Narcolepsy and Long Term Disability

Narcolepsy is a chronic neurological disorder that is caused by the brain’s inability to regulate a stable sleep-wake cycle. Those who suffer from narcolepsy receive mixed signals from their brain about when to sleep. That is why narcoleptics fall asleep at random (and often inopportune) times.

One may develop narcolepsy at any time, although the onset of the first symptom usually occurs after puberty – in one’s late teens to young adulthood. Excessive daytime sleepiness (EDS) is the first noticeable symptom of narcolepsy. The severity of EDS is typically progressive. It can take a number of years for this symptom to progress to a point of concern and for other related symptoms to present themselves.

Narcolepsy is commonly undiagnosed or misdiagnosed because few patients realize they are experiencing a neurological disorder when the symptoms begin. It is thought that as many as 125,000 to 200,000 Americans have narcolepsy, but fewer than 50,000 may have been properly diagnosed.

Causes of Narcolepsy

The exact cause of narcolepsy is still unknown, but much research is still being done to determine the cause. Scientists and researchers believe there are numerous factors that influence the disorder. For example, a recent discovery has shown that those who suffer from narcolepsy lack the chemical hypocretin. Hypocretin is responsible for the feeling alert and aids in sleep regulation. Researchers have also found abnormalities in narcoleptics’ regions of the brain that regulate REM cycles. The current scientific view is that all of these factors contribute to the cause of narcolepsy.

Signs and Symptoms of Narcolepsy

There are no physical abnormalities in narcolepsy, and – with the exception of sleep studies – laboratory studies will be normal. Patients who suffer from narcolepsy can experience a number of different symptoms, but excessive daytime sleepiness is the most common. There are a number of other symptoms associated with narcolepsy as well, such as cataplexy and sleep paralysis. Below is a list of the symptoms most commonly associated with narcolepsy:

  • Excessive Daytime Sleepiness – characterized by recurrent periods of an irresistible urge to sleep.
  • Cataplexy – attacks of loss of muscle tone, sometimes with actual collapse, during which the individual always remains conscious.
  • Sleep Paralysis – a transient sensation of being unable to move while drifting into sleep or upon awakening. In addition, some persons have periods of automatic behavior and most have disturbed nocturnal sleep.
  • Hallucinations, including hypnagogic hallucinations – hallucinations which occur between sleep and wakening.

The sleep symptoms will range from mild drowsiness to severe sleepiness in which the individuals spend the entire day drifting in and out of sleep, unable to work, play or supervise the home. Sleep periods range from a few seconds to 30 minutes. The sensation is described as ordinary but uncontrollable drowsiness. When observed by others, the sleep appears natural and is readily interrupted by stimuli. Once awakened, the narcoleptic patient is alert. Not all individuals will have all of the symptoms. Cataplexy, however, is observed in 70 percent of all cases, and its associated presence is ordinarily sufficient to establish narcolepsy, without laboratory sleep studies.

Determination of the Severity of Narcolepsy

It is not necessary to obtain an electroencephalogram (EEG) in narcolepsy cases. A routine EEG is usually normal, and when special attempts are made to obtain abnormal rapid eye movement (REM) sleep patterns, they may or may not be present even in true cases of narcolepsy.

Also, narcolepsy is not usually treated with anticonvulsant medication, but is most frequently treated by the use of drugs such as stimulants and mood elevators for which there are no universal laboratory blood level determinations available. Finally, it is important to obtain from an ongoing treatment source a description of the medications used and the response to the medication, as well as an adequate description of the claimant’s alleged narcoleptic attacks and any other secondary events such as cataplexy, hypnagogic hallucinations or sleep paralysis.

Applying for Long Term Disability Benefits with Narcolepsy

The long term disability (LTD) insurance company needs to determine the severity of your narcolepsy symptoms before making a determination on (LTD) benefit eligibility. This means your claim for disability benefits should contain detailed medical records that show:

  • A formal narcolepsy diagnosis;
  • Frequency and duration of symptoms of narcolepsy;
  • Persistence of symptoms even when following prescribed medical treatments; and
  • Severe disruption of your ability to function due to symptoms.

In order to qualify for long term disability insurance benefits, you’ll need to show your narcolepsy so severely impacts your “residual functional capacity” that you are unable to perform full time work.

Your Residual Functional Capacity

Residual functional capacity (RFC) is a term used to indicate the limits of one’s physical and mental capabilities caused by an impairing medical condition. One’s RFC is typically measured in relation to one’s ability to perform activities of daily living, such as driving, going to the store, cleaning one’s home, bathing, grooming, dressing, and generally caring for oneself. It is also measured by looking at the kinds of physical and mental job duties or tasks one is still able to perform.

If you are applying for benefits, you should verify that your medical records accurately reflect the limitations you experience due to your narcolepsy symptoms.

Necessary Medical Documentation to Prove Narcolepsy

Medical records and other documentation are a critical to receive long term disability insurance benefits. The evidence submitted in support of your claim should include information that supports your diagnosis, as well as records that reflect your symptoms and the treatments you’ve undergone in an effort to control those symptoms. Documentation contained in a claim for disability benefits due to narcolepsy should include:

  • Diagnostic test results, like EEGs, sleep studies and other exams (which may also rule out other medical conditions);
  • Medications you take as well as any negative side effects they may cause;
  • Other treatment or therapies that you’ve been prescribed, such as a strict napping schedule to try and decrease your narcolepsy symptoms;
  • A treating physician’s opinion(s) as to your residual functional capacity, including any decreases in daily productivity or inability to complete certain tasks because of muscle weakness or drowsiness; and/or
  • Detailed statements from your doctor(s) identifying your condition, symptoms, outlook and overall status.

Getting Help for Your Narcolepsy LTD Claim

You must ensure your claim for LTD benefits contains thorough medical records and other documentation to support your disability claim. Your doctor can help you collect the right information to satisfy the LTD insurance company’s requirements. An experienced long term disability insurance attorney can assist in collecting information and in reviewing your claim and all your LTD forms for consistency, accuracy and to promote a quicker and favorable determination on your eligibility for benefits.