What is narcolepsy?
- Rare disease – 1 out of 2,000 people, or 0.05% prevalence• core feature is excessive daytime sleepiness – at least 3 days per week for at least 3 months.
- Narcolepsy without cataplexy (type 2)
- About 30% of narcolepsy
- Primarily profound sleepiness
- Sometimes hypnagogic hallucinations (vivid dream-like images while falling asleep)
- Sleep paralysis (a temporary inability to move or speak just before falling asleep or just after waking up)
- Narcolepsy with cataplexy (type 1) about 70% of narcolepsy• have cataplexy (sudden loss of muscle tone, triggered by strong emotions,usually positive ones, such as laughing or joking), does not faint, is conscious,last a minute or two
- Patients have low levels of orexin in the spinal fluid
What are treatments for narcolepsy?
- Sleep hygiene
- Eliminate medications or substances that worsen sleep
- Eliminate blue light before bed
- Cool, dark room
- Consider partner snoring or kicking at night
- Medications• provigil, nuvigil (wake-promoting agents)
- Dexedrine, ritalin, adderall (stimulants)
- Xyrem (sodium oxybate)
- New medication, first to be approved for both narcolepsy and cataplexy
- Repairs and consolidates sleep, more time in deep sleep
- Likely that patients will take this in addition to a wake-promoting agent or stimulant
- Significant side effects – abuse potential, respiratory depression, coma, death
- More complicated to take – has a oral solution that is diluted by patient in water
What if it isn’t narcolepsy? – other sleep problems
- Medications for depression and anxiety can cause insomnia
- May have sleep apnea
- May have restless legs syndrome or periodic limb movement disorder (these can also be caused by psychiatric medications like antidepressants)When should I see a sleep specialist?
- Suspected sleep apnea – needs to have sleep study in the lab• restless legs / period limb movement disorder – most doctors not trained to treat this
What are some different medications to treat insomnia?
- Benzodiazepines (like xanax, valium, etc) – decrease time in deep sleep and REM sleep, can worsen sleep apnea
- Sonata – short-acting drug can be used in the middle of the night, good for sleep-onset
- Ambien – significant problems with parasomnias (abnormal behaviors while sleeping)
- Lunesta – thought to help depression with insomnia
- Restoril – sometimes used for anxiety with insomnia
- Silenor / doxepin – improves the last 2-3 hours of sleep
- Remeron – sometimes used for depression or anxiety + insomnia
- Belsomra – new medication for “turning off wakefulness”
If you think you may have narcolepsy or are having trouble sleeping, please feel free to reach out to our offices and we will be happy to make you an appointment at 919-636-5240.
Live Mentally Healthy,
Dr. Jennie Byrne
Dr. Jennie Byrne