How to Cope With Narcolepsy

Narcolepsy is a neurological condition that disrupts sleep patterns. The narcoleptic sleeps poorly at night, and suffers from excessive sleepiness and sleep attacks during the day. Physical events that normally take place during REM, or dreaming, sleep intrude into waking hours. Symptoms like cataplexy, hallucinations, and sleep paralysis are expected in sleep, but annoying to the point of being disabling when they occur while the narcoleptic is awake.

Unfortunately, since narcolepsy is thought to be a genetically linked autoimmune disorder, there is no way to treat its causes directly. Research continues into the exact mechanism of narcolepsy, but until it's better understood treatment is symptomatic, meaning it focuses on alleviating the unpleasant effects of narcolepsy.

The narcoleptic sleeps as much as a normal person, but does not sleep and wake in the usual sequence. The narcoleptic patient must either adjust the sleep/wake pattern to necessary activities, or tailor the activities to the fragmented sleep/wake cycle.

Behavioral changes are recommended as supplements to treatment with prescription drugs. The goal is to minimize the disturbances caused when the narcoleptic suddenly falls asleep or displays REM-like physical symptoms during daily routines. Treatment recommendations vary depending on the narcoleptic's individual experience with the disorder.

Behavioral Adjustments

These changes in daily routine are intended to produce two effects: first, to improve sleep at night, and second, to lessen the amount of sleeping during the day. You should not count on these alterations to eliminate anomalies in your sleep-wake cycle, but it is possible to achieve some improvement by adhering strictly to the following guidelines.

Prescribed Medication

The drug therapies used to counteract narcolepsy are stimulants (to keep the narcoleptic awake during the day), sodium oxybate (to regulate sleep and control cataplexy), tricyclic antidepressants (for cataplexy), and selective serotonin or norepinephrine reuptake inhibitors (for cataplexy, hypnagogic hallucinations and sleep paralysis).

As with behavior modifications, prescribed medications are intended to make narcolepsy easier to live with rather than to cure it altogether, although some promising studies have shown success in treatment with hypocretins (the neurotransmitters thought to be absent in narcolepsy).

Stimulants to Promote Alertness

Sodium Oxybate (Xyrem)

Also called gamma-hydroxybutyrate (GHB), this drug helps control cataplexy and EDS, and makes it easier to sleep at night. Due to its high abuse potential, popularity on the black market and dangerous side effects, access to sodium oxybate is strictly limited.

Antidepressants to Reduce REM Symptoms

Some antidepressant drugs are given specifically to suppress the occurrence of REM events during waking hours, meaning cataplexy, hypnagogic hallucinations, and sleep paralysis. The first group is the tricyclic antidepressants (TCAs). There are two classes of TCAs, distinguished according to whether they possess sedative or stimulating properties.

All the medications discussed above have restrictions on their use as well as various unpleasant side effects, so it is wise to see how much improvement you can achieve through behavioral modifications before you move on to prescription drugs.