Narcolepsy Treatment

Although no treatment can cure narcolepsy or idiopathic hypersomnia, your symptoms can be greatly improved through behavioral and drug therapy.

Behavioral Therapy
You may be recommended to take one or two short naps during the day and exercise regularly to promote alertness. You should also maximize your total sleep time at night, keep a regular sleep-wake schedule, and avoid heavy meals and alcohol, which may induce sleepiness. It may be helpful to educate family members, friends, or colleagues to avoid feeling embarrassed or misunderstood by your condition.

Medication
Medications that increase alertness are commonly used to treat narcolepsy and idiopathic hypersomnia. You should receive a tailored treatment plan so that you find the right balance between benefits and potential side effects. 

Stimulant

Excessive Daytime Sleepiness resulting from narcolepsy or idiopathic hypersomnia is typically treated with a central nervous system stimulant. Numerous stimulants have long been available and are effective for improving excessive sleepiness. The more traditional medications include amphetamine-like stimulants (e.g. Ritalin, Dexedrine), but may cause side effects such headaches, irritability, anxiety, insomnia, anorexia, or irregular heartbeat or tachycardia. A newer wake-promoting drug called modafinil (Provigil and Nuvigil), is also commonly used. Modafinil is not a traditional amphetamine-like stimulant, but it is also very effective in improving daytime alertness. Modafinil typically has less long-term side effects than older stimulants and is generally well tolerated. Some patients may develop a headache when first starting modafinil, which typically resolves once on a steady dose.

Antidepressant

Cataplexy, hypnagogic hallucinations, and sleep paralysis may be treated with antidepressants such as protriptyline (Vivactil) or serotonin reuptake inhibitors.

Cataplexy and Excessive Daytime Sleepiness can also be treated with some antidepressant medications.

Sodium Oxybate

Cataplexy and Excessive Daytime Sleepiness can also be treated with with sodium oxybate such as Xyrem or Lumryz. Xyrem is a liquid taken at bedtime and generally four hours later, but only once at bedtime. It is very sedating, but short acting, meaning that patients typically do not have sleepiness or grogginess upon awakening the next morning. Lumryz is an extended release and is taken only at bedime once. Sodium oxybate has shown to improve nighttime quality of sleep, daytime alertness and cataplexy. Sedation and nausea are the most common side effects. Patients may also be prescribed Xywav, a low sodium oxybate which has less impact on the cardiovascular system. As with Xyrem, patients take their first dose at bedtime, and commonly, a second dose in the middle of the night. Sodium oxybate is not recommended for patients with liver problems since the body may not be able to break it down, resulting in an unhealthy built up.