How do medications treat narcolepsy?

If you have narcolepsy, an antidepressant may help regulate your REM sleep cycle and alleviate the cataplexy, sleep paralysis, and hallucinations you may have. Prescription stimulants may help keep you awake during the day. Sodium oxybate may help you sleep only at night and may relieve cataplexy. All of these drugs can have serious side effects; as with all prescription medicines, be sure to follow your doctor's orders.

Once you have been diagnosed with narcolepsy, you have a better idea of what to do next to manage it. Your doctor will likely suggest a combination of lifestyle therapy and medication. First, let's cover medication. Your doctor may prescribe:

• An antidepressant, such as a tricyclic or a selective serotonin and noradrenergic reuptake inhibitor, which help control cataplexy.
• A nervous system alerting agent, such as modafinil (Provigil), which helps reduce daytime sleepiness. This is the most common treatment for those who need medication.
• An amphetamine-like stimulant, like methylphenidate (Ritalin) and dextroamphetamine (Dexedrine or DextroStat), which can be very effective in keeping you alert, but may come with many side effects, like shakiness, upset stomach, heart rhythm issues, irritability, anorexia, and nervousness. Not usually a good long-term solution, because you can build a tolerance to it, and it is often abused.
• A sedative, like sodium oxybate or gamma hydroxybutyrate (GHB or Xyrem), which induces sleep at night, so you're more awake during the day. This one has stiff safety warnings.

These medications can be very effective in reducing daytime drowsiness. But be very careful with dosage and noting any side effects. Read and follow the instructions carefully, and be aware of any safety warnings.

Not all narcoleptics require medication to manage their symptoms. Some people have done remarkably well by noting their individual sleeping and waking patterns and triggers and making lifestyle changes to accommodate.