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My Experiences With Narcolepsy And Nursing/obversations/yolo!


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#1 mwalesh

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Posted 29 April 2013 - 05:42 PM

Hey everyone.. I've been reading these boards for awhile and this is my first post. Any advice or opinions are much appreciated!

A little background..

 

I'm a 24 year old female currently in my last semester of school and graduation with my Associates in Nursing is just a few weeks away, thank god! I've been an LPN for two years in addition to that. I guess the medical background is an advantage because I'm always looking for literature, studies, data in regards to my narcolepsy and the best ways to manage it. I don't have cataplexy or the typical narcolepsy thought of with episodes of sudden loss of conciousness. I'm just excessively tired always, every day, with a few other quirky symptoms.

 

I was diagnosed about 4 years ago after 2/4 abnormal MSLTs after my sleep study showed no RLS or apneas. Previously, I was diagnosed with ADD and put on stimulents in high school which helped tremendously to improve my focus. (I'll throw in here that I was tested negative for Iron deficientcy, thyroid issues, etc. Don't even get me started on the suggestions of depression..) After high school, symptoms began to get worse and my excessive sleepiness was really putting a damper on my life. As I'm sure many of you share similiar feelings, I can't describe how much I fight this diagnosis verses me just being lazy, because that is usually how I feel. I really hate the person I am when I am so sleepy, and at this point I'm concerned that the time I spend sleeping is allowing me to miss valuable opportunties in life as well as preventing me from getting the most of experiences that should be enjoyable. It seems that the stimulants I take lose their effectiveness every year or two and I've been on every stimulant available as well as Provigil/Nuvigil. Currently I take adderoll 30mg twice a day, but at this time they really only work for an hour or two before I could easily go to sleep, and on the days where I work and then have something going on after I usually take 3, even 4 just to do what I need to do. I guess to sum this up I'm at the point where I am aware of the consequences of taking such a high dose of amphetamines, and it scares me, but without them I would be an empty shell and life wouldn't have much value for me. I know that sounds so depressing, but I look at it in the sense that I want to live life to the fullest, and travel and meet people and see all the things I want to because we really don't know when our time can be cut short. WIth that said, hopefully it doesn't come down to my medication being harmful to my life, so here's what I've got going on and what I've been doing about it.

 

1. Sleep Inertia- "physiological state characterised by a decline in motor dexterity and a subjective feeling of grogginess immediately following an abrupt awakening. The impaired alertness may interfere with the ability to perform mental or physical tasks. Sleep inertia can also refer to the tendency of a person wanting to return to sleep." That's me!

 

Been doing some studying on this and honestly this is what really sets me back as far as sleeping issues. To put it simply, when I wake up in the morning, I feel like I've been hit by a bus, always, for as long as I can remember. I have never, ever, woke up naturally feeling refreshed. Physiologically speaking, this is what happens to a normal person when they are awoken from a REM sleep state. With narcolepsy, I'm always in this sleep state and its the reason for why I can sleep 14hrs and still wake up feeling exhausted, and why I often dream before I'm even fully asleep. It takes me a good 3-4 hours to get up and get going with my day. As a typical narcoleptic, my alarm clock is set in about 5 different ways and I sleep until the VERY.LAST.MOMENT. possible. Which usually makes me rush to get to work or school. Its so frustrating because when I go to bed at night, I usually give myself a pep talk that goes, "Okay, your going to get up an hour earlier, make a pot of coffee, maybe read the paper, get the day started on a good note!" But this never happens, and even as I write it I realize how ridiculous it sounds. While I usually hide this from people, or make excuses as to why I can't do Sunday brunch or go for a run before 10am, the times I have tried to explain it resulted in the other person going, "Huh? Just get up 10 minutes earlier for gods sake!" I'm not sure if this is from the sleep paralysis but my blood pressure is super low when I first wake up (I tried to monitor this for a few days but the machine just "errored" it was so low) and my body hurts. Not in the way that lifting weights makes you sore, but its like I sleep so hard and deep that its just physically exhausting. I also am really dizzy, and its not uncommon for me to hit the wall on the way to the bathroom. What I've gotten into the habit of doing lately is setting my alarm an hour earlier to take an adderoll and then going back to sleep. This usually makes waking up and getting going easier because my heart is beating faster, thus making my BP higher. Although if I don't have to get up for anything I can easily sleep through the adderoll. This difficulty in getting up is a huge source of frustration in my life and it really bugs me because I feel like I could accomplish so much more if I could get up before noon.

