What's the treatment for narcolepsy?
Although there is no cure for narcolepsy, treatment options are available to help reduce the various symptoms. Treatment is individualized depending on the severity of the symptoms, and it may take weeks or months for an optimal regimen to be worked out. Complete control of sleepiness and cataplexy is rarely possible. In the treatment of narcolepsy, it is
important to define clear outcome goals for specific target symptoms.
Treatment is primarily by medications, but lifestyle changes are also important. The main treatment of excessive daytime sleepiness in narcolepsy is with a group of drugs called central nervous system stimulants. For cataplexy and other REM-sleep symptoms, antidepressant medications and other drugs that suppress REM sleep are prescribed. Caffeine and over-the-counter drugs have not been shown to be effective and are not recommended.
The main symptom of narcolepsy, excessive daytime sleepiness, can be partially relieved with stimulants such as modafinil (Provigil), methylphenidate (Ritalin and other brand names) or dextroamphetamine (Dexedrine), as well as with regularly scheduled short naps during the day. Stimulants are generally given in a single morning dose or in morning and lunchtime doses. Too high a dose or one that is given later in the day may disturb nocturnal sleep. Generally, the biggest therapeutic concern is the development of tolerance - some clinicians believe that the use of drug holidays may reduce this problem.
Cataplexy and sleep paralysis can be treated with a variety of medicines that can make you more resistant to entering REM sleep. Most of these medicines were developed for use as antidepressants. Examples of effective medications include protriptyline (Vivactil), clomipramine (Anafranil), venlafaxine (Effexor) and fluoxetine (Prozac). Cataplexy also can be treated with sodium oxybate (also called gamma hydroxybutyrate or Xyrem), although the use of this drug is tightly controlled because it has been abused recreationally. For reasons that are not well understood, a low dose of this medicine reduces cataplexy attacks and improves daytime sleepiness in people who have narcolepsy with cataplexy, even though the drug causes sedation in most people without narcolepsy.
Gamma-hydroxybutyrate, or GHB (Xyrem) is an agent that appears to improve healthy sleep (by reducing REM sleep) and control cataplexy in patients with narcolepsy. It has been approved by the FDA, but with tight restrictions on its use. The drug is controversial, however. It is sold illegally as a street drug and can cause dependence in high doses over time. Very serious side effects, including seizures, coma, and respiratory arrest have been reported with its use.
Psychological counseling may be important for difficulties associated with self-esteem and for emotional support, especially since people with narcolepsy have difficulty doing tasks that require concentration, and may be regarded as unmotivated by family and peers.