narcolepsy is an excessive sleepiness disorder which is characterized by excessive daytime sleepiness , sleep paralysis , cataplexy , nocturnal sleeping patterns , and hypnagogic hallucinations .
some of these symptoms , such as sleep paralysis and hypnagogic hallucinations , are thought to be the result of dissociated rem sleep .
there is no cure for narcolepsy , but different medications can be used to offset symptoms experienced .
pharmacological treatment tries to stimulate the individual during the day and reduce sleep disturbances at night .
studies suggest that individuals with narcolepsy struggle with educational and occupational problems despite pharmacological treatment .
it is believed that maintaining regular nocturnal sleep habits and attention to sleep hygiene can help to optimize daytime alertness .
massage therapy ( mt ) is a health care option that can aid in the prevention and treatment of pain and physical dysfunction through physical manipulation .
although massage therapy assessment and treatment often focus on physical outcomes , a well - recognized review of mt research suggests that massage therapy has a significant impact on psychological outcomes , such as reduction in anxiety and depression .
no studies have specifically been conducted on the effect of massage therapy on individuals with narcolepsy .
the effects of massage therapy on sleep have been studied in a number of different populations .
one study investigated the effects of massage therapy and sleep in infants with low birth weight .
this study showed that the group of infants with low birth rates that received the massage therapy intervention was more alert during the day .
this study also showed that the massage therapy intervention facilitated positive sleep patterns in the infants , which included reducing breathing disorders such as sleep apnea and snoring , and increasing daytime alertness and improving the quality of sleep . a study investigating
the effects of massage therapy on elders with sleep disorders in a nursing home showed that the intervention group which received the massage therapy treatments effectively produced a relaxation response in the elderly individuals as measured by their resting heart rate , systolic and diastolic blood pressure , and scores on the visual analogue scale ( vas ) . in some of the cases ,
the intervention induced sleep , decreased sleep disruptions , and improved the overall sleep quality .
this case report is the first to investigate the research question ,  does massage therapy have an effect on a patient with narcolepsy ? 
it was hypothesized that massage therapy would improve the sleep patterns of a patient with narcolepsy .
as the intervention would be conducted during the day , the treatment plan focused on providing a massage therapy intervention designed to be stimulating rather than sedative . stimulating massage therapy techniques are thought to act as wake - promoting agents or stimulants to the body s sensory neurons .
it was anticipated that this would promote proper sleep patterns by helping the participant stay alert during the day and possibly reduce sleep disturbances at night .
this study is a prospective single - case design in which massage therapy was provided to a patient with narcolepsy .
the participant was a 23-year - old teacher who was diagnosed with narcolepsy with cataplexy five years ago .
her symptoms include excessive daytime sleepiness , periodic leg movements ( plm ) , and cataplexy .
she experiences fatigue throughout the day which makes it more difficult to fall asleep at night .
when she wakes up in the morning to go to work , she feels as though she has not had a restful sleep and continues to be tired throughout the day .
when she comes home from work in the evenings , she feels exhausted and takes a nap , which sometimes turns into sleep for over 23 hours .
she tries to take shorter , more frequent naps when possible , so that she does not fall asleep for long periods of time , but finds it difficult to do once she falls asleep .
the intervention in this study was massage therapy and was administered by a student massage therapist who provided massage techniques within the scope of practice in ontario . at this point in her program , the student had completed about 1700 hours of her 2430-hour program .
the massage therapy intervention was designed to positively impact the patient s sleep patterns by stimulating daytime wakefulness .
the treatment primarily included rapid tapotement and petrissage applied to the anterior and posterior surfaces of legs , the back , and both arms .
the protocol was pragmatic , meaning that the therapist could choose the exact techniques , the length of time each was administered , and the order .
each treatment was once a week for forty - five minutes , for five weeks . in the sixth week of the study ,
the questionnaire was completed with no intervention . the leeds sleep evaluation questionnaire ( lseq )
this tool uses ten visual analogue scales , each 100 mm , in four areas .
these areas include the concerning ease of getting to sleep ( gts ) , the perceived quality of sleep ( qos ) , the ease of awakening from sleep ( afs ) , and the integrity of early - morning behaviour following wakefulness ( bfw ) .
the questionnaire was completed in the week prior to the start of the massage therapy intervention and prior to the intervention in each of the following weeks .
each visual analog scale ( vas ) was measured and the resulting score recorded for analysis .
the data were organized by grouping the visual analog scales by section ( ease of getting to sleep , the perceived quality of sleep , the ease of awakening from sleep , and the integrity of early - morning behaviour following wakefulness ) . as such , ease of getting to sleep included the results of three vass , perceived quality of sleep included two vass , ease of awakening from sleep included two vass , and the integrity of early - morning behaviour following wakefulness included the results of three vass .
the data were analyzed by calculating the percent change using the results of the final data collection point , subtracting the results from the first data collection point , and dividing it by the results of the first data collection point and multiplying by 100 ( [ data 6 - data 1]/data 1  100 ) .
the total change , found by combining the results of all of the visual analog scales into a composite score and using the same formula as above , was also calculated .
the participant was a 23-year - old teacher who was diagnosed with narcolepsy with cataplexy five years ago .
her symptoms include excessive daytime sleepiness , periodic leg movements ( plm ) , and cataplexy .
she experiences fatigue throughout the day which makes it more difficult to fall asleep at night .
when she wakes up in the morning to go to work , she feels as though she has not had a restful sleep and continues to be tired throughout the day .
when she comes home from work in the evenings , she feels exhausted and takes a nap , which sometimes turns into sleep for over 23 hours .
she tries to take shorter , more frequent naps when possible , so that she does not fall asleep for long periods of time , but finds it difficult to do once she falls asleep .
the intervention in this study was massage therapy and was administered by a student massage therapist who provided massage techniques within the scope of practice in ontario . at this point in her program , the student had completed about 1700 hours of her 2430-hour program .
the massage therapy intervention was designed to positively impact the patient s sleep patterns by stimulating daytime wakefulness .
the treatment primarily included rapid tapotement and petrissage applied to the anterior and posterior surfaces of legs , the back , and both arms .
the protocol was pragmatic , meaning that the therapist could choose the exact techniques , the length of time each was administered , and the order .
each treatment was once a week for forty - five minutes , for five weeks . in the sixth week of the study ,
this tool uses ten visual analogue scales , each 100 mm , in four areas .
these areas include the concerning ease of getting to sleep ( gts ) , the perceived quality of sleep ( qos ) , the ease of awakening from sleep ( afs ) , and the integrity of early - morning behaviour following wakefulness ( bfw ) .
the questionnaire was completed in the week prior to the start of the massage therapy intervention and prior to the intervention in each of the following weeks .
each visual analog scale ( vas ) was measured and the resulting score recorded for analysis .
the data were organized by grouping the visual analog scales by section ( ease of getting to sleep , the perceived quality of sleep , the ease of awakening from sleep , and the integrity of early - morning behaviour following wakefulness ) . as such , ease of getting to sleep included the results of three vass , perceived quality of sleep included two vass , ease of awakening from sleep included two vass , and the integrity of early - morning behaviour following wakefulness included the results of three vass .
the data were analyzed by calculating the percent change using the results of the final data collection point , subtracting the results from the first data collection point , and dividing it by the results of the first data collection point and multiplying by 100 ( [ data 6 - data 1]/data 1  100 ) .
the total change , found by combining the results of all of the visual analog scales into a composite score and using the same formula as above , was also calculated .
overall , there was a 123% total change on the leeds sleep evaluation questionnaire between the initial and final use of the tool .
higher numbers indicate improvement on each of the visual analog scales , so the change is an improvement in symptoms ( figure 1 ) .
global leeds sleep evaluation questionnaire scores . in the first area , getting to sleep , a 148% improvement was seen following the six - week period ( figure 2 ) . for the questions about quality of sleep ( qos )
, there was 1100% improvement from the beginning to end of the study ( figure 3 ) .
the questions related to awake following sleep ( afs ) showed a 121% change ( figure 4 ) . finally , behavior following wakening ( bfw ) improved by 28% ( figure 5 ) .
the results of this study suggest that massage therapy had a positive effect on the sleep patterns of this participant with narcolepsy .
in particular , substantial improvement was experienced by the participant in the area of quality of sleep . from figure 3
, one can see that the data points suggest a steady improvement in quality of sleep over the study with the results tapering off in the last week of the study .
future studies might consider a longer time period to see if the impact of weekly treatments on quality of sleep plateaus following four treatments .
the characteristic of getting to sleep also showed a fairly steady improvement over the study , although the percent change from beginning to end of the study was not as large .
awake following sleep shows an erratic pattern , and it is unclear whether the percent change seen was as a result of the massage therapy intervention or other factors .
behaviour following wakening did not show substantial improvement , and this would be interesting to explore further .
it is worth considering whether this study was sufficiently long to capture any effect massage therapy might have on this characteristic .
the results of this study suggest that these massage therapy treatments improved the participant s sleep patterns , in particular by helping her get to sleep and improving her quality of sleep .
a study regarding the effects of massage therapy and sleep found similar results , whereby massage therapy improved sleep by reducing sleep latency due to less disturbed sleep .
while massage therapy seemed to benefit the participant in this study , these results may not generalize to all patients with narcolepsy .
in addition , this study can not suggest a cause and effect relationship between massage therapy and narcolepsy ; a more rigorous study is needed .
it is recommended that future research focus on the population of individuals with narcolepsy and sleep behaviours in various populations .
based on the experience of this case study , the authors suggest the following considerations : timing of the intervention : does the timing of the intervention of massage therapy have an effect on the outcome ? timing the stimulating massage therapy treatment with times of fatigue may increase the effectiveness .
similarly , soothing massage therapy treatment closer to bedtime may also alter the impact of massage therapy on sleep behaviours .
dosage of the intervention : it is important to better understand the amount of massage therapy that is needed to create change in sleep patterns and to maintain that change . using different lengths of treatment plans will help to better understand the appropriate dosage of massage therapy .
measurement tools : while the leeds sleep evaluation tool was easy to administer and analyze , future studies may choose to use additional or alternate measurement tools . due to the importance of rem sleep patterns to individuals with narcolepsy
, it would be interesting to investigate whether or not massage therapy treatments have an impact by altering the rem patterns during sleep .
this single - case report was conducted to answer the question ,  does massage therapy have an effect on a patient with narcolepsy ? 
results of this study suggest that massage therapy can improve sleep patterns in a patient with narcolepsy .
in particular , quality of sleep and the ability to get to sleep showed the most promising impact . further clinical research on massage therapy and narcolepsy is needed to better understand the preliminary results of this case .
 purposethe purpose of this case report was to investigate the effects of massage therapy on the sleep patterns of a woman with narcolepsy.participantthe 23-year - old woman s primary symptoms included excessive daytime sleepiness and periodic leg movements ( plm ) , which were associated with her diagnoses of both narcolepsy and cataplexy.interventionfive 45-minute massage therapy treatments were administered over a five - week period . 
 the patient s sleep patterns were recorded each week before the treatment . 
 a final measurement was recorded in the sixth week . 
 the sleep patterns were monitored using the leeds sleep evaluation questionnaire , which included ten visual analogue scales.resultsthe results of this case report included an improvement in getting to sleep by 148% , an improvement in quality of sleep by 1100% , an improvement in awake following sleep by 121% , and an improvement in behaviour following wakening by 28% using the leeds sleep evaluation questionnaire.conclusionthis case report suggests that massage therapy had a positive effect on this patient with narcolepsy . 
 further research is needed to investigate the effects of massage therapy on narcolepsy and sleep patterns . 