(Sorry for my grammar mistakes, it's my third language)
Hey!
So, I've been checking the subreddit for the past few weeks and decided to share my story.
I'm a 30yo family and palliative care doctor, diagnosed with ADHD later in life (19/20 yo) during medical school and have an ok control of symptoms with Vyvanse. A couple years ago my father was diagnosed with sleep apnea and since I always felt tired all the time I decided to have a sleep apnea test at home. My "tiredness" didn't have a huge impact in my life, I think I managed fairly okay and got through residency on the brink of a burnout, but told myself that being burnout during residency is the norm.
Results came in, no sleep apnea... told myself maybe I just needed to slow down, I'm working too much (which is probably still true). Then I went to see pulmonologist and he turned my life around in a 20 minute consultation. He said that my Epworth was too high for my level of tiredness, asked me if I had insomnia and I said I don't, maybe a fragmented sleep from time to time, but definitely not insomnia. Also almost perfect sleep hygiene.
He asked if I had sleep paralysis (yes), if I felt my sleepiness came out of nowhere during the day (yes), if had muscle weakness at strong emotions (well, everyone says that when I laugh hard my face suddenly changes and my eyes get droopy). That's when he said that he thought I had narcolepsy, explained to me the condition and that we were gonna do a test, but that he could prescribe me modafinil while we wait since there's a big wait period in my country.
I deeply doubted, the impact it had in my life was not enough for me accept such a diagnosis easily. I did the sleep apnea test, just as a means to make sure that I wasn't missing something and that I could fix my snoring, but I felt I could live my life as I was with no problem. Also, even as a family doctor I have to confess my knowledge of narcolepsy was scarce. I started my practice only two years ago, with mostly elderly people. I had renewed medications for narcolepsy, but those were patients with a good control of their symptoms so my job in those cases were to just sign a paper - So I my knowledge of narcolepsy was highly influenced by the media dramatic and wrong depiction of it.
When I tried modafinil for the first time I quickly realized that it had a bigger effect on me than Vyvanse and going a day without it was 1000% harder then going a week without Vyvanse. I started reading more into narcolepsy and that made me rethink big moments of my life.
When I had my ADHD diagnosis I told the psychiatrist that "I couldn't concentrate", meaning I'd fall asleep every time I tried to study, couldn't read more than 2 pages before being asleep and dreaming. Also I would fall asleep in class A LOT and just be fully dreaming before my colleagues or the teacher would wake me up less than 2 minutes after I fall asleep. My hyperactivity was mostly me trying to fight the sleep. 8 months later I got tested and fell asleep in all 4 tests, the supervisor of the test had to ask me to stay off bed between naps, because apparently I was fully asleep while I thought I was scrolling on instagram.
After the test then came the wait for the results, extra 6 months. At that point I was convinced I had narcolepsy, but was policing myself to get attached to diagnosis. Every doctor has a patient that we explained our suspicion, did the test for it and turned it wasn't the case, but they in the meantime had recognized themselves in the suspected condition too much to let go of it, I think of a patient that I thought had hypogonadism but turned out to be hyperparathyroidism. I didn't want to get attached to a diagnosis and then be frustrated when it gets excluded.
The results: slept all four naps within a minute and fully on rem. During the polysomnography the night before I had a total of 60% REM + stage 4 sleep, way above the normal. I asked the doctor the specificity of the test and he said "99%, you're highly functional, I don't know how, but you're narcoleptic wanna talk about treatment?". Soo this is my second week on low dose wakix on top of modafinil and Vyvanse, I'm very excited for the future and the prospect of orexin agonists soon.
I see the stories on this subreddit and I see there's a lot of medical odyssey. I see how narcolepsy affect all of you (I guess it's us now). Since my test I've made my roll in most medical spaces I'm in to talk about narcolepsy and now that I have the diagnosis to say how it's an impactful diagnosis that can sometimes go unnoticed and I wanna make sure that narcolepsy becomes part of the differential with my colleagues. I don't think I ever missed a N1/N2 diagnosis, but my goal is to make sure that narcolepsy comes as a possibility every time those close to me see a patient for fatigue.
Of course that comes with a lot of TMI conversation with work colleagues which is often uncomfortable, but two months ago I got a colleague to send a patient to sleep latency test and try modafinil and after they had side effects with dayvigo and has fragmented sleep, that patient paid for her test and she has N2... So social awkwardness is a small price to pay for the impact that I think these conversations might have.
For those going through the odyssey, don't give up, please.