Although there is no cure for narcolepsy, narcolepsy treatment options are available to help reduce the various symptoms.
Treatments for narcolepsy are individualized depending on the severity of the symptoms, and it may take weeks or months for an optimal regimen to be worked out. Complete control of sleepiness and cataplexy is rarely possible.
Narcolepsy treatment is primarily by medications, but lifestyle changes are also important. The main narcolepsy treatment of excessive daytime sleepiness in narcolepsy is with a group of drugs called central nervous system stimulants.
The drowsiness is normally treated using stimulants such as methylphenidate (Ritalin®), amphetamine (Adderall®), methamphetamine (Desoxyn®) or adrafinil (Modafinil® or Provigil®).
However, in many cases, planned short naps can act as natural cures of narcolepsy. Planned regular short naps can reduce the need for drowsiness narcolepsy treatment to a low or non-existent level. The loss of muscle control is treated using clomipramine, impramine, or protryptiline but this need only be done in severe cases.
In addition to drug therapy, an important part of narcolepsy treatment is scheduling short naps (10 to 15 minutes) two to three times per day to help control excessive daytime sleepiness and help the person stay as alert as possible. Daytime naps are not a replacement for nighttime sleep.
Medications acts as stimulants are standard narcolepsy treatments. Medicine for Narcolepsy treatment include the following:
- Methylphenidate (Ritalin).
- Dextroamphetamine (Dexedrine).
- Pemoline (Cylert).
Methylphenidate and dextroamphetamine last for two to five hours and are the standard agents for excessive daytime sleepiness. Pemoline is effective for eight to 10 hours.
These agents are useful as narcolepsy treatment for people who can manage wakefulness with a night's sleep and scheduled naps. They can improve mood, mental acuity, and other aspects of mental functioning.
Stimulants used for narcolepsy treatment can have significant side effects, including the following:
- Changes in blood pressure and rapid heartbeat.
- Weight loss.
Stimulants used for narcolepsy treatment should be avoided or taken only under a physician's guidance in people with heart disease, hyperthyroidism, glaucoma, anxiety disorder, and high blood pressure.
Modafinil (Provigil, Alertec) is a novel medicine for narcolepsy treatment that promotes long-lasting wakefulness. It is now approved for narcolepsy treatment. Before treatment, patients in one study were able to stay awake only an average of six minutes out of twenty.
After taking the medicine for narcolepsy, awake time increased to 12 to 14 minutes and some patients had normal wake times. In another study, modafinil increased the ability to stay awake by 50% and reduced the number of involuntary sleep episodes by about 25%.
Some of its additional benefits include what it does not do:
- It does not cause anxiety to the degree that the standard stimulants do.
- It has less potential for abuse than the stimulants. In one trial, no one developed dependence on the drug after up to nine weeks of daily use.
- Patients do not appear to have a rebound effect as stimulants do. In other words, people who take do not usually "crash" when the drug wears off.
- Modafinil does not appear to affect natural hormones important in sleep, including cortisol (the major stress hormone), melatonin, and growth hormone. Therefore, studies are reporting that it does not interfere with voluntary naps during the day or with the quantity or quality of nighttime sleep.
Modafinil does not appear to reduce cataplexy. Some evidence suggests that taking it along with Ritalin may help prevent cataplexy attacks and does not appear to have any harmful interactions.
It should be noted, however, that long-term safety and effectiveness of modafinil is not yet known. In one study, modafinil appeared safe for at least 16 weeks of use, but longer studies are needed.
Although most current research suggests that modafinil poses less of a risk for abuse than many of the stimulants used for narcolepsy treatment, some evidence suggests that it might have stimulant properties that could lead to abuse.
Side effects include the following:
- Dry mouth.
- Nasal and throat congestion.
- Possible interference with hormonal methods of birth control, including the Pill.
Patients who switch to modafinil from stimulants like methylphenidate (Ritalin) for narcolepsy treatment, experience few problems if they taper the stimulant dose gradually.