Treatment of Narcolepsy

Narcolepsy is a chronic sleep disorder characterized by excessive sleepiness accompanied by a series of auxiliary symptoms, typically beginning in adolescence or young adulthood.

In the treatment of narcolepsy, it is important to define clear outcome goals for specific target symptoms. There are medications to use to help with narcolepsy and its symptoms, as well as behavioral modifications to help the patient deal with this disease.

Some important behavioral changes are:

• Avoiding drugs that can affect sleep (even over the counter medications).
• Napping during the day, for 20-30 minutes may increase a narcoleptic’s ability to function well and maintain work and social obligations.
• Narcoleptics often have many difficulties socially and in their work related lives, due to their disease. There are some professionally supervised support groups that help patients cope with these issues. More information can be found at http://www.narcolepsynetwork.org/.

Medication treatments are usually divided into two categories that address different treatment goals: daytime sleepiness and cataplexy. The only medication shown to improve both of these problems is sodium oxybate (Xyrem).

A relatively new “wake promoting” agent, called modafinil (Provigil), has recently become the primary treatment in improving daytime sleepiness. Other more traditional stimulants - dextroamphetamine (Dexedrine), methylphenidate (Ritalin), and pemoline (Cylert) - can also be used.

Stimulants are generally given in a single morning dose or in morning and lunchtime doses. Too high a dose or one that is given later in the day may disturb nocturnal sleep. Generally, the biggest therapeutic concern is the development of tolerance - some clinicians believe that the use of drug holidays may reduce this problem. Tolerance has not been noted to be a major problem with modafinil.

The current treatments for the sometimes disabling symptoms of cataplexy are sodium oxybate and different types of anti-depressant drugs, such as venlafaxine (Effexor) and fluoxetine (Prozac). The antidepressants are able to decrease the amount of REM and therefore do not allow its intrusion into the awake state, which is the cause of cataplexy.