Treating Narcolepsy

Overview

There is no known cure for narcolepsy, but there are strategies to control its symptoms:
  • Medications (See Medications Section)
  • Lifestyle adjustments
  • Good sleep hygiene
  • Napping
  • Excessive daytime sleepiness (EDS) is narcolepsy’s primary symptom. The polysomnogram and multiple sleep latency tests are key to determining if EDS is caused by narcolepsy or other reasons, such as an underlying medical condition, sleep deprivation, medication, or the consumption of caffeine, alcohol or nicotine.

Procedural Details

Narcolepsy often goes undiagnosed for a decade or more after symptoms first appear. This is because narcolepsy’s early symptoms may be subtle. When the symptoms develop, people might not recognize they have a disorder of the central nervous system and therefore don’t know to seek diagnosis and treatment.

Excessive daytime sleepiness (EDS) is narcolepsy’s primary symptom. The polysomnogram and multiple sleep latency test are key to determining if EDS is caused by narcolepsy or other reasons, such as an underlying medical condition, sleep deprivation or medication.
  • Polysomnogram. This overnight test continuously measures bodily functions such as heart rate, respiration, eye movements, blood pressure, blood oxygen levels, electrical activity in the brain and movement in the muscles. A polysomnogram sheds light on whether the rapid eye movement (REM) stage of sleep takes place at abnormal times in the sleep cycle or if sleep disrupting conditions such as sleep apnea are present. This information then helps determine if the excessive daytime sleepiness is due to narcolepsy or something else.
  • Multiple sleep latency test. This study occurs during the day, often following an overnight sleep study. The goal is to measure how long it takes to fall asleep and whether the REM stage of sleep occurs at abnormal times. Small electrodes are placed on various areas of your body to record brain waves, eye movements, heart and respiratory rates and chin muscle tone. During the test, you will take several timed naps every two hours throughout the day.
Besides sleep tests, you may be asked to fill out extensive and specialized questionnaires and keep sleep logs, or sleep diaries, for two or three weeks. Testing spinal fluid for levels of hypocretin, a brain chemical that is low in those with narcolepsy, may be useful test in the for some patients.

Medications

Stimulants: Sleep specialists turn to several different types of stimulants to combat excessive daytime sleepiness. The names of the generic drugs are modafinil, methylphenidate hydrochloride, dextroamphetamine sulfate, and occasionally methamphetamine hydrochloride.

Antidepressants: Two classes of antidepressants, tricyclics and selective serotonin re-uptake inhibitors (SSRIs), are used to help alleviate cataplexy, sleep paralysis and hypnogogic hallucinations.
  • Tricyclics include imipramine, desimpramine, clomipramine, protriptyline.
  • SSRIs include fluoxetine, paroxetine, and sertraline.
  • Venlafaxine.
Sodium oxybate: This medication is given at bedtime and is effective for treating cataplexy and sleepiness during the day.

Considerations

Anyone with narcolepsy severe enough to disturb normal daytime activities should consider discussing treatment options with a sleep specialist. If you have other health conditions such as high blood pressure, diabetes or heart disease, ask your physician or pharmacist how your current medications might interact with medications prescribed for narcolepsy.

Effectiveness

With proper medication, most people with narcolepsy can significantly improve their levels of alertness.

Risks

Side effects may occur with any medication. A few of the most common side effects of drugs for narcolepsy are:
  • Stimulants: headache, irritability, nervousness, insomnia, irregular heartbeat, mood changes.
  • Antidepressants: drowsiness, sexual dysfunction, decreased blood pressure. In a small set of patients, selective serotonin re-uptake inhibitors (SSRIs) can cause overexcitement, anxiety, insomnia, nausea and reduced sexual drive.
For women who are pregnant, the long-term effects of these drugs on a developing fetus are unknown. Your physician may advise you to stop your narcolepsy drug regimen during pregnancy.

Suddenly halting the use of prescribed narcolepsy medications can have serious side effects. Stopping short-acting stimulants can cause a rebound of sleepiness. If you’re taking antidepressants to help manage cataplexy, suddenly stopping them can cause rebound cataplexy. If your medication regimen needs to be altered, consult your sleep specialist before making any changes.

Urgency

Falling asleep while driving or operating heavy machinery is one of the risks people with narcolepsy face. Injuries can also occur during falls if you suddenly fall asleep or experience cataplexy. If you experience excessive daytime sleepiness, cataplexy, sleep paralysis or have bizarre hallucinations as you go to sleep, be sure to see your physician or a sleep specialist.