Treatment for Narcolepsy
There is no cure for narcolepsy, so excessive daytime sleepiness, sudden sleep onset, and cataplexy are treated symptomatically. Therapies for narcolepsy involve the practice of getting sufficient sleep each night, proper sleep hygiene practices, and drug therapy.
Proper sleep hygiene, including a consistent sleep schedule and the avoidance of shift work and alcohol, is especially important for people who have narcolepsy.
Patients with narcolepsy often feel refreshed after a short nap; therefore, taking short scheduled naps can benefit patients combating excessive daytime sleepiness. For example, a 15-minute nap after lunch and another at 5:30 p.m. may help diminish the intensity of daytime sleepiness and provide temporary alertness.
Drug Therapy to Treat Narcolepsy
Stimulants are the mainstay of drug therapy for excessive daytime sleepiness and sleep attacks in narcolepsy patients. These drugs include methylphenidate (Ritalin), modafinil, dextroamphetamine, and pemoline. Other medications, such as certain antidepressants and drugs that are still being tested in the United States, are also used to treat the predominant symptoms of narcolepsy.
Note: In October of 2005, the Food and Drug Administration (FDA) withdrew approval for magnesium pemoline (Cylert), a drug that had been used rarely as a treatment for narcolepsy. This medication carries a high risk for liver failure. Generic versions have remained on the market to allow physicians to find alternative treatments for their patients.
Stimulant dosages are determined on a case-by-case basis. These medications generally are taken in the morning and at noon. Major side effects of stimulants include irritability, anxiety, quickened heart rate, high blood pressure (hypertension), substance abuse, and disturbances of nocturnal sleep.
Methylphenidate and dextroamphetamine are known to cause hypertension. Headache, usually related to dose size, is a common side effect of modafinil. This side effect occurs in up to 5 percent of patients. Pemoline poses a very low but noticeable risk for liver complication. These stimulants do not affect the occurrence of narcolepsy's auxiliary symptoms and they usually are not used to treat them.
Methylphenidate and dextroamphetamine carry a risk for addiction. A newer modafinil drug (called Provigil) does not act as a stimulant and does not produce side effects like anxiety and irritability. The therapeutic effects of Provigil have been observed in maintenance of wakefulness test research, where patients have tripled their wakefulness.