![]() ![]() (See "Screening for depression in adults" and "Unipolar depression in adults: Assessment and diagnosis".) Patients should be screened for depression at least every one to two years, and those who screen positive should be referred for appropriate evaluation and treatment. Psychiatric – Patients with narcolepsy are at increased risk for psychiatric comorbidities, particularly depression and anxiety.Thus, patients often benefit from participation in support groups that focus on coping skills and identification of community resources to assist with administrative and medical issues. They also have the additional burden of coping with misperceptions about the causes and the involuntary nature of their symptoms.Ĭommon misconceptions, even among medical caregivers, are that sleep attacks and cataplexy (emotionally triggered muscle paralysis resulting in partial or complete collapse) are manifestations of poor motivation, denial, or avoidance. Psychosocial support - Patients with narcolepsy face various psychosocial and work-related challenges throughout their lives as a result, they may have difficulty meeting economic and social responsibilities. Prazosin and other alpha-1 antagonists can worsen cataplexy. Other medications such as theophylline or excessive caffeine can cause insomnia, which can worsen daytime sleepiness. (See "Excessive daytime sleepiness due to medical disorders and medications".) It is often helpful to treat these disorders first and then to focus on improving the sleepiness that is caused by the narcolepsy.Īvoidance of certain drugs - Certain medications and substances should be avoided by patients with narcolepsy due to their potential to worsen symptoms.ĭrugs that can worsen daytime sleepiness include benzodiazepines, opiates, antipsychotics, antiseizure medications, and alcohol. (See "Insufficient sleep: Evaluation and management".)Ĭomorbid sleep disorders - 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 can contribute to their daytime sleepiness. Sleep deprivation may worsen narcolepsy symptoms, and therefore patients should be counseled to maintain a regular and adequate sleep schedule. If it can be arranged, a brief nap at work or school is often helpful. Specifically, a short nap around 1 PM or 2 PM is often helpful as it can improve alertness for one to three hours, reducing the need for stimulants in the afternoon. One or two well-timed, 20-minute naps will often improve sleepiness, though some patients only benefit from long naps. Many patients feel more alert with daytime naps, although most will require pharmacotherapy in addition. Napping and sleep hygiene - Daytime naps are the mainstay of nonpharmacologic therapy for narcolepsy. (See "Clinical features and diagnosis of narcolepsy in adults" and "Clinical features and diagnosis of narcolepsy in children".) The diagnosis and neurobiology of narcolepsy and the treatment of narcolepsy in children are discussed separately. ![]() ![]() Treatment of narcolepsy of adults is reviewed here. Most patients require pharmacologic therapy, and many feel more alert with daytime naps. In many patients with narcolepsy, sleepiness and cataplexy substantially interfere with daily life, impacting school, work, relationships, and social life. Management of narcolepsy is symptomatic, and there are no disease-modifying therapies yet available. INTRODUCTION - Narcolepsy is a central disorder of hypersomnolence characterized by excessive daytime sleepiness in all patients, along with additional symptoms that may include cataplexy (in narcolepsy type 1), disrupted nighttime sleep, sleep paralysis, and hypnogogic and hypnopompic hallucinations. ![]()
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