What is the treatment for narcolepsy?
There is no cure for narcolepsy, but medications and lifestyle modifications can help manage symptoms such as excessive daytime sleepiness (EDS). Medications include:
- Stimulants such as modafinil (Provigil) or armodafinil (Nuvigil) are usually tried first for narcolepsy because they are less addictive than older treatments such as methylphenidate (Aptensio XR, Concerta, Ritalin) or various amphetamines. Side effects are uncommon but may include headache, nausea, or anxiety
- Sunosi (solriamfetol) is a newer type of stimulant that may also be used to improve wakefulness in adults with EDS due to narcolepsy or obstructive sleep apnea
- Pitolisant (Wakix) was approved in 2019 and can help improve EDS and cataplexy. It has been demonstrated to have minimal risk of abuse and is the only anti-narcoleptic drug not scheduled as a controlled substance in the USA
- Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac, Sarafem) or serotonin and norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine (Effexor XR) can suppress REM sleep and help alleviate the symptoms of cataplexy, hypnagogic hallucinations, and sleep paralysis. Side effects can include weight gain, insomnia, and digestive problems
- Tricyclic antidepressants, such as protriptyline (Vivactil), imipramine (Tofranil), and clomipramine (Anafranil), can help reduce cataplexy. Side effects include dry mouth and dizziness
- Sodium oxybate (Xyrem) is highly effective for cataplexy and can help improve nighttime sleep. In high doses, it may also help control daytime sleepiness. Side effects include nausea, bed-wetting, and worsening of sleepwalking and it should not be taken with alcohol or other sleeping medications.
Related questions
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What lifestyle changes help with narcolepsy?
Lifestyle modifications can help manage symptoms of narcolepsy, and can include:
- Improving your sleep habits and sticking to a bedtime schedule. Go to sleep and wake up at the same time every day, including weekends.
- Take regular, short, naps of 20 minutes throughout the day
- Avoid nicotine and alcohol, especially at night
- Get regular exercise but do it at least four to five hours before bedtime.
References
- Narcolepsy. Diagnosis. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/narcolepsy/diagnosis-treatment/drc-20375503
- Narcolepsy Fact Sheet National Institute of Neurological Disorders and Stroke 2021. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Narcolepsy-Fact-Sheet
- The Early Signs of Narcolepsy. April 21, 2020. Encroe Research Group. https://encoredocs.com/2020/04/21/the-early-signs-of-narcolepsy/
Read next
How do you test for narcolepsy?
The main test used to help diagnose suspected narcolepsy is an overnight sleep study (called a polysomnogram) followed the next day by the Multiple Sleep Latency Test (MSLT). A polysomnogram records brain waves, eye movements, muscle tone, and breathing across a night of sleep. This evaluates the amount and quality of night-time sleep and can look for any evidence of an additional sleep disorder (such as sleep apnea or periodic limb movements in sleep). The MSLT is a series of five scheduled naps spread across the day and it is done the day after the polysomnogram so a doctor can determine whether the prior night’s sleep could be affecting the daytime naps. Every 2 hours, the person is allowed to sleep for 20 minutes or more. Continue reading
How should Adderall make you feel, with or without ADHD?
Adderall is a stimulant medication that contains dextroamphetamine and amphetamine. It is FDA approved to treat attention deficit hyperactivity disorder (ADHD) and narcolepsy. People taking Adderall for ADHD typically notice improved focus and attention and reduced impulsivity. In people without ADHD, it can also enhance focus, alertness, and energy levels. Continue reading
Modafinil (Provigil) vs Adderall: What's the difference?
Modafinil and Adderall are both classified as CNS stimulants but have different chemical structures, which means there are differences in their addiction potential and risk of side effects. Modafinil and Adderall both have stimulant-type effects, but modafinil is a much milder stimulant than Adderall.
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