Narcolepsy

Finding The Right Treatment

Treatment

Narcolepsy is treated with medication. The most commonly used medication, available since 1999, is a central nervous stimulant known as modafinil (Provigil). This drug, also known as a “wakefulness” medication, has few side effects and it improves daytime sleepiness and alertness. It is approved by the Food and Drug Administration (FDA) as a treatment for narcolepsy. In 2007, another wakefulness medication, armodafinil (Nuvigil) also was approved by the FDA to treat narcolepsy.

In the past, people with narcolepsy were treated with amphetamines such as Adderall or Ritalin; however, these drugs can have more risks than wakefulness drugs.

More recently, in 2019, the FDA approved two new medications to treat narcolepsy, including solriamfetol (Sunosi) and pitolisant (Wakix). Sunosi inhibits the reuptake of dopamine and norepinephrine, two important brain chemicals. This inhibition results in an improved alertness. Pitolisant is specifically meant for people with Type 1 narcolepsy and it works by blocking key histamine receptors, resulting in an increased level of wakefulness.

Dietary supplements

There are an increasing number of supplements, such as an herb, vitamin, mineral, and other supplements claiming to improve sleep, depression, stress, restlessness, or anxiety. While it is possible for a supplement to improve one’s symptoms, their effects are often unproven.

Be aware that dietary supplements are not controlled by the FDA and, therefore, are not subject to the standards of quality, uniformity, and testing for efficacy and safety as regulated medications. It is important to share a list of all medications and supplements with one's treating provider because some of them may interact with the medications they prescribe.

Healthcare providers that can prescribe medications

Psychiatrists, psychiatric nurse practitioners, and physician assistants are practitioners who are trained to diagnose and treat mental health conditions by prescribing medications. Sometimes it's hard to find a psychiatric provider because there are so many people who need them. So, individuals often choose to see a different kind of provider who can prescribe. This could be a doctor they already see, like a primary care doctor, family doctor or OB/GYN, or a new primary doctor.

Nonmedication treatment

Narcolepsy disrupts the sleep cycle pattern and tends to cause insomnia. There are non-medication options for insomnia that could be a beneficial addition to a treatment regimen for narcolepsy. CBT (Cognitive Behavioral Therapy) has been endorsed by the National Institutes of Health as an effective method for treating insomnia. CBT for Insomnia addresses the underlying causes of insomnia including insomnia-driven thoughts and behaviors.

Techniques covered in CBT-I include changing sleep thoughts and behaviors, applying lifestyle habits that improve sleep, and practicing relaxation techniques. Typically, the CBT-I program is led by a therapist and includes an initial individual assessment and five individual treatment sessions over a six-week period.

The decision to start therapy

Many people try to cope with their distress on their own, then feel disappointed when they find that this is very difficult to do. Deciding to start therapy can be hard; it takes courage.

For some people, it can take time to warm up to the idea of sharing one’s intimate thoughts or disclosing details of one’s life, especially for those who grew up in a culture where seeking psychological help was frowned upon.

Psychotherapy is increasingly accepted as not only a way to improve mental health symptoms, but also a means for self exploration and personal growth. No problem is too small for a trained therapist: an individual need not worry that others may have it worse. The willingness to reach out for help is increasing: in 2020, one out of every six Americans (men and women) reported seeing a therapist.

Seeