Daytime sleepiness is a common symptom of narcolepsy, and it comes on quickly. During an attack, you can suddenly nod off. Falling asleep can be a big problem if you're doing something that needs your full attention, like driving.
But you don't have to give up your driver's license or your freedom. It is possible to safely drive with narcolepsy, as long as you get on the right treatment and take a few precautions.
What Are the Risks?
Driving requires fast reactions. You need to be able to brake or steer quickly if the car ahead of you stops suddenly or an animal runs in front of your car. When you're sleepy, your reaction time slows and your focus on the road may not be as sharp.
Sleep attacks come on fast. If you fall asleep at a stoplight, you might be OK. But if you nod off on the highway, you could get into an accident. At high speeds, your car travels the length of a football field in just 4 to 5 seconds. It could veer off the road or hit another vehicle in that time.
During attacks, it's common to fall straight into rapid eye movement (REM) sleep. This is the deep sleep stage when you dream. In REM sleep you can't move your body, which increases your risk for a crash.
Cataplexy is another worry when you drive. Strong emotions like stress or fear trigger this sudden loss of muscle tone. When you lose control of your muscles while driving, you can't steer or step on the brake.
In studies, two-thirds of people with narcolepsy said they've fallen asleep behind the wheel. Nearly 30% say they've had cataplexy while driving. Overall, people with narcolepsy are two to four times more likely to have a car accident than people who don't have this condition.
Is It Legal to Drive With Narcolepsy?
Yes, but it may not be safe. You need to be medically able to drive, which includes being able to stay awake.
The National Highway Traffic Safety Administration (NHTSA), the government agency that oversees highway safety, says that people with narcolepsy should only drive if they're on a treatment that helps them stay awake.
Driving laws vary from state to state. Most states ask you to voluntarily report any medical conditions that could affect your ability to drive when you apply for a driver's license. A few states, like California and Pennsylvania, require you to report conditions like narcolepsy that might affect your driving ability.
Can Medication Help Me Drive Safely?
Narcolepsy treatments like modafinil (Provigil), pitolisant (Wakix), sodium oxybate (Xyrem), and stimulant drugs (Adderall, Concerta, Ritalin, and others) can help you stay awake during the day. Taking them might make it safer to drive and reduce your risk for an accident. Just keep in mind that no medicine is 100% effective at preventing accidents or keeping you awake while you drive.
Plus, these drugs can come with side effects like:
If your doctor prescribes any medication for narcolepsy, ask how it could affect your ability to drive.
What Else Can I Do?
Some states require a doctor's letter stating that your narcolepsy is well-controlled. Even if your state doesn't ask for this letter, it's a good idea to find out from your doctor if it's safe for you to drive.
Your doctor can check your medical history, examine you, and go over the medicines you take. A Maintenance of Wakefulness Test (MWT) is a way for your doctor to check how alert you are and how well you may be able to stay awake during activities like driving.
There are a few things you can do to stay safe when you drive. Try to avoid driving at times of the day when you know you feel tired, like late at night or early in the morning.
Try to avoid driving after you:
- Eat a big meal
- Drink alcohol
- Take medicine that makes you sleepy, such as antihistamines or anti-anxiety drugs
You might want to take a nap before you drive to help prevent narcolepsy attacks on the road. Break up longer drives with nap breaks or share the driving with a friend.
If you get episodes of cataplexy, try not to do anything before you drive that might upset you, make you laugh, or trigger other strong emotions.
Some “life hacks” you might have heard about aren't helpful. Chewing gum, turning up the radio volume, blasting the air conditioner, or opening windows won't keep you awake. They might even increase your risk for a crash because they're distracting.
When you drive, watch for these signs that you're starting to fall asleep:
- Your eyelids droop.
- Your head nods.
- You blink often.
- You daydream.
- You can't remember the last few miles you've driven.
If any of these things happen, pull over before you fall asleep.