Narcolepsy medications & treatments
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Narcolepsy is a sleep disorder characterized by severe daytime drowsiness and uncontrollable episodes of falling asleep. It affects an estimated 1 in 2,000 Americans, but since narcolepsy is often undiagnosed, that number may be higher. It occurs equally in men and women. Narcolepsy symptoms can start at any age, but they often first appear between the ages of 15 to 25. Although there is no cure for narcolepsy, there are treatment options to help manage your symptoms and improve your quality of life.
What is narcolepsy?
Narcolepsy is a chronic neurological disorder that affects the ability of the brain to regulate wakefulness and sleep. If you have narcolepsy, you can often find it hard to stay awake for long periods of time and may suddenly fall asleep during any activity, such as driving, eating, or talking.
There are 2 major types of narcolepsy:
- Narcolepsy Type 1 (NT1). This type is characterized by a sudden loss of muscle tone (cataplexy) and/or low hypocretin levels (also known as orexin), which is a chemical in the body that helps control your sleep-wake cycle.
- Narcolepsy Type 2 (NT2). People with this type have similar symptoms as NT1 but do not experience cataplexy and have normal levels of hypocretin.
While experts are not sure of the exact cause of narcolepsy, there are some risk factors thought to play a part in developing symptoms:
- Autoimmune disorders. Researchers think your body’s immune system may attack the brain cells that contain hypocretin, leading to low levels and the development of symptoms.
- Family history. You have about a 1-2% chance of developing narcolepsy if you have a close relative with this condition.
- Brain injury. Although rare, you may develop narcolepsy if you have an injury or tumor in the part of your brain that controls REM sleep and wakefulness.
Researchers also believe some cases may be due to viral infections or exposure to toxins in the environment such as pesticides and secondhand smoke.
How is narcolepsy diagnosed?
To properly diagnose narcolepsy, your healthcare professional will look at your symptoms, review your medical history and medications, and perform a physical exam. Further testing or sleep studies may be done if your doctor makes a preliminary diagnosis of narcolepsy.
Symptoms you may experience with narcolepsy include:
- Excessive daytime sleepiness (EDS). This is the first symptom to usually appear with this condition. You may find yourself falling asleep during normal daily activities such as talking, driving, or working. EDS must be present for at least 3 months to justify a narcolepsy diagnosis.
- Cataplexy. This sudden loss of muscle control is typically triggered by strong emotions such as laughter, excitement, crying, surprise, or anger. The effects can be mild such as drooping of your eyelids or severe such as total body collapse.
- Hallucinations. These hallucinations may occur at any time and are often vivid and frightening. They typically occur either when you are falling asleep (hypnagogic hallucinations) or waking up (hypnopompic hallucinations).
- Sleep paralysis. These episodes of not being able to move or speak while falling asleep or waking up usually only last a few seconds or minutes.
- Insomnia. Even though you may have excessive sleepiness during the day with this condition, you often have disrupted nighttime sleep as well. This can be due to sleep apnea or vivid dreams.
Further testing will be needed to confirm your diagnosis of narcolepsy. These are usually done at a sleep disorder center and can include:
- Polysomnography (PSG). This overnight test records brain and muscle activity, breathing, and eye movements to determine how fast you fall asleep, how many times you wake up during the night, and how often your REM sleep is disturbed. This can also be used to rule out other conditions such as sleep apnea.
- Multiple sleep latency test (MSLT). This test is done during the day, usually following a PSG. You will be asked to take five short naps, usually separated by two hours. They will look at your sleep patterns and measure how fast you fall asleep and how quickly you enter into rapid eye movement (REM) sleep.
What are some narcolepsy treatment options?
There is no cure for narcolepsy so the treatment goals are to reduce symptoms through medications and lifestyle changes.
- Stimulants. The first line of treatment is usually a central nervous system (CNS) stimulant that is taken during the day to help you stay awake. Your doctor may try Provigil (modafinil) or Nuvigil (armodafinil) to help with daytime sleepiness. They have fewer side effects and are less addictive than older stimulants. If these are not effective, they may prescribe an amphetamine such as Ritalin (methylphenidate). Two newer medications that have been approved are Sunosi (solriamfetol) and Wakix (pitolisant). Pitolisant is the first medication approved by the FDA to treat excessive daytime sleepiness that is not classified as a controlled substance.
- Antidepressants. These medications are used to treat the symptoms of cataplexy, hallucinations, and sleep paralysis. They can include selective serotonin reuptake inhibitors (SSRIs) such as Prozac (fluoxetine), serotonin and norepinephrine reuptake inhibitors (SNRIs) such as Effexor XR (venlafaxine), and tricyclic antidepressants (TCAs) such as Anafranil (clomipramine).
- Xyrem (sodium oxybate). This medication, used to treat cataplexy and EDS, must be taken in 2 doses a night. You take the first before bedtime and then a second dose up to 4 hours later.
What is the best medication for narcolepsy?
The best medication for the treatment of narcolepsy will depend on the individual’s specific medical narcolepsy, medical history, medications that the individual is already taking that may potentially interact with narcolepsy medications, and the individual’s potential response to the treatment. It is advisable to always speak with your healthcare provider about the best medication for you. The table below includes a list of the most prescribed or over-the-counter narcolepsy medications approved by the Food and Drug Administration (FDA).
Best medications for narcolepsy
|Drug name||Drug class||Administration route||Standard dosage||Common side effects|
|Provigil (modafinil)||Stimulant||Oral||1 to 2 tablets (200mg to 400mg) every morning.||Headache, runny nose, nausea, decreased appetite, nervousness, stomach pain|
|Nuvigil (armodafinil)||Stimulant||Oral||1 tablet (150mg to 250mg) every morning.||Headache, nausea, dry mouth, dizziness, nervousness, diarrhea|
|Ritalin (methylphenidate)||Stimulant||Oral||1 to 3 tablets (10mg to 30mg) daily divided every 8 to 12 hours.||Headache, decreased appetite, nausea, nervousness|
|Adderall (amphetamine/dextroamphetamine)||Stimulant||Oral||5mg to 60mg daily. May be taken once daily or divided every 4 to 6 hours||Loss of appetite, headache, insomnia, stomach pain, weight loss|
|Xyrem (sodium oxybate)||CNS depressant||Oral||12ml to 16ml (6g to 9g) per night in 2 divided doses.||Headache, nausea, dizziness, sore throat, infection, vomiting|
|Sunosi (solriamfetol)||Dopamine/norepinephrine reuptake inhibitor||Oral||1 tablet (75mg to 150mg) once daily when you wake up.||Headache, decreased appetite, nausea, nervousness, insomnia, dry mouth|
|Wakix (pitolisant)||Histamine H3 antagonist||Oral||1 to 2 tablets (8.9mg to 17.8mg) once daily.||Headache, nausea, insomnia, upper respiratory tract infection, nervousness|
|Anafranil (clomipramine)||TCA||Oral||1 capsule (25mg to 75mg) once daily.||Dry mouth, headache, constipation, fatigue, nausea, weight gain, sexual dysfunction|
|Prozac (fluoxetine)||SSRI||Oral||1 capsule (10mg to 20mg) once daily.||Insomnia, nausea, headache, weakness, diarrhea, drowsiness|
|Effexor XR (venlafaxine)||SNRI||Oral||1 capsule (up to 225mg) once daily.||Headache, nausea, insomnia, weakness, sexual dysfunction, high blood pressure|
Your healthcare provider will determine the right dosage based on your response to the treatment, medical narcolepsy, weight, and age. Other possible side effects may exist; this is not a complete list.
What are the most common side effects of narcolepsy medications?
As with all medicines, those used for narcolepsy will have some side effects, depending on the class you are taking. The most common ones include:
- Decreased appetite
- Weight loss
- Sexual dysfunction
What are some home remedies for narcolepsy?
Lifestyle changes are a key piece in managing the symptoms of narcolepsy.
Try to include some of the following in your daily habits:
- Stick to a regular sleep schedule. Going to sleep and waking up at the same time every day, including on the weekends, can help you sleep better.
- Relax before lying down to sleep. Try warm baths, meditation, relaxing music, as well as scents such as lavender before going to bed.
- Schedule daytime naps. Short naps of 10 to 20 minutes during the day may help reduce drowsiness for a few hours.
- Avoid nicotine, caffeine, and alcohol. These substances, especially at night, can worsen your insomnia.
- Exercise regularly. Exercising for 20 minutes a day at least 4 or 5 hours before bedtime can improve your sleep quality and keep you at a healthy weight.
- Avoid heavy meals. Eating a large meal right before bedtime can make it harder to sleep.
Frequently asked questions about narcolepsy
Can my narcolepsy be cured?
Narcolepsy cannot be cured. It is a chronic, lifelong condition that can be managed will proper treatment and behavioral changes.
If I have narcolepsy, will my child develop it as well?
Most cases of narcolepsy have no family history but there is a very small risk of passing it on. If you have NT1 (excessive daytime sleepiness with cataplexy), the risk for your child is about 1-2%. For NT2 (excessive daytime sleepiness without cataplexy), the risk is a little higher at 4%.
What other conditions can be misdiagnosed as narcolepsy?
The most common conditions that cause some of the same symptoms that cause a misdiagnosis include depression, insomnia, and obstructive sleep apnea.
What are some serious complications of narcolepsy?
Some studies have shown a higher risk of the following conditions:
- Hypertension (high blood pressure)
- Heart failure
- Heart attack
- Major depressive disorder
- Bipolar disorders
- Anxiety disorders
Related resources for narcolepsy
- Narcolepsy practice essentials. Medscape
- Narcolepsy overview. Mayo Clinic
- What is narcolepsy? WebMD
- Narcolepsy fact sheet. National Institute of Neurological Disorders and Stroke
- Narcolepsy symptoms and causes. Cleveland Clinic
- Narcolepsy. Sleep Foundation
- What is Narcolepsy? John Hopkins Medicine