 

2. Cataplexy, Hallucinations, Sleep paralysis- I do not have the cataplexy episodes where I suddenly lose conciousness, but I have noticed sudden numbess mostly in my legs with strong emotions, most often fear. For example, if I'm speeding (which is often because I'm always late for things!) and I pass a cop, I get this shooting numbness that lasts maybe up to ten seconds. Maybe this is related to my BP, not sure. Any input?

I've been told I'm quite entertaining while I sleep, and I believe it. What happens often is the hallucinations that I usually am concious of when they are happening. For example. I'll awaken and see a giant spider at the foot of my bed. I'll be terrified and either I'll be paralized for the minute or two it takes me to realize that its just the shape of my blankets or I'll fly out of my bed and the room with my heart pounding and shaking. This happens so often its usually unremarkable. I also occasionally speak in my sleep, and I have sleepwalked. But the hallucinations are really the most prevalent sign. As far as sleep paralysis, again not sure if this is related, but 90% of the time when I sleep, I awaken with my arms, hips, hands, legs, completely numb, and what I describe as "noodle-ly" before blood flow returns and they then get pretty painful fo ra few minutes. I'm thinking this is because I sleep so hard that I don't change position enough and circulation gets cut off whereever I might have funky positioning. I have had episodes where I wake up terrified because I am completely paralyzed but these are rare, maybe a few times a year.

 

3. Progression- I know there has been some evidence as to one of the causes of narcolepsy being Mono, which I had when I was 15. While I was a big sleeper as a kid, it wasn't close by any means to the degree it is now and I definitely see a trend where it got worse after I had mono.

 

4. Experiments!- The past two years I've been into looking for alternative ways to treat narcolepsy without much gain. I take vitamins and fish oil supplements daily. I do alot of long distance running. (But obviously I need to be up for a few hours and take my adderoll otherwise I probably wouldn't last more than a mile) Tried the gluten free diet for 3 months and at first I thought I was waking up easier but over time this went away. I've found that times I eat significantly high amounts of carbs (mexican food, pizza, etc) I get super tired after, and if I sleep, I have crazy dreams and get really thirsty. (Looking into getting a blood glucosometer to test my blood sugars at these times because the symptoms feel similar to hyperglycemia) Looking into giving the ketogenic diet a shot because I think I do feel better on small amounts of carbs. I drink on occasion, maybe 3-4x a month. Interesting observation, I wake up significantly more "refreshed" after a night of drinking, thats to say that besides the nausea, headache typical of a hangover, I can actually wake up without being able to fall back asleep. Since alcohol messes with REM sleep, I wonder if it stops me from going into it so fast and for as long as a I normally do? Any thoughts on this? (Don't worry, not looking into treating my narcolepsy with alcoholism, just an observation!)  I don't smoke or do drugs. I have an appointment with a sleep specialist in a few weeks and I'm going to look into giving Zyrem a shot because besides switching meds constently for the rest of my life, its the only other option.

 

4. Professional Work- This is also an area that is becoming increasingly worrysome. While I'm sure its related to the stress of being a full-time nursing student in her last semester (previous semester I was half time) while still trying to work during my free time, but concentrating on my tasks is getting harder and I find myself making mistakes. Obviously, as a nurse, this is a huge concern. A few symptoms I've been seeing the past few months that are new are memory relapses, difficulty vocalizing my thoughts, and brain fog. There was an incident that really freaked me out a few weeks ago when I was handed a medication by a patients mother to refridgerate. When it came time to give this medication, I could not remember clearly if that mother gave it to me, and since it was a busy morning and I had an exam on my mind, I concluded that I must have mistaken this thought she gave me something for another patients family member who brought supplies I took. Long story short, I couldn't find this medication and wasn't able to give it. Later it was found by my manager in the fridge. When she confronted me about it, I told her the truth, that I didn't remember getting the medication, or putting it in the fridge. It was a rude awakening because it was a semi-important med that could have put my patients life in danger, and it really scared me. I'm taking a year off of nursing to do some traveling after I graduate for a few reasons. One being I love to travel, and want to do it before I tie myself down to a full-time nursing schedule. (Which I'm not even sure I am capable of handling) but I also need this break to figure out how to handle my narcolepsy better without putting other people at risk. If I'm experimenting with treatments like Zyrem, or giving the ketogenic diet a shot, I don't want side effects to hinder my nursing responsibilities. Anyone have similiar experiences or concerns?

