Although there is no cure for narcolepsy, the symptoms can be managed with medications. Sleepiness is treated with stimulants, while the symptoms of cataplexy and abnormal REM-sleep can be treated with antidepressants.
The EDS is treated with amphetamine-like stimulants like dexamphetamine, methylphenidate or modafinil. These drugs are first-line therapy because of their low cost, availability, and higher efficacy.
These medications are controlled substances, and with the exception of Modafinil, tolerance and abuse is possible.
Side effects of stimulants are possible irritability or anxiety, and insomnia. Modafinil may cause headaches and nausea.
Cataplexy can be lessened by antidepressant drugs, which work by suppressing REM sleep. Clomipramine is indicated for use in narcolepsy. Additionally, SSRIs and SNRIs have shown to be effective. Side effects may include dry mouth, constipation, and blurred vision.
For individuals who have EDS, poor nighttime sleep, and cataplexy, sodium oxybate is an efficacious drug for all three symptoms. It has minimal side effects and very little interaction with other drugs.
In addition to medication, lifestyle adjustments such as attention to sleep hygiene, scheduling daytime naps, and establishing a normal exercise and meal schedule may also help to reduce narcolepsy symptoms. It is also imperative to avoid any activity that could pose a health threat until any cataplexy is controlled.
Here are some guidelines for good sleep hygiene:
- Keep a consistent sleep schedule. Get up and go to bed at the same time every day, even on weekends or during vacations
- Set a bedtime that is early enough for you to get at least 7 hours of sleep
- Do not go to bed unless you are sleepy
- If you do not fall asleep after 20 minutes, get out of bed
- Establish relaxing bedtime rituals
- Use your bed only for sleep and sex
- Make your bedroom quiet and relaxing. Keep the room at a comfortable, cool temperature
- Limit exposure to light in the evenings
- Do not eat a large meal before bedtime. If you are hungry at night, eat a light, healthy snack
- Reduce your fluid intake before bedtime
- Exercise regularly and maintain a healthy diet
- Avoid consuming caffeine in the late afternoon or evening
- Avoid alcohol.
Narcolepsy is a chronic neurological disorder that causes fragmented night sleep, excessive daytime sleepiness, and sudden body collapses from temporary muscle weakness. It typically begins in the teens or early twenties.
As drowsiness or feeling tired all the time is a common, universal complaint, it can take many years to determine the cause is narcolepsy.
All individuals with chronic daytime sleepiness should see their primary care provider to determine the underlying cause.
Although there is no cure for narcolepsy, with prescription medication and good lifestyle habits, individuals with narcolepsy can live healthy, normal lives.