Nearly half of patients with narcolepsy report that their sleepiness and cataplexy substantially interfere with their daily lives, including jobs, marriages, or social lives . The mainstays of therapy are brief daytime naps and pharmacologic therapy .
It is important to realize that patients with narcolepsy often have concomitant obstructive sleep apnea, periodic limb movements of sleep, fragmented sleep, and/or rapid eye movement (REM) sleep behavior disorder that contribute to their daytime sleepiness. It is often helpful to treat these disorders first and then to focus on improving the sleepiness that is caused by the narcolepsy. This topic assumes that coexisting sleep disorders have been treated and reviews the treatment of narcolepsy and its symptoms. The diagnosis and neurobiology of narcolepsy are discussed separately. (See "Clinical features and diagnosis of narcolepsy".)
There are several nonpharmacologic interventions that may benefit the patient with narcolepsy:
●Avoiding certain drugs – Some drugs should be avoided by patients with narcolepsy. Drugs that can worsen daytime sleepiness include benzodiazepines, opiates, antipsychotics, and alcohol. Other medications such as theophylline or excessive caffeine can cause insomnia, which can worsen daytime sleepiness. In addition, prazosin and other alpha-1 antagonists can worsen cataplexy.
●Napping/sleep hygiene – Behavioral interventions are often helpful for optimal control of narcolepsy. One or two well-timed 20 minute naps will often improve sleepiness for one to three hours though some patients only benefit from long naps . If it can be arranged, a brief nap at work or school is often helpful. Sleep deprivation may worsen narcolepsy symptoms and therefore patients should be counseled to maintain a regular and adequate sleep schedule .