 

Well thats all for now. Sorry I wrote an entire book here, I guess venting some of these concerns was good for me and needed to be done. I want to try and know everything possible in regards to the narcolepsy so that at least when I beat myself up for wasting an entire beautiful day asleep in bed, or not going out with my friends on a friday night because I'm too tired; I know I'm doing all I can. Narcolepsy is especially hard because I dont think people can understand it unless they have it, and having to defend myself that I'm not lazy can be hard. So thanks for reading, and again, I'd love to hear from others with similiar experiences, advice, or input!



#2 sk8aplexy

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Posted 29 April 2013 - 08:36 PM

Interesting, can relate very much with the description of your experience. 

Nothing I'm saying below is meant to scare you or to say it is what to expect, it is just from my experience...

I'm not a doctor, so know that.  I think I may have written you a book of a response too (looking back at it now.[ ).

 

1. Very much this sounds like how I was for years, I never considered it sleep paralysis but I do think it may be a form of it.  Was able to sleep very deep but waking, or more so actually getting up and out of bed, was so difficult or at times near impossible; like I was chained to the bed or wearing heavy weights...  Unfortunately, now at 33, I have lost this and awaken typically having to get out of bed due to neck pain.  Prior I could lay there for hours, getting a total hours in bed of 8-12 hours.  Now, I'm lucky to stay in bed 6-8 and I awaken so much more than I used to. 

 

2. Unfortunately, what you say about passing a cop and feeling shooting numbness, I think may be Cataplexy?  Would you say that 'flickering muscles' fits the sensation?  Cataplexy effects each one of us with it differently, and that is to say in both what the trigger/s are and also in the effect/s of it; it is sporadic, it is unpredictable, it varies in degrees of its effect/s, it can be there when you'd most expect it and/or least expect it or not there when you'd least expect it or most expect it, there is no manner to simply describe it.  What I can definitely say, from my experience with it, is that the things which contribute to it being triggered (in respect to not what, but why it is more likely to occur) are stress, anxiety, nerves and/or emotion, fatigue and/or tiredness, even exhaustion.  In respect to what can trigger it, in my experience, definitely laughter (telling/saying something funny more than hearing, but also hearing something funny, or of course observing, etc...), feelings of pleasantness (like handing off a plate of food I've prepared or achieving something all of a sudden, that is like landing a trick I've been working on skateboarding, etc..), sillyness (kind comments towards me in regards to food or other things, being asked for change, someone smiling at me unexpectedly, etc..), and least often is frustration/anger (usually though this has also to do with sillyness or specifically not being understood and it being annoying); there are other triggers and sorry if that was a bit much.   

I can also say that fighting it, can escalate it dramatically, in my experience.  The best thing I can do is, unless it's very minimal and just the head drooping, to get down to the ground ASAP and basically sprawl out my limbs while breathing and concentrating on my body; this dissipates the flickering and/or paralysis.

I'm not gonna say you are experiencing Cataplexy or not, but as I said earlier it does sound like it.   Somehow it just seems like a 'triggering sort' of occurrence, for some people.  No idea if it would trigger mine.? 

I once was passing a vehicle going around 70 on a small highway and the car I was passing kept speeding up, there was a bend upcoming and trees blocking sight around the bend, I was following the road passing line/lines so I figured there'd be plenty of time; but an SUV appeared and I was almost beyond the car but didn't want to push it so, I slowed down and turned my caution lights on immediately, during such I noticed that the oncoming SUV was a sheriff and I could see him with his arms raised (like saying 'WTF'), I swerved back behind the car (that wouldn't let me pass them) and put my hand up sort of to wave 'sorry' to the Sheriff...  Now, this definitely I'd have thought would cause a Cataplexy, but thankfully it did not; although I hardly drive much anymore and especially long distance which is ROUGH because if you don't drive you're trapped in a bubble basically (especially when you live in a smaller city). :[

 

What you describe regarding waking up with numbness in arms and what not, I've experienced this too, but not very often, although it seems to be in spurts of weeks perhaps when it does occur.

