Narcolepsy treatment helps patients regulate sleep
By Deborah Jeanne Sergeant
Many people experience a “three o’clock slump” in energy, when a nap sounds really good but a cup of coffee fills the bill so they can make it through the rest of their day.
For people with narcolepsy, the urge to sleep during the daytime feels overwhelming—and can happen unexpectedly.
The condition can cause them to nod off when they do not want to sleep. A cup of coffee doesn’t help.
“It’s caused by lack of orexin, a chemical in the brain. This deficiency causes narcolepsy and not everyone who has daytime sleepiness has narcolepsy,” said Carleara Weiss, Ph.D., registered nurse and research assistant professor at UB’s Center for Nursing Research.
Orexins are neuropeptides responsible for controlling arousing from sleep, staying awake and appetite. Without sufficient orexins, people can struggle to stay awake even when they desire wakefulness.
“The person will be working or talking with friends and just fall asleep,” Weiss said. “Or they’re driving and need to stop the car. Even if they’re typing at the computer, they have to fall asleep. Normally, we can have a cup of coffee and keep going. The person with narcolepsy can’t.”
Unwanted sleepiness is not the only effect of narcolepsy. Weiss said that nightmares, hallucinations and changes in their deep sleep can also affect patients with narcolepsy.
“Many people with narcolepsy also have depression as well,” she added. “I think one important piece of narcolepsy is adjustment of lifestyle and incorporating napping. For example, they will need to take a nap or naps during the day. It’s not because they’re lazy. Physiologically, they need the naps.”
Narcolepsy type 1 includes cataplexy, when a person’s body abruptly loses muscle control in a way similar to fainting. Physician Alberto Monegro, sleep medicine specialist with UBMD Internal Medicine & UBMD Pediatrics, explained that a loss of orexin is thought to be the cause of type 1.
“Narcolepsy type 2 is thought to be caused by partial damage of orexin neurons or their projections,” Monegro said.
Monegro is a pulmonologist and critical care physician with UBMD Internal Medicine and an assistant professor with Jacobs School of Medicine and Biomedical Sciences at UB.
Cataplexy is not involved with narcolepsy type 2.
Although it can be difficult for patients to receive a prompt diagnosis for narcolepsy, once they do, the proper treatments can help. Monegro said that they include alert promoting agents, stimulants, antidepressants, and the anti-cataplectic agent known as sodium oxybate.
“New medications have come to market as well such as the dopamine and norepinephrine reuptake inhibitor known as solriamfetol, and the histamine H3-receptor antagonist inverse agonist drug known as pitolisant,” he added. “Alert-promoting medications such as modafinil and armodafinil are effective in improving wakefulness. Other medications are also effective in treating narcolepsy when both excessive daytime sleepiness and cataplexy are present such as sodium oxybate, pitolisant, and atomoxetine.”
Anyone experiencing symptoms like unwanted daytime sleepiness should seek treatment from a primary care provider and, if needed, a sleep specialist.