They don't want to laugh. They inhibit their joy of childhood because they don't want that feeling of losing tone, control and then falling."

Sheldon states that the factor to determine whether or not a person is a carrier of the narcolepsy gene has not yet been determined but if a parent has the disorder or knows of a family history, they need to observe their child for any signs and symptoms and if present, get them evaluated by both a pediatrician and an accredited sleep disorders clinic at once. "Either a family history or the presence of symptoms are indications for further evaluation," says Sheldon. "A pediatrician can examine for the presence of narcolepsy and should then refer the child and the parents to an accredited sleep disorder center that will make the diagnosis. The pediatrician can then follow the patient through their progress. But the diagnosis really needs to be made at the sleep disorder center."

Treatment
There are several steps involved in the treatment of narcoleptic children. Depending upon how severe the symptoms are and how well the child reacts to the various steps will indicate how and when the next step is taken. "The first thing to do is comprehensive sleep hygiene," says Sheldon. "We make sure their sleep cycles and habits are as good as they can possibly be. The second is prophylactic naps. A brief nap that lasts 10 to 15 minutes can result in up to two hours of refractory alertness in a narcoleptic. They feel good and are alert and can pay attention and do well for about two hours and then they deteriorate again."

If sleep evaluation and periodic, scheduled naps to not offer improvement, it may be necessary to introduce the use of medications as a treatment for narcolepsy. "In severe cases or cases that do not respond to previous treatment, the next step is the use of stimulants, most commonly, methylphenidate hydrochloride, also known as Ritalin," says Sheldon. "In addition, if cataplexy is present and one of the more troublesome symptoms but is not improved with the stimulants, then other medications like tricyclic antidepressants are used. This is one reason why children with narcolepsy evidence by cataplexy improve when diagnosed and treated for depression. The same holds true for those misdiagnosed with ADHD and treated with Ritalin. They may improve and get better but they have the wrong diagnosis."

Children with narcolepsy can lead an absolutely normal life once they have been diagnosed and are being treated for the disorder. "I typically explain to my patients that there is nothing that they can't do as long as they take their medication," says Sheldon. "However, I discuss two big things with parents whose children are narcoleptic. First, the only time that narcolepsy becomes life threatening is when children get older, don't take their medication and drive a car. Then it becomes life threatening to them and to others because they will fall asleep while driving and hurt themselves, someone else or both. The second thing is that it is a genetic disorder. It can be passed on to their children. It will not keep them from having children at all and it shouldn't be a reason not to have children. But they should know that if they do have children they should have their children evaluated and treated early so that they can have the full benefit of a happy fulfilled life as well."

"I was diagnosed with narcolepsy at the age of 9," says Brian Chaney, a construction worker from Medina, Ohio. "I remember not being able to wake up in the mornings and falling asleep just about anywhere, regardless of what I was doing. I have been taking medication ever since. I drive, I work and I do whatever I want to do. As long as I take my medication, I can live my life and not worry about it or even think about it."

Narcolepsy is a very treatable disorder. Receiving a diagnosis of narcolepsy does not mean the end of a happy, carefree childhood; it only means that treatment or medication is necessary. Narcoleptic children who receive treatment can run, play, laugh, cry, sleep over at a friend's, plan to get their driver's licenses and anything else they wish to do.

"That's the bottom line -- it's treatable," says Sheldon. "There is no reason that children with narcolepsy have to be any different from children without it. All they need is treatment that is proper for them and no one would be able to pick them out of a crowd."

Read Part One.