If you live with narcolepsy, various treatments — including medication, therapy, and self-care — can help you manage your symptoms.
Treatment options are the same for type 1 and type 2 narcolepsy, as they focus on treating five major symptoms:
- excessive daytime sleepiness (EDS)
- cataplexy, or sudden muscle weakness
- hallucinations that occur when you fall asleep or wake up
- sleep paralysis
- poor sleep at night with multiple awakens and arousals
It is important to realize that people with narcolepsy may have concomitant sleep disorders, such as obstructive sleep apnea, that can contribute to their daytime sleepiness. It is often helpful to treat these disorders first and then focus on improving the sleepiness that narcolepsy causes.
Narcolepsy treatment options include:
- medication management
- lifestyle changes
- behavioral modification
The most common treatments for narcolepsy can be broken down into two categories:
- medications, pharmacologic treatments, such as central nervous system stimulants, and other medications to treat specific symptoms of narcolepsy
- behavioral approaches, which focus on lifestyle changes and daily habits to improve sleep quality and reduce the likelihood of other emotional challenges
Medications cannot cure narcolepsy, but they can help you manage your symptoms. According to the National Institute for Neurological Disorders and Stroke (NINDS), most people can manage the excessive sleepiness and cataplexy related to narcolepsy by using a combination of behavioral changes and medications.
To treat EDS and sleep attacks
People with narcolepsy experience EDS every day. Medication doesn’t provide complete relief from EDS, but it can help prevent serious accidents.
Currently, four medications can be used to help manage EDS symptoms:
- Modafinil and armodafinil. These are FDA-approved treatments for EDS in narcolepsy and similar sleep disorders. They work in the brain’s hypothalamus to promote wakefulness and reduce sleep attacks. In addition, these wakefulness-promoting agents carry fewer side effects and lower potential for addiction compared with traditional stimulants.
- Stimulants. Some stimulants, such as amphetamine or methylphenidate, can help promote alertness and prevent sleep attacks. However, stimulants may not help with cataplexy, have side effects, and can carry a chance for misuse.
- Norepinephrine and dopamine reuptake inhibitor (NDRI). Solriamfetol is one example of an NDRI. It was FDA approved in 2019. Its side effects are similar to modafinil, and it’s a reasonable choice for treating EDS in narcolepsy.
- Histamine (H3) receptor agonist. Pitolisant is a newer option in this class of drugs. It was FDA approved in 2019. It has shown to be beneficial for reducing EDS and cataplexy in people with both type 1 and type 2 narcolepsy.
- Sodium oxybate. This is an
FDA-approved treatmentfor both EDS and cataplexy. However, its use is highly restricted due to safety concerns, such as central nervous system depression and misuse.
Treating disrupted nighttime sleep
Many people with narcolepsy experience disrupted nighttime sleep (DNS), where they wake often during the night. There aren’t many FDA-approved medications to treat disrupted nighttime sleep symptoms.
The total time spent sleeping during a 24-hour period is generally the same as someone without narcolepsy, because you tend to sleep frequently for shorter periods through the day and night.
Benzodiazepines and hypnotic non-benzodiazepines may improve the overall quality of sleep among people with narcolepsy. However, there’s preliminary research on the impact of these drugs. Also, sodium oxybate has demonstrated a higher value in improving nighttime sleep.
Treatment for cataplexy, hallucinations, and sleep paralysis
For people with type 1 narcolepsy, medication can help treat cataplexy, hallucinations, and sleep paralysis.
Antidepressants are the most common medication used to treat cataplexy. Two classes of antidepressants may be effective:
- tricyclic antidepressants, such as imipramine and clomipramine
- selective serotonin and norepinephrine reuptake inhibitors (SSNRIs), such as venlafaxine and fluoxetin
Antidepressants carry fewer side effects than amphetamines, though some side effects can arise, such as high blood pressure and irregular heartbeat.
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Along with medications, various behavioral techniques can help in narcolepsy treatment. These involve lifestyle strategies that help promote better nighttime sleep and daytime alertness.
You can try out these nonmedical treatment options, adapting them to fit your individual lifestyle preferences:
- Scheduled naps. Planning 15- to 20-minute naps throughout the day can help you manage daytime drowsiness. After a short sleep period, people with narcolepsy are more likely to wake up refreshed, as they can reach REM sleep faster than people without narcolepsy. Planned naps before activities that require high alertness levels, such as driving, can be highly beneficial.
- Good sleep hygiene. Most people with type 1 and type 2 narcolepsy have poor nighttime sleep. While falling asleep is rarely an issue, constantly waking up can cause sleep fragmentation that impacts sleep quality. Good sleep hygiene involves maintaining a consistent sleep-wake cycle, avoiding alcohol and caffeine before bedtime, and creating a sleeping environment that promotes rest.
- Cognitive-behavioral therapy (CBT). CBT can help manage depression and hypersomnia in people with narcolepsy. According to
researchpublished in 2014, CBT for narcolepsy can help you maintain your medication regimen and practice good nighttime sleep hygiene practices. Over time, CBT may help you with sleep attacks, cataplexy episodes, hypnagogic hallucinations, sleep paralysis, and alertness.
Living with narcolepsy can be challenging. Making simple changes to your sleep habits and lifestyle can help manage symptoms and minimize their impact on your daily life.
To help reduce excessive daytime sleepiness and promote a more profound and restorative nighttime sleep, consider adopting good sleeping habits:
- Follow a strict bedtime routine. Try getting into the habit of going to bed and waking up at the same time every day, including on weekends.
- Develop a relaxing bedtime routine. This might look like a warm bath or shower, meditation, or aromatherapy to help you relax before sleeping.
- Ensure a good sleeping environment. Keep your room at a comfortable temperature, avoid distractions like lights or sounds, and try to go to bed in a pitch-dark room.
- Avoid stimulants before bedtime. Example include caffeine, alcohol, and smoking.
- Avoid exercising too close to bedtime. Ideally, aim to have at least 2 hours between finishing your workout and going to bed.
- Eat small evening meals. Large or heavy meals before bed can make your digestive system stay too active while you’re trying to sleep and may cause you to wake up in the middle of the night.
It may also help to keep a sleep log or journal. Your sleep log contains information about your bedtime, how long it takes you to fall asleep, your sleep habits, and morning wake times. Sharing this information with your doctor can help them better understand your sleep-wake cycles and levels of wakefulness or sleepiness to help create a more accurate treatment plan.
Not only is narcolepsy a challenging condition to live with, but it can also be difficult for others to understand. Some of the symptoms can be frightening for people who are unaware of the condition.
You may find it helpful to talk with your friends and family about your condition. You might find that talking about your symptoms with a narcolepsy support group may also help you manage the psychosocial symptoms of living with this condition.
People in support groups may be able to provide real-life advice about living with narcolepsy. You might find that talking with other people in a similar situation can help you build a sense of fellowship and help you realize you’re not alone in this condition.