Narcolepsy TREATMENT

Narcolepsy
Overview

TREATMENT

Treatment plans for narcolepsy usually combine lifestyle modifications and medication. Plans need to be highly individualized and may require adjustment over time.

Lifestyle modifications
A patient's treatment team works with him or her to develop a daily plan to increase wakefulness. Elements of the plan may include:

Having a regular nighttime sleep schedule and adhering to it even on weekends
Taking naps at strategic times
Avoiding nicotine and alcohol
Getting regular exercise
Making changes at work or school to break up monotonous tasks. The Americans with Disabilities Act prohibits discrimination against workers with narcolepsy and requires employers to provide reasonable accommodation to qualified employees.
Avoiding driving if drowsy. If patients with narcolepsy must drive a long distance, they'll need to work with their treatment team to establish a medication schedule that ensures the greatest likelihood of wakefulness during the drive, and will need to stop for naps and exercise breaks whenever they feel drowsy. Patients should not drive if their sleepiness is not well controlled.

Medications
The best medication for a given patient depends on whether the patient experiences cataplexy, other medications being taking for other conditions, the patient's age, and response to particular drugs. Some medications often prescribed include:

Stimulants: Stimulate the central nervous system to help stay awake during the day. They include:
Modafinil (Provigil): Newer stimulant that isn't as addictive and doesn't produce the highs and lows often associated with older stimulants.

Methylphenidate (Ritalin)

Various amphetamines: Although effective, they may cause side effects, such as nervousness and heart palpitations.

Antidepressants: Suppress REM sleep to help alleviate the symptoms of cataplexy, hypnagogic (the boundary state between sleep and wakefulness) hallucinations, and sleep paralysis. Options include selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants.

Sodium oxybate (Xyrem): Controls cataplexy, sleep paralysis and hallucinations, helps improve nighttime sleep, and in high doses may also help control daytime sleepiness (though taken only at night). Associated with possible serious side effects, however, such as trouble breathing during sleep, sleepwalking and bed-wetting, and therefore strictly regulated by the Food and Drug Administration.