If you have narcolepsy, you may experience excessive daytime sleepiness or a sudden loss of muscle control, called cataplexy. Treatments for narcolepsy typically focus on improving your symptoms and managing the condition.
Doctors can prescribe different medications to treat narcolepsy, depending on your symptoms.
It may take time to find an effective solution. Some people may need only one medication, while others may need a combination of drugs to see an improvement.
This article will review the treatment option and lifestyle measures that can help manage narcolepsy.
Modafinil
Modafinil is a stimulant medication. It helps you feel more energetic during the day and reduces daily sleepiness.
This drug is usually the first type of treatment for narcolepsy because it is generally effective, has fewer side effects, and has less chance of dependence than other drugs.
However, it can cause an irregular heartbeat, and you will need to attend regular check-ups. This medication is not suitable during pregnancy.
Other side effects of modafinil may include:
- dry mouth
- headache
- nausea
- decreased appetite
- anxiety
- dizziness
- insomnia
- diarrhea
- rhinitis
- nervousness
- rash
- insomnia
Modafinil is also available under the brand name Provigil.
Amphetamine-like stimulants
Doctors may recommend taking amphetamine-like stimulants if treatment with modafinil does not help. Amphetamine-like stimulants include medications such as methylphenidate (Concerta, Ritalin).
Doctors usually prescribe these drugs to people with attention deficit hyperactivity disorder (ADHD). They are not licensed for narcolepsy, but doctors can prescribe them off-label to help increase wakefulness during the day.
People who take methylphenidate need to be monitored as this drug can lead to various side effects, including:
- misuse and dependence
- a rapid heart rate or palpitations
- anxiety
- insomnia
- low appetite and weight loss
- a dry mouth
- nausea
- abdominal pain
- excess sweating
Sodium oxybate
Sodium oxybate is an FDA-approved medication for people with cataplexy and excessive daytime sleepiness. This drug can help prevent narcolepsy episodes by reducing brain activity. However, the prescription of this drug is heavily regulated due to its many side effects.
People typically take sodium oxybate in 2 doses at night. The first dose is usually taken before going to sleep while the second one must be taken 2.5–4 hours after going to bed.
Sodium oxybate side effects may include:
- headache
- dizziness
- nausea and vomiting
- diarrhea
- swelling in the limbs
- sweating
- back or stomach pain
- weakness
- bedwetting
- uncontrolled shaking of parts of your body
- burning, tingling, or creeping sensation on your skin
- numbness
You should contact your doctor if these symptoms do not go away.
In rare cases, taking sodium oxybate can lead to a medical emergency. You should seek immediate medical attention if you experience the following symptoms:
- agitation
- aggression
- anxiety
- depression
- thoughts of harming or killing yourself
- confusion or hallucinations
- difficulty breathing
- sleepwalking
- changes in appetite or weight
Sodium oxybate is also known by the brand name Xyrem.
Antidepressants
Antidepressants can help control cataplexy episodes. The types of antidepressants used for narcolepsy are tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors (SNRIs), and selective serotonin reuptake inhibitors (SSRIs).
These drugs are typically used as a second-line treatment for narcolepsy. A doctor may also prescribe antidepressants with other narcolepsy medications to improve their efficacy.
Tricyclic antidepressants
Tricyclic antidepressants may include:
- protriptyline (Vivactil)
- imipramine (Tofranil)
- clomipramine (Anafranil)
- desipramine (Norpramin)
Tricyclic antidepressants medications can cause side effects, including:
- dry mouth
- constipation
- dizziness
- slightly blurred vision
- reduce urine output
- drowsiness
- weight gain
- night sweats
- changes in the heart rhythm
SSRIs and SNRIs
SSRIs and SNRIs include medications such as:
- fluoxetine (Prozac)
- venlafaxine (Effexor)
- atomoxetine (Strattera)
If you take SSRIs or SNRIs, you may experience side effects, such as:
- anxiety
- agitation
- upset stomach
- constipation or diarrhea
- loss of appetite
- insomnia or drowsiness
- dizziness
- headache
- difficulties in achieving orgasm or maintaining an erection
Pitolisant
Pitolisant (Wakix) is a new medication for narcolepsy. It is a histamine 3 receptor antagonist/inverse agonist that increases the histamine levels in your brain. Doctors typically prescribe it for treating narcolepsy and excessive daytime sleepiness. Pitolisant comes in the form of tablets with different strengths.
A 2022 study found pitolisant has similar efficacy to modafinil in treating narcolepsy.
If you take pitolisant, you may experience side effects, such as:
- headache
- insomnia
- nausea
- abdomen pain
- increased appetite
- increased heart rate
- anxiety
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Get free cardLifestyle options
Various lifestyle choices may improve the symptoms of narcolepsy, such as:
- Having a bedtime routine: Aim to go to sleep and wake up at the same time every day.
- Relaxing before bedtime: Avoid exercise for at least 2 hours before bed. Having a warm bath and relaxing your body can also promote sleepiness.
- Exercising daily: Regular movement can help prevent weight gain and boost overall well-being.
- Avoid eating before bedtime: Eating large meals before bed can make sleeping more difficult.
- Avoid caffeine, alcohol, and smoking before bedtime: Alcohol, smoking, and caffeine can make falling asleep more difficult. It’s best to avoid drinking caffeine or alcohol several hours before bedtime.
- Taking frequent naps: Napping can help you recover when you feel sleepy throughout the day.
- Having a comfortable sleeping environment: Tips include keeping the room where you sleep at a comfortable temperature and creating a quiet, distraction-free environment for sleeping.
Your doctor can recommend strategies for implementing these changes in your daily routine. They can also prescribe alternative medication if you experience drowsiness as a side effect of medications.
Summary
There is currently no cure for narcolepsy, but medications and lifestyle changes can help manage it.
Medications — such as modafinil and antidepressants — can help reduce excessive daytime sleepiness and prevent cataplexy episodes.
Avoiding caffeine, alcohol, and heavy meals before bed can improve your sleep quality. Having a bedtime routine and trying to relax your body before going to sleep can also promote rest and sleepiness.
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