Institute for Continuing Education

Coping with Narcolepsy

Course Objectives

Upon successful completion of this module, you will be able to:

• Analyze the current classification of narcolepsy subtypes according to the International Classification of Sleep Disorders (ICSD-3), distinguishing narcolepsy type 1 (with cataplexy) from narcolepsy type 2 (without cataplexy) based on clinical features, polysomnographic findings, and hypocretin deficiency.
• Evaluate the pathophysiology of narcolepsy, including the role of hypocretin/orexin deficiency, autoimmune mechanisms, genetic predisposition (HLA-DQB1*06:02), and neurobiological substrates underlying excessive daytime sleepiness, cataplexy, sleep paralysis, and hypnagogic hallucinations.
• Apply diagnostic criteria and testing procedures for narcolepsy, including polysomnography (PSG) technical requirements, Multiple Sleep Latency Test (MSLT) protocols and interpretation, cerebrospinal fluid hypocretin-1 measurement indications, and differentiation from other causes of hypersomnolence.
• Synthesize the technical aspects of conducting MSLTs for narcolepsy evaluation, including patient preparation, recording montage specifications, nap opportunity protocols, sleep onset and REM latency determination, scoring criteria, and recognition of factors affecting test validity.
• Compare and contrast pharmacological treatment approaches for narcolepsy, including stimulants (modafinil, armodafinil, methylphenidate, amphetamines), sodium oxybate mechanism and administration, antidepressants for cataplexy, and emerging therapies, evaluating efficacy, side effects, and appropriate patient selection.
• Assess non-pharmacological management strategies and lifestyle modifications for narcolepsy, including scheduled napping, sleep hygiene optimization, dietary considerations, exercise recommendations, and behavioral interventions to maximize functioning and quality of life.
• Explain the psychosocial impact of narcolepsy and the role of healthcare providers in facilitating appropriate accommodations, including educational modifications, workplace adaptations, disability considerations, driving safety evaluation, and mental health support for patients coping with chronic hypersomnolence and associated symptoms.

Course Information

NARCOLEPSY IS CHARACTERIZED BY UNCONTROLLABLE SLEEPINESS (ALSO CALLED EXCESSIVE DAYTIME SLEEPINESS) AND INTERMITTENT MANIFESTATIONS OF REM SLEEP AT TIMES WHEN A PERSON WOULD NORMALLY BE AWAKE. Beside sleepiness, the REM manifestations may include cataplexy, sleep paralysis, and hypnagogic hallucinations. Narcolepsy is not a common disease.

Successful treatment of narcolepsy requires an accurate diagnosis to exclude patients with other sleep disorders, which have different treatments, and to avoid unnecessary complications of drug treatment. Treatment objectives should be tailored to individual circumstances. Modafinil, amphetamine, methamphetamine, dextroamphetamine, methylphenidate, selegiline, pemoline, tricyclic antidepressants, and fluoxetine are effective treatments for narcolepsy, but the quality of published clinical evidence supporting them varies. Scheduled naps can be beneficial to combat sleepiness, but naps seldom suffice as primary therapy. Regular follow up of patients with narcolepsy is necessary to educate patients and their families, monitor for complications of therapy and emergent of other sleep disorders, and help the patient adapt to the disease.