 

3. It progresses.  Some are lucky to have not so much progression and others are unlucky, having worse progression.  It seems to come and go, for some, and be constant or continuous for others...

Having other health matters definitely seems to play into the progression, at least I assume as such seems possible in my case; the progression though has been odd and variable.

 

4. A few things that have helped me for sure are:  avoiding GMO and eating as much Organic as I can manage versus non-organic, I'm intolerant to certain flours/sugars/oils/salts and dairy (whatever you try, requires a close attentiveness with a long period of time and it can be real hard to gauge, also in my experience after going off a certain thing for a period of time when I went back to such it effected me much more than ever prior, but again it can be so hard to judge/gauge) so I prepare and cook near everything that I eat from scratch carefully using proper ingredients (and I'm still finding things that cause me trouble, I may have to go full ketogenic?), learning as much as you can about the condition and paying close attention has been very helpful for me, I take vitamin D and fish oil plus use a lot of turmeric/cinnamon/cocoa, I also attempt very hard to stay within boundaries when it comes down to near everything as when I do not there seems most always to be some negative rebounding effect (be that headache, more Cataplexy, more HH with SP, worse sleep -which sometimes seems hard to imagine being possible-, etc..),  Acupuncture/cupping/massage have helped me in many ways but are pricey at all and especially over time...  Drugs have not helped me, I have too many negative impacting side effects which do not outweigh the benefit (which I've not had from any of them; I've not tried Xyrem, but with a breathing matter I should not try, nor have had it offered).

 

5. I don't know what to say here. 

 

I hope that you do find some-thing/s that work for lessening your symptoms and also that benefit, encouraging, your nursing plans.



#3 DeathRabbit

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Posted 30 April 2013 - 09:38 AM

mwalesh, have you been tested for persistent mono?  There are a growing number of documented cases where people never fully "kick" the disease, and instead have sort of a chronic retrograde infection that flares up really badly at times and causes many of the same symptoms as N. Since it's autoimmune most of the time, it could be that the mono caused an autoimmune resposne that gave you N like you said. But persistent mono would be a much better diagnosis, because then you could just go on a few months worth of anitbiotics and be cured! It's worth mentioning to your doc. I knew nothing about it until my PCP sent me to a hemotologist because I had a chronic high white count (still to this day unexplained). He was the one who suggested and tested for chronic mono. Unfortunately, I was negative, but I did have the antibody, meaning I had mono in the past, something I was not aware of.



#4 2Tired4This

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Posted 01 May 2013 - 12:09 PM

My doctor did mention that there is a lot of talk about Mono being a cause of Narcolepsy. He also added that a lot of problems are thought to be caused by Mono haha. I also had mono as a young kid. Since you mentioned Persistent Mono it actually sounds VERY similar to what I experience on a day to day basis. It doesn't account for the SP and HH but what really struck me was the fact that Chronic Mono symptoms are inflamed lymph nodes. I have had one lymph node protruding/swollen for almost a whole year now. It was probably swollen before then too, i just started keeping tabs on it recently. I also see myalgia noted, which makes a lot of sense to me because I will have periods throughout my day where one specific group of muscles hurts like hell for no reason usually lasting 30 minutes. Some days my hip joints hurt especially bad when walking too. 

 

Fibromyalgia, Chronic Mono, & Narcolepsy share a lot of traits so I guess it is easy to confuse them though. I would like to get myself tested for Chronic Mono if that is possible.



#5 sk8aplexy

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Posted 01 May 2013 - 12:32 PM

^^^^  Definitely couldn't relate and also agree more with what you've just described and mentioned...  ^^^^



#6 DeathRabbit

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Posted 01 May 2013 - 01:49 PM

Go see a hemotologist, I guess. They can check your antibodies to see if you've got a current infection. Maybe a normal doc could order those tests too, but I'd see the specialist to be sure; it would certainly suck to suffer for years on end when a few months of Amoxicillin could've fixed everything. To be honest, I'd love to try some anitbiotics anyway, just cuz. Another symptom I have is increased tonsiloliths, which is also indicative of a chronic infection. If I were a rich sob, I'd get tested for every possible pathogen that can cause fatigue and malaise. Unfortunately, that's now how it works. Although there was an interesting project I saw a presentation on in college that would be amazing to see come into fruition. It was basically a diagnos-o-tron. It would take a variety of blood, urine, and other bodily samples and then run a check against a database of every infection ever documented. It was also billed as a way to reduce healthcare cost, because it would deliver results in a few minutes, and cut out all the extra effort of mailing off samples to get analyzed and all that jazz. Really wondering what happened to that project now. I don't even remember what it was called. The guy was talking about how he wanted to set them up in free clinics so poor people could just walk in and get an instant, thorough exam.



