7 Narcolepsy Treatments for Managing Symptoms, According to Sleep Medicine Experts
A diagnosis of narcolepsy might explain someone's excessive daytime sleepiness or sudden episodes of muscle weakness (known as cataplexy), but what can doctors do about it? There's no cure for narcolepsy, but the National Institute of Neurological Disorders and Stroke (NINDS) says some symptoms can be managed with medicines and lifestyle changes.
Here, experts break down the current evidence on narcolepsy treatments.
How do you treat narcolepsy?
Before discussing specific therapies, it's important to get to the root of the problem.
Pradeep Bollu, MD, a neurologist and sleep medicine specialist at Prisma Health in Columbia, South Carolina, tells Health that a person should consult a sleep specialist if they "experience sleepiness to the degree that it affects their activities of daily living."
A neurologist or sleep medicine specialist can determine whether you have narcolepsy—a chronic disorder of the brain's sleep-wake cycle—and not some other neurologic condition. Typically, this involves a physical examination and two critical tests, says Cleveland Clinic. A polysomnogram (PSG) takes place overnight and shows doctors how fast you fall asleep, if your sleep is disrupted, and rules out sleep apnea. The next day involves a multiple sleep latency test, in which a person takes five naps two hours apart, and doctors track the speed you fall asleep and enter REM (rapid eye movement) sleep.
Once a diagnosis is firmed up, it's time to explore treatment. Your doctor will create a plan based on your symptoms and their frequency.
While narcolepsy can present differently throughout a person's lifetime, it isn't necessarily harder to treat the longer you've had it. The amount of time someone has experienced narcolepsy also doesn't usually impact treatment plans. New symptoms, however, may call for a change in care, such as later-developed cataplexy, says Marie Nguyen Dibra, MD, is a sleep physician at Sleep Dallas.
The best treatment option depends entirely on the patient. "No treatment is necessarily more effective than another but, similar to other medical conditions, what's important is individualizing therapy based on the patient's symptoms, drug interactions, how the medication fits into their lifestyle, and safety and tolerability," says Asim Roy, MD, medical director of Ohio Sleep Medicine Institute and assistant clinical professor at Northeast Ohio Medical University.
Per the NINDS, there are two primary categories of treatment for people with narcolepsy: lifestyle changes and medication.
Lifestyle changes for narcolepsy
A range of behavioral changes play a significant part in managing narcolepsy. Here are some of the lifestyle changes that can help with narcolepsy treatment.
Take short naps
When possible, frequent naps are an excellent technique for managing symptoms of narcolepsy. People with narcolepsy should try to take 20-minute naps at regular points throughout the day, says Dr. Dibra. Doing so should reduce feelings of sleepiness for the next few hours. Unless necessary, she cautions patients to avoid taking naps in the evening as this may lead to insomnia.
Dr. Roy concurs. "People with narcolepsy should not feel guilty about taking a nap," he tells Health.
Avoid caffeine in the afternoon
People with narcolepsy may turn to caffeine in an attempt to stay awake during the day. However, having caffeine in the afternoon or evening may lead to greater difficulty sleeping at night and even more fragmented sleep—a common symptom of narcolepsy. Dr. Roy advises people to minimize caffeine consumption after noon, especially if they're naturally sensitive to caffeine.
According to Dr. Dibra, nicotine and alcohol are also best avoided in the evening as they can similarly worsen symptoms of narcolepsy.
Getting your steps in can do wonders for managing narcolepsy symptoms. "Regular, moderate exercise may help you feel more awake during the day and sleep better at night," Dr. Dibra tells Health.
In a 2017 study from Sleep Medicine, researchers studied the effects of cardiopulmonary fitness—related to the hearts or lungs—on people with narcolepsy types 1 and 2. In both cases, more exercise inversely correlated with the degree of sleepiness and frequency of cataplexy episodes experienced.
Maintain a consistent sleep schedule
Before Dr. Roy explores medication options with his patients, he encourages them to "take control of managing their narcolepsy by trying to have a regular sleep schedule—that means going to bed and waking up at the same time each day," he says.
This schedule must also include weekends, says Cleveland Clinic. Consider removing electronics or other stimulants from your room, such as a television and phone, if you often stay up late or get distracted before bed.
Medications for narcolepsy
There are various medicines available to manage narcolepsy, with the right option varying from person to person. "The choice of drugs is primarily determined by the symptom profile, coverage options, and coexisting medical conditions," says Dr. Bollu.
Below are the primary medications doctors use for narcolepsy treatment.
Stimulants can help people with narcolepsy stay awake during the day. The most commonly prescribed stimulants are modafinil (Provigil) or armodafinil (Nuvigil), per Cleveland Clinic. These drugs work by promoting wakefulness, says the US National Library of Medicine, but they can also bring side effects such as headache and nausea.
Another word of caution: Modafinil, pitolisant, and armodafinil can interfere with hormonal birth control, according to a 2020 review on living with narcolepsy in the journal Nature and Science of Sleep.
In some instances, a doctor may use methylphenidate, such as Ritalin, to treat narcolepsy. However, these medications can be addictive or cause side effects such as heart palpitations, says Mayo Clinic.
Doctors may prescribe antidepressants to people with narcolepsy to treat symptoms such as poor nighttime sleep, cataplexy, sleep paralysis, and hallucinations. According to Mayo Clinic, they can limit REM sleep which, in turn, may minimize hallucinations, sleep paralysis, and cataplexy.
Within this category are selective serotonin reuptake inhibitors (SSRIs), like Lexapro and Zoloft, or serotonin and norepinephrine reuptake inhibitors (SNRIs), like Pristiq and Cymbalta, per Mayo Clinic. Side effects may include weight gain or insomnia—the latter a big negative for people with narcolepsy. Let a doctor know if you experience this so you can change course.
Tricyclic antidepressants, like Vivactil and Tofranil, have also proven effective in treating cataplexy, explains Dr. Dibra.
Unlike other narcolepsy medications, sodium oxybate is a bedtime option meant to promote deeper sleep overnight. While researchers are unsure how it works, sodium oxybate helps improve sleep quality, reduces daytime sleepiness, and helps with cataplexy, explains Dr. Bollu.
According to the Division of Sleep Medicine at Harvard Medical School, sodium oxybate only lasts a few hours, so people typically wake up and take a second dose halfway through the night. Doctors often start patients on a low dose and slowly increase it if needed. Excessive daytime sleepiness and cataplexy can improve after several weeks of regularly taking sodium oxybate.
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