Narcolepsy

Diagnosis  

Your healthcare provider may suspect narcolepsy if you experience excessive daytime sleepiness and sudden muscle weakness, known as cataplexy. They will likely refer you to a sleep specialist for a formal diagnosis, which involves an overnight stay at a sleep center for a detailed sleep analysis. 

To diagnose narcolepsy and assess its severity, the sleep specialist will consider: 

• Sleep History: You’ll complete the Epworth Sleepiness Scale, a short questionnaire assessing your sleepiness levels in various situations. 
• Sleep Records: You may be asked to track your sleep patterns for a week or two to see how they correlate with your alertness. 
• Actigraph: This wearable device measures your activity and rest periods, offering insights into your sleep habits. 
• Polysomnography: During an overnight stay at a medical facility, flat metal discs (electrodes) on your scalp record brain waves, heart rate, breathing, leg, and eye movements. 
• Multiple sleep latency test: This test assesses how quickly you fall asleep during the day. You’ll take short naps at a sleep center, and specialists will monitor your sleep patterns. 

In some cases, genetic tests may be performed to check for a predisposition to type 1 narcolepsy. If indicated, a lumbar puncture (spinal tap) may measure hypocretin levels in your spinal fluid, but this is done only in specialized centers. 

These tests help rule out other possible causes of your symptoms, such as sleep deprivation, medication side effects, or sleep apnea. 

Treatment  

Narcolepsy has no cure, but there are ways to manage its symptoms: 

Medications: 

• Stimulants: These drugs stimulate the nervous system and help people with narcolepsy stay awake during the day. Common options include modafinil and armodafinil. They have a lower risk of addiction and mood swings compared to older stimulants. Side effects are rare but may include headaches, nausea, or anxiety. 
• Newer stimulants: Solriamfetol and pitolisant are newer stimulants used for narcolepsy. Pitolisant may also help with cataplexy. 
• Other stimulants: In some cases, methylphenidate  or amphetamines may be prescribed. These can be effective but carry a risk of habit–forming and side effects like nervousness and rapid heartbeat. 
• Serotonin and norepinephrine inhibitors (SNRIs) or SSRIs: These medications reduce REM sleep and are used to manage cataplexy, hallucinations, and sleep paralysis. Examples include venlafaxine (Effexor XR), fluoxetine (Prozac), and sertraline (Zoloft). Side effects may include weight gain, insomnia, and digestive issues. 
• Tricyclic antidepressants: Older antidepressants like protriptyline, imipramine (Tofranil), and clomipramine (Anafranil) can treat cataplexy but may cause dry mouth and dizziness. 
• Sodium oxybate and oxybate salts: These drugs are effective for cataplexy and improving nighttime sleep. They may also help with daytime sleepiness. They are taken in two doses, one at bedtime and one a few hours later. Xywav is a newer, lower–sodium formulation. Side effects can include nausea, bed–wetting, and sleepwalking. Avoid combining them with other sleep–inducing medications or substances like alcohol, as it can be dangerous. 
• Be cautious with over–the–counter medications: Some non–prescription drugs, like allergy or cold medicines, can make you drowsy. If you have narcolepsy, your doctor may advise against taking them. 

Researchers are exploring potential new narcolepsy treatments, including drugs that target the hypocretin chemical system and immunotherapy. However, more research is needed before these treatments become available.