#7 sk8aplexy

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Posted 01 May 2013 - 02:47 PM

http://www.computerw...eating_patients

 

I second the urge and desire for such.  As I am also not rich, nor even making an income, in fact I'm awaiting to find out if I'm considered disabled(?); not gonna help much if I am, but would a slight bit...

Maybe it's me, but getting doctors to actually 'hear' what I'm telling them and/or 'connect dots' seems impossible; I have a lot to say and I speak my mind, plus being resistant to a lot, really leaves me cornered.

The GP I've had for over a handful of years I like, but have some concerns with.

It seems for him to run test that I ask for, can be way too difficult, in ways he's great because he tends to follow through with referral request and he seems to actually respect (to a point) 'my having an interest into my own matters and/or perhaps having some say in things/direction' although he doesn't like to go very deep into things as at times would really help.

Living in a smaller town with a huge college, I actually drive to the capitol of the state to see my GP and any other doctor, unless it's an emergency or obvious matter (yet even then I am so hesitant -read my recent post, 'horror' experience I had with the Neurologist group and the Sleep Lab here...-).

The horrors of the current systemics...



#8 Dazedandsosleepy

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Posted 19 May 2013 - 11:50 AM

"Been doing some studying on this and honestly this is what really sets me back as far as sleeping issues. To put it simply, when I wake up in the morning, I feel like I've been hit by a bus, always, for as long as I can remember. I have never, ever, woke up naturally feeling refreshed. Physiologically speaking, this is what happens to a normal person when they are awoken from a REM sleep state. With narcolepsy, I'm always in this sleep state and its the reason for why I can sleep 14hrs and still wake up feeling exhausted, and why I often dream before I'm even fully asleep. It takes me a good 3-4 hours to get up and get going with my day. As a typical narcoleptic, my alarm clock is set in about 5 different ways and I sleep until the VERY.LAST.MOMENT. possible. Which usually makes me rush to get to work or school. Its so frustrating because when I go to bed at night, I usually give myself a pep talk that goes, "Okay, your going to get up an hour earlier, make a pot of coffee, maybe read the paper, get the day started on a good note!" But this never happens, and even as I write it I realize how ridiculous it sounds. While I usually hide this from people, or make excuses as to why I can't do Sunday brunch or go for a run before 10am, the times I have tried to explain it resulted in the other person going, "Huh? Just get up 10 minutes earlier for gods sake!" I'm not sure if this is from the sleep paralysis but my blood pressure is super low when I first wake up (I tried to monitor this for a few days but the machine just "errored" it was so low) and my body hurts. Not in the way that lifting weights makes you sore, but its like I sleep so hard and deep that its just physically exhausting. I also am really dizzy, and its not uncommon for me to hit the wall on the way to the bathroom. What I've gotten into the habit of doing lately is setting my alarm an hour earlier to take an adderoll and then going back to sleep. This usually makes waking up and getting going easier because my heart is beating faster, thus making my BP higher. Although if I don't have to get up for anything I can easily sleep through the adderoll. This difficulty in getting up is a huge source of frustration in my life and it really bugs me because I feel like I could accomplish so much more if I could get up before noon.

2. Cataplexy, Hallucinations, Sleep paralysis- I do not have the cataplexy episodes where I suddenly lose conciousness, but I have noticed sudden numbess mostly in my legs with strong emotions, most often fear. For example, if I'm speeding (which is often because I'm always late for things!) and I pass a cop, I get this shooting numbness that lasts maybe up to ten seconds. Maybe this is related to my BP, not sure. Any input?"

This is/was me. I finally got a sleep study done and was basically dx'd "most likely Narcolepsy"
Put on Xyrem and feel like I get sleep now with the exception that I must make myself get out of bed or I will sleep until noon(I let myself do that on weekends) I am also on adderall 20mg BID which I started even before the sleep study because I was dx'd with ADD but later found out those symptoms are also symptoms of N. Adderall is failing right now because I also have to do the 6 hour energy shots to stay awake. This will be my second month on Xyrem ad had to increase to 3gm twice a night already because I stay awake through the first dose after about two wks of taking it. I am also an LPN in school for my RN and worry how this will affect my work. Good luck

#9 2Tired4This

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Posted 19 May 2013 - 06:52 PM

I'm actually really allergic to amoxicillin. The last time I took it I broke out with a huge rash that make me look like a cheetah. I had discolored spots ALL over my body. They didn't really itch or hurt, but it was the weirdest thing to ever happen to me.



#10 mwalesh

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Posted 21 May 2013 - 12:08 AM

Hey everyone, sorry for the long delay in response, just busy graduating nursing school! :) Not without a few sleep related issues, such as sleeping through a final exam. Whoops. Fortunately the instructor believed my BS car problem story.

 

Anyways, in response to the much appreciated questions, I have been tested for the chronic mono-Negative. No lymph node issues. Sk8aplexy- I've been looking into giving cupping/more homeopathic remedies consideration. Right now i've added more strength training into my exercise routine, also eating better. Organic, less dairy, less carbs. I've been feeling good lately. But its also summer and warming up. This helps me by giving me an extra kick of motivation to wake up in the morning. I really hate sleeping through beautiful days.

 

Well I'm going in tomorrow to see a sleep specialist. Got a list made up of my symptoms, trial and errors with meds, diet. I've recently been experimenting with sleep aids and I've discovered that (shockingly) I do wake up on my own before my alarm clock. Thats not to say I'm as fresh as the people who drink Folgers look after their first cup of Am coffee, but its really significant because that simply is totally abnormal for me. Definitely planning on bringing this up tomorrow. Also, I'd like to inquire about the use of Wellbutrin. The idea of anti-depressants scares me *BEEP*less with the side effects, not being in control of my mood, not to mention that I do not believe I have depression; but at this point I'm willing to try anything! Apparently it is known for having sleep-wake properties, and right now that's my biggest complaint. Anyone familiar with this one?

Also going to inquire about Xyrem.

 

Keep your fingers crossed for me. Hope this doctor will LISTEN.



#11 MINItron

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Posted 25 May 2013 - 01:15 AM

I know that when I took Wellbutrin to quit smoking every night was like having a movie playing in my head all night long. My dreams were even more vivid, and unusual than normal. I currently take Protriptyline, a tricyclic antidepressant, as a REM suppressant because I have hyponea when I am in REM. It has made my night time sleep much better. I don't dream myself awake nearly as much now, and can sleep for more than 6 hours at a time for the first time in forever. There are a lot of different antidepressants out there, and everyone responds to them differently. There is likely one out there that can help you, it may take some trial and error.



#12 Krickett

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Posted 18 June 2013 - 04:40 PM

Wow, once again i am both shocked and dismayed that so many people have suffered so much of the exact same thing that I have.. its a bizarre emotion.. I too was in nursing school (and a combat medic in the Army) however when i was diagnosed i was told i would have to be medically discharged, and advised that nursing was probably not the right feild for me to be in, as it presents a danger to the well being of the paient if i have a C attack or forget something because i am so foggy ect... as I am sure you have well thought of.. however.. even though i have an additional passion i can go to school for in the form of forensic science, I am somewhat questioning the validity of that..Before i moved and gained an ill informed idiot for a sleep doctor, the combination Xyrem (4.5+4.0 g) and Adderol ( 40mg BID PRN) made such a significant change in my life it was amazing.. a whole new life basically.. and i feel that I could very easily have continued in nursing on this medication combination, although I personally (whily i know it's *BEEP*ty to say) would not want to hire a nurse with narcolepsy... there is just too many variables.. which makes me sad because i have always very passionately loved medicine.. sorry this isnt meant to scare you or try to dissuade ou from the career you love..just my personal experience



#13 Krickett

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Posted 18 June 2013 - 04:41 PM

Also, please excuse my hideous typing.. i'm fairly sleep deprived today



#14 Ferret

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Posted 18 June 2013 - 05:16 PM

Krickett, I feel your pain. I had to shelve my career as a Registered Medical Laboratory Technologist because of Narcolepsy with Cataplexy. Fifteen years work in Microbiology and Chemistry down the tubes. The health and well being of those you care for should always come first.
YOU come in a close second though. Take care. You will get through this and find a satisfying life!