Narcolepsy

Diagnosis

Your healthcare professional may suspect narcolepsy if you have symptoms such as excessive daytime sleepiness and sudden loss of muscle tone, called cataplexy. A referral to a sleep specialist is common, and formal diagnosis often requires an overnight stay at a sleep center for a detailed sleep analysis.

Diagnosis usually involves:

• Sleep history. You may complete the Epworth Sleepiness Scale, which measures your likelihood of falling asleep in different situations.
• Sleep records. You might track your sleep patterns for one to two weeks, sometimes using a wrist-worn device called an actigraph.
• Polysomnography. This overnight sleep study measures brain waves, heart rate, breathing, and leg and eye movements using electrodes.
• Multiple sleep latency test. You take several naps at the sleep center while specialists observe your sleep patterns. People with narcolepsy often fall asleep quickly and enter rapid eye movement (REM) sleep sooner.
• Genetic testing and lumbar puncture. Rarely, genetic tests may be performed for type 1 narcolepsy, and a spinal tap may measure hypocretin levels in specialized centers.

These tests also help rule out other causes of daytime sleepiness, such as insufficient sleep, medications, or sleep apnea.

Treatment

There is no cure for narcolepsy, but symptoms can be managed with medicines and lifestyle changes.

Medicines

Medicines for narcolepsy include:

• Stimulants. These help improve daytime alertness. Options include modafinil (Provigil), armodafinil (Nuvigil), solriamfetol (Sunosi), pitolisant (Wakix), methylphenidate (Ritalin, Concerta), and amphetamines (Adderall XR, Desoxyn). Side effects may include headache, nausea, anxiety, nervousness, or a fast heartbeat.
• SSRIs and SNRIs. These antidepressants suppress REM sleep and help with cataplexy, hallucinations, and sleep paralysis. Examples are venlafaxine (Effexor XR), fluoxetine (Prozac), duloxetine (Cymbalta), and sertraline (Zoloft). Possible side effects include weight gain, insomnia, and digestive issues.
• Tricyclic antidepressants. Older antidepressants like protriptyline, imipramine, and clomipramine (Anafranil) treat cataplexy but can cause dry mouth and lightheadedness.
• Sodium oxybate and oxybate salts. Medicines such as Xyrem, Lumryz, and Xywav help relieve cataplexy, improve nighttime sleep, and control daytime sleepiness. Side effects may include nausea, sleepwalking, and bed-wetting. Combining these with other sedatives, narcotics, or alcohol can be dangerous.

Certain over-the-counter medicines, such as allergy and cold remedies, may cause drowsiness and should be avoided if you have narcolepsy.

Researchers are exploring additional treatments, including those targeting the hypocretin system and immunotherapy, but more studies are needed before these options are widely available.