NARCOLEPSY: Symptoms, Treatment Options and Side Effects Explained

What is narcolepsy?

 Rare disease – 1 out of 2,000 people, or 0.05% prevalence
 core feature is excessive daytime sleepiness – at least 3 days per week for at least 3 months.
 Narcolepsy without cataplexy (type 2) 
 
 About 30% of narcolepsy
 
 Primarily profound sleepiness
 
 Sometimes hypnagogic hallucinations (vivid dream-like images while falling asleep)
 Sleep paralysis (a temporary inability to move or speak just before falling asleep
or just after waking up)
 Narcolepsy with cataplexy (type 1)  about 70% of narcolepsy have cataplexy (sudden loss of muscle tone, triggered by strong emotions,usually positive ones, such as laughing or joking), does not faint, is conscious,last a minute or two
 
 Patients have low levels of orexin in the spinal fluid
 
What are treatments for narcolepsy?
 Sleep hygiene
 
 Eliminate medications or substances that worsen sleep
 
 Eliminate blue light before bed
 
 Cool, dark room
 
 Consider partner snoring or kicking at night
 
 Medications provigil, nuvigil (wake-promoting agents)
 
 Dexedrine, ritalin, adderall (stimulants)
 
 Xyrem (sodium oxybate)
 
 New medication, first to be approved for both narcolepsy and cataplexy
 
 Repairs and consolidates sleep, more time in deep sleep
 
 Likely that patients will take this in addition to a wake-promoting agent or stimulant
 Significant side effects – abuse potential, respiratory depression, coma, death
 
 More complicated to take – has a oral solution that is diluted by patient in water
 
What if it isnt narcolepsy? – other sleep problems
 Medications for depression and anxiety can cause insomnia
 
 May have sleep apnea
 May have restless legs syndrome or periodic limb movement disorder (these can also
be caused by psychiatric medications like antidepressants)When should I see a sleep specialist?
 Suspected sleep apnea – needs to have sleep study in the lab restless legs / period limb movement disorder – most doctors not trained to treat this
 
What are some different medications to treat insomnia?

 Benzodiazepines (like xanax, valium, etc) – decrease time in deep sleep and REM
sleep, can worsen sleep apnea
 Sonata – short-acting drug can be used in the middle of the night, good for sleep-
onset
 Ambien – significant problems with parasomnias (abnormal behaviors while sleeping)
 
•Lunesta – thought to help depression with insomnia
 
 Restoril – sometimes used for anxiety with insomnia
 
 Silenor / doxepin – improves the last 2-3 hours of sleep
 
 Remeron – sometimes used for depression or anxiety + insomnia
 
 Belsomra – new medication for turning off wakefulness
 
If you think you may have narcolepsy or are having trouble sleeping, please feel free to reach out to our offices and we will be happy to make you an appointment at 919-636-5240. 
 
Live Mentally Healthy,
Dr. Jennie Byrne
Author
Dr. Jennie Byrne, M.D., PhD.

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