There are a number of medications used to treat the symptoms of narcolepsy. Drugs that act as stimulants or reduce the other symptoms of narcolepsy are standard treatments for the condition. They include:
Methylphenidate (Aptensio XR, Concerta, Cotempla XR-ODT, Daytrana, Metadate ER, Methylin, QuilliChew ER, Quillivant XR, Ritalin, and Ritalin LA): Methylphenidate 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 taking it one day each week (typically on a weekend). During that day, the person should not engage in activities that require being awake, such as driving.
Antidepressants: The tricyclic antidepressants Anafranil and Tofranil and the selective serotonin reuptake inhibitor (SSRI) Prozac are often used to reduce the frequency of cataplexy, a condition in which a person experiences a sudden (but temporary) loss of muscle tone. Side effects of the tricyclics include stomach upset, dry mouth, fatigue, weight gain, sexual side effects and, in some cases, irregular heartbeats (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.
Sodium oxybate (Xyrem, Xywav): 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.
Pitolisant (Wakix): This drug is used to treat excessive daytime sleepiness. It acts on the histamine receptors and mimics histamine. Pitolisant uses the histamine receptors to prompt your brain to stay awake.
Solriamfetol (Sunosi): This dual-acting dopamine and norepinephrine reuptake inhibitor is also used to treat narcolepsy. It has proven effective in helping patients stay awake for longer periods of time.
If you decide to take medication, your doctor may do what’s called titration. That means they start you at a low dose and slowly raise it until you’re at the maximum dose or start having side effects.
Behavioral Modifications that Help with Narcolepsy
Medication isn't always enough to manage narcolepsy. That's where lifestyle changes come in. There are several things you can do at home to ease symptoms. They include:
Stick to a sleep schedule. Many people see improvement in their symptoms if they get up and go to bed at the same time each day. Aim for about 7 to 8 hours of sleep each night.
Schedule naps during the day. One study suggests a combination of scheduled nighttime sleep (such as from 11 p.m. to 7:30 a.m.) and two 15-minute naps during the day is best.
Make your bedroom sleep-friendly. Keep your bedroom cool so you're less likely to wake up sweating in the middle of the night. Consider buying blackout or light-filtering curtains, especially if you work at night and need to sleep during the day. A sleep mask or white noise machine might help, too.
Use electronic devices wisely. Your tablet, smartphone, and other devices give off blue light. This type of light can affect your circadian rhythm, or sleep-wake cycle. It tricks your brain into thinking it's daytime, so your body might make less melatonin. That's a sleep hormone.
Avoid heavy meals and alcohol. Heavy meals take longer for your body to digest, which can sometimes affect sleep. They could also lead to heartburn that keeps you up at night, especially if it's something spicy. Alcohol might make you fall asleep faster, but it also impacts the rapid eye movement (REM) phase of sleep. So you might not be as rested when you wake up.
Exercise regularly. Staying active can boost energy levels and keep you more alert during the day. Just be sure to avoid exercising within 3 hours of bedtime.
Avoid long drives and operating heavy machinery. This lowers the risk of accidents. A 30-minute drive might be fine, but a road trip probably isn’t. If you’ve fallen asleep behind the wheel before or you’re just sleepy all the time, your doctor can do a maintenance of wakefulness test. It tests to see if you can stay awake in a “boring” environment. Staying alert isn’t a guarantee you won’t fall asleep elsewhere, but the results can help your doctor figure out dosages and what else you may need. Working as a commercial driver, forklift operator, or anything else involving heavy machinery isn’t recommended.
Complementary or alternative medicine alone can’t treat narcolepsy, but it may help with symptoms. Options include:
The Right Balance
A mix of medication and lifestyle changes is usually best. It may take a while for you and your doctor to find what works, but you’ll figure it out over time.