The impact of narcolepsy symptoms and treatment on sex life - Current Evidence and Reports / Volume 25 (Yearbook 2024) / Issues / Current Problems of Psychiatry

The impact of narcolepsy symptoms and treatment on sex life - current evidence and reports

Wpływ objawów i leczenia narkolepsji na życie seksualne - aktualne dowody i doniesienia naukowe

REVIEW PAPER

Curr Probl Psychiatry Vol. 25 (2024), 118-126

10.12923/2353-8627/2024-0012

Karol Kasprzak¹, Agnieszka Dyzma-Kasprzak¹,
Zuzanna Wingralek¹, Agnieszka Pukaluk-Lewinska²

¹ Student Research Group at I Department of Psychiatry, Psychotherapy and Early Intervention, Medical University, Lublin, Poland
² University Public Hospital no. 1, Lublin, Poland

Full Text

Abstract

Introduction: Narcolepsy (NT) can manifest as excessive daytime sleepiness (EDS), cataplexy, hypnagogic (HHG) and hypnopompic (HHP) hallucinations, sleep paralysis, orgasmolepsy – all of which may affect patients' functioning. The aim of the study was to determine the impact of NT, specific sexual dysfunctions and drugs used in NT on sex life.

Materials and methods: A narrative review was conducted, using keywords: narcolepsy, sexual dysfunctions, medications in narcolepsy from repository inception to March 17, 2024 searching PubMed/MEDLINE, Google Scholar, Crossref, Cochrane databases. The quality of the reviewed articles was assessed using the Scale for the Assessment of Narrative Review Articles (SANRA).

Results: Sexual activity and satisfaction are reduced in up to 81.1% of patients. There are often multiple co-occurring autonomic dysregulations in patients, including the genitourinary system, causing sexual dysfunction (erectile dysfunction in 48% of men; vaginal lubrication in 81% of women). Orgasmolepsy negatively affects sexual and social relationships in more than 1⁄3 of respondents. Sleep paralysis can be accompanied by HHG, which often present the impression of sexual assault and harassment. They may cause anxiety, post-traumatic stress disorder (PTSD) features, depressed mood, in extreme cases leading to suicide attempts. Of the drugs used in NT, only methylphenidate can increase libido and reduce erectile dysfunction in NT.

Conclusions: Orgasmolepsy, sexual and autonomic dysfunction in NT significantly reduce patients' quality of sex life. Sleep paralysis with sexual HHG can reduce psychological well-being. A holistic intervention approach, using behavioural interventions, cognitive-behavioural therapy, education of the patient and their loved ones, is crucial in the treatment of sexual difficulties.

Keywords: narcolepsy, sexual dysfunctions, medications in narcolepsy

Streszczenie

Wstęp: Narkolepsja (NT) może objawiać się nadmierną sennością w ciągu dnia (excessive daytime sleepiness, EDS), katapleksją, halucynacjami hipnagogicznymi (hypnagogic hallucinations, HHG) i hipnopompicznymi (hypnopompic hallucinations, HHP), paraliżem przysennym, orgazmolepsją, które zaburzają funkcjonowanie pacjentów. Celem pracy jest określenie wpływu NT, współwystępujących specyficznych dysfunkcji seksualnych oraz leków stosowanych w terapii NT na życie seksualne.

Materiały i metody: Przeprowadzono przegląd narracyjny z użyciem słów kluczowych: narkolepsja, dysfunkcje seksualne, leczenie narkolepsji oraz deskryptorów czasowych do 17 marca 2024 r., przeszukując bazy PubMed/MEDLINE, Google Scholar, Crossref, Cochrane. W celu weryfikacji jakości przeglądanych artykułów posłużono się sześciopunktową skalą SANRA (Scale for the Assessment of Narrative Review Articles).

Wyniki: Wykazano, że aktywność i satysfakcja seksualna są obniżone nawet u 81,1% pacjentów. U chorych często współwystępują liczne zaburzenia regulacji autonomicznej, w tym układu moczowo-płciowego, powodując dysfunkcje seksualne (erekcji -48% mężczyzn; nawilżenia pochwy -81% kobiet). Orgazmolepsja negatywnie wpływa na seksualne i społeczne relacje u ponad ⅓ badanych. Paraliżowi przysennemu często towarzyszą nieprzyjemne HHG, które przedstawiają wrażenie napaści i molestowania seksualnego. Mogą powodować lęk, cechy zespołu stresu pourazowego (post-traumatic stress disorder, PTSD), obniżony nastrój, a w skrajnych przypadkach prowadzić do prób samobójczych. Spośród leków stosowanych w NT jedynie metylofenidat może zwiększać libido i zmniejszać zaburzenia erekcji.

Wnioski: Orgazmolepsja, dysfunkcje seksualne i autonomiczne w NT znacząco obniżają jakość życia seksualnego pacjentów. Paraliż przysenny z HHG o charakterze seksualnym często negatywnie wpływają na dobrostan psychiczny. Holistyczne podejście z wykorzystaniem interwencji behawioralnych, terapii poznawczo-behawioralnej, edukacji pacjenta i jego bliskich są kluczowe w leczeniu zaburzeń seksualnych w przebiegu NT.

Słowa kluczowe: narkolepsja, dysfunkcje seksualne, leczenie narkolepsji

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