Sleep Disorders: Treatments for Narcolepsy

There are a number of medications used to treat the symptoms of narcolepsy. Drugs that act as stimulants and/or reduce the other symptoms of narcolepsy are standard treatments for narcolepsy and include:

• Ritalin: Ritalin helps to reduce excessive daytime sleepiness and improves alertness. Side effects include headache, irritability, nervousness, and gastrointestinal problems. Nighttime sleep may be impaired, thus decreasing sleep time. There are concerns that this drug may become ineffective if used continuously for long periods. Therefore, some doctors advise people with narcolepsy to abstain from medication 1 day each week (typically on a weekend; drug holiday). During that day, the person should not engage in activities that require being awake, such as driving.
• Provigil (Modafinil): This drug has been shown in several trials to reduce excessive daytime sleepiness. Headache is the most common side effect.
• Antidepressants: The tricyclic antidepressants Anafranil and Tofranil and the selective serotonin reuptake inhibitor (SSRI) Prozac are often used to treat cataplectic attacks. They help reduce the frequency of cataplexy in people with narcolepsy. Side effects of the tricyclics include stomach upset, dry mouth, fatigue, weight gain, sexual side effects and, in some cases, irregular heart beats (arrhythmias). Side effects of Prozac and the other SSRIs also include stomach upset and sexual dysfunction, however, side effects appear to be seen less often and may be less severe than the tricyclic antidepressants.
• Xyrem: This drug is used to treat a small subset of people with narcolepsy who have excessive daytime sleepiness and cataplexy that does not respond to the other medications. It is the only drug approved by the FDA for cataplexy. It has a history of abuse as a recreational drug; therefore, the FDA has classified it as a controlled substance.

Home Care Tips

There are several things you can do at home to help improve the symptoms of narcolepsy and include the following:

• Maintain a regular sleep schedule. Many people have an improvement in their symptoms if they maintain a regular sleep schedule, usually 7-8 hours of sleep per night.
• Schedule naps during the day. One study suggested that the optimal sleep pattern is a combination of scheduled nighttime sleep (such as from 11:00 pm to 7:30 am) and two 15-minute naps throughout the day.
• Avoid heavy meals and alcohol. Both can interfere with sleep.
• Do not drive or operate machinery when you feel sleepy.
• Exercise regularly.