Treatment of Narcolepsy



When I was in high school, I didn't want to take medication.

I realized that I have to.

See for me, I like just having natural sleep.

It's just that--

There's a dramatic difference.

Since diagnosis, it took a little bit

to really know which drugs work best.

If I don't go to bed early, I'm more sleepy during the day.

And no matter how tired or groggy I feel,

I drag myself out of bed and I go for a run for at least 20

to 25 minutes.

It changed my life.


I'm Audrey Cross.

And I have narcolepsy and cataplexy.

I love plants or really pretty trees.

That's made me cataplectic.

Because I get excited about plants a lot.

And it's kind of weird.

And people don't know what the trigger is sometimes.

Because other people aren't as excited about that tree as

I am.

Getting the diagnosis meant that there was something

that could be done about it.

My mom found a great doctor for me.

And it's been helpful.


I have an appointment Dr. Kirsch.

Come in, Audrey.

Have a seat.

Thank you.

Audrey is a college-aged student who

presented with sleepiness and episodes

of falling that weren't really well understood.

And she underwent sleep testing.

And that demonstrated that she had narcolepsy.

It's really important for anybody

with a sleep disorder, particularly

people who have narcolepsy, to get enough sleep at night time.


A person with narcolepsy should aim

for at least eight hours of sleep every night

and on the same schedule.

Number two is napping when you can.

Because at some basic level, we know you're going to be sleepy.

But a lot of caffeine--

Generally, good health is important.

Trying to minimize the amount of alcohol.

Keep in a good exercise pattern.

Limiting smoking and drugs.

Leading that healthy lifestyle will

lead to potentially improvement in sleepiness.

Even with a good behavioral program,

they're going to require some amount of medication

to be well controlled in terms of their sleepiness

and/or their cataplexy.


There are two problems that people with narcolepsy

typically have.

One is the sleepiness during the daytime.

And the other is the falling episodes, the cataplexy.

So let's talk about the sleepiness first.


There are two medication classes that are typically

used to help people stay awake.

One are kind of standard stimulants.

The problems with the stimulants are that people sometimes

get some side effects.

They get a little jittery.

They get some palpitations in their heart.

We also have a second class which

is modafinil and armodafinil.

And these are stimulant medications which

work a little bit differently.

But they do tend to have less side effects.

And often that's where I might start with using

that kind of medication first.

And if it's not effective, coming back to this older

classification of medications.

On a personal level, I try to find a medication that

works in a long-acting way as a baseline for alertness

during the daytime and then spot treat

with short-acting stimulants if I need to.

Then we have the cataplexy.

If cataplexy is happening a couple times a day--

which it sounds like it is-- to me,

that sort of defines that we should

think about trying to treat you for cataplexy.

And there are a couple kinds of treatments for that.

When you're talking about cataplexy,

you're often talking about using either

an antidepressant medication, tricyclic antidepressants,

or SSRIs or SNRIs.

The newer ones tend to have less side effects than the older


The last medication that we have to potentially try and get you

under treatment is a medication called sodium oxybate.

It's a very specific medication that we only

use for narcolepsy.

It also seems to make people's cataplexy

much better controlled.

And it makes their sleepiness a little bit better.

It knocks you out so that you can get a really deep sleep

that narcoleptics don't tend to get.

With any of these medications, it really

is an individual treatment.

It's something that you would start as low as you can

and slowly move up, trying to manage the symptoms as best

you can.

Do I have to take a medication forever?

You're going to need to have probably some medication.


What I would say is these medications, not necessarily.

Remember that we constantly evolve

in terms of our understanding of disorders.

And things change over time.

So I never tell anybody that you're

going to do anything for the rest of your life

because medicine continues to evolve over time.

With medication and better sleep habits,

is there a way that-- am I going to be normal again?

You're going to have to adapt your living

a little bit to having a diagnosis of narcolepsy.

But what I would say is many people

with narcolepsy, when adequately treated,

can live fairly normal lives.

The doctors that I've had have really

tried to help me be able to live my life the way that I want to.

I need to get eight hours of sleep at night minimum.

And I need to have a regular sleep schedule.

And I need to have a 20 to 30 minute nap every day.

I'm just in sync now with carrying medication with me.

I have a keychain container.

And I keep it in my wallet.

And it has backups of whatever medication I might need.

And that has managed my sleepiness really well.

I've been able to stay awake through some classes

that the average person falls asleep through.

And that feels really good.

Because I look around and all my peers are asleep.

But I'm able to stay awake.