How Narcolepsy Is Treated

Occurring in about 1 in 2,000 people, narcolepsy is a neurological disorder characterized by bouts of intense daytime sleepiness, cataplexy (sudden loss of muscle control), visual hallucinations, and sleep paralysis, among other symptoms.

Since attacks of this condition can be unpredictable, it can severely impact quality of life, including social relationships and work or academic performance.

While the exact causes of this disorder aren’t known and there is no definitive cure, approaches can be taken to manage the condition. Treatments for narcolepsy include making lifestyle changes as well as taking prescribed medications, such as Provigil (modafinil) or other stimulants, some classes of antidepressants, and others.       

Home Remedies and Lifestyle

Even if you’re taking medications for narcolepsy, lifestyle changes are essential in treating the condition. Helpful approaches include:

• Getting daily exercise: Regular exercise has been shown to improve sleep quality and reduce the severity of some associated conditions. At a minimum, aim for at least 20 minutes of physical activity four to five hours before bedtime.
• Taking naps: Taking short, regular daily naps at times of the day when you’re drowsiest can also help ease symptoms.
• Avoiding alcohol and caffeine: Alcohol, a depressant, and caffeine, a stimulant, can both impact the quality of sleep. At the least, drinking should be avoided for several hours before you go to bed.
• Skipping large meals: Large, heavy meals, if consumed right before bed, can also disrupt the quality of sleep. In turn, this can make symptoms worse, too.
• Quitting smoking: Among the many health benefits of tobacco-smoking cessation, ditching this habit can improve sleep quality.
• Having a regular sleep schedule: Maintaining regular sleeping habits—even on weekends or days off—is another approach that can help with narcolepsy. Make sure you get up and go to bed at the same times every day.

Prescriptions

The primary medical approach to narcolepsy involves prescribed medication. Generally speaking, the specific drug indicated will depend on the specific symptoms that arise. These prescribed medications include the following.

Provigil

Provigil (modafinil) is the most commonly prescribed treatment for narcolepsy. This drug is particularly effective in taking on excessive daytime sleepiness.

A stimulant first approved by the Food and Drug Administration (FDA) in 1999, it is a first-line treatment for this condition. Compared with other drugs of this class, Provigil has less of an effect on memory and alertness and is less likely to create dependency.

Other Stimulants

Stimulant drugs, particularly Ritalin or Methylin (methylphenidate) and Desoxyn (methamphetamine), can also help take on daytime drowsiness and sleep attacks associated with narcolepsy.

Using these requires care, however, as there is a high propensity for harmful side effects, including heart palpitations, irritability, nervousness, and interrupted sleep. In addition, these drugs have higher abuse potential.

Xyrem

Xyrem (sodium oxybate) is an FDA–approved medication indicated to take on cataplexy, in particular, though it also helps improve nighttime sleep quality and addresses daytime sleepiness.

However, the use of this drug does increase the risks of side effects, including central nervous system depression, such as slowed breathing and heart rate, lethargy, and confusion.

Antidepressant Drugs

Known to be effective against cataplexy, sleep paralysis, and hallucinations, two classes of antidepressants are employed—tricyclics and selective serotonin reuptake inhibitors (SSRIs). Of the tricyclics, Tofranil (imipramine), Norpramin (desipramine), and Anafranil (clomipramine), among others, are indicated.

SSRIs like Prozac (fluoxetine), Effexor (venlafaxine), and Strattera (atomoxetine) are also effective. Though these have fewer side effects than stimulants, use can lead to male impotence, irregular heart rhythm, and elevated blood pressure.                                                                        

Specialist-Driven Procedures

While surgery for narcolepsy doesn’t exist, researchers have begun investigating non-pharmaceutical therapies. With narcolepsy cases having been linked to deficiencies of a neurotransmitter called hypocretin, potential approaches involve boosting these levels. Current work is focused on several techniques for doing so:

• Cell transplantation is a potential approach that involves implanting cells that stimulate hypocretin production.
• Gene therapy, in which genes that promote hypocretin production are introduced, represents another potential treatment for narcolepsy.
• Direct application of hypocretin itself is another potential method, which can be done via the bloodstream (intravenous administration), the nasal cavity (intranasally), and through an opening in the brain (intracisternally).

It’s important to note, however, that experimental work on these approaches is ongoing, and they aren’t currently available.      

A Word From Verywell

While there is no “silver bullet” that can eradicate narcolepsy, current medications, alongside lifestyle changes, can certainly help minimize this condition's impact. Today, doctors are better equipped than they’ve ever been to take it on, and the outlook will only improve as research continues.

Patient education and understanding are essential to the successful management of this disorder. Be proactive and engaged in therapy. With the right support system of loved ones and friends, as well as the right medical professional, narcolepsy can be addressed effectively.