Treatment

Treatment

Lifestyle treatment of narcolepsy includes taking three or more scheduled sleep-times throughout the day. One study suggested that the best approach is a combination of scheduled nighttime sleep and two 15-minute naps (for example one before lunch and another before dinner). Patients should also avoid heavy meals and alcohol, which can interfere with sleep.

People with mild narcolepsy symptoms that do not require medication may be able to maintain alertness with sleep scheduling. In a 2001 study, scheduled sleep periods were also helpful for patients who were extremely sleepy in spite of medications. The benefits of scheduled naps, however, are not clear for patients whose condition responds to medication. In the same study, patients who took stimulants and were able to maintain alertness or were only moderately sleepy derived no additional benefit from the naps.

Medications for narcolepsy target the major symptoms of sleepiness and cataplexy. Stimulant drugs are used to manage excessive daytime sleepiness while antidepressants and other compounds address cataplectic symptoms. The FDA has approved two drugs specifically for the treatment of narcolepsy. They are now the first-line treatments:

• Modafinil (Provigil): For excessive daytime sleepiness
• Sodium oxybate (Xyrem): For cataplexy

Drug Treatments for Sleepiness

Modafinil. Modafinil (Provigil) is a drug used to treat the excessive sleepiness associated with narcolepsy and other sleep disorders. (Modafinil does not treat cataplexy.) The FDA approved modafinil in 1998. Since that time, it has largely replaced methylphenidate (Ritalin) and other stimulants for treatment of narcolepsy sleepiness. Patients who switch to modafinil from stimulants such as methylphenidate experience few problems if they gradually taper off the stimulant dose.

Modafinil helps patients with narcolepsy stay awake during the day. In one study, patients who had not yet taken modafinil were able to stay awake only an average of 6 out of 20 minutes. After taking the medication, awake time increased to 12 - 14 of every 20 minutes, and some patients had normal wake times. In another study, modafinil increased the ability to stay awake by 50% and reduced the number of involuntary sleep episodes by about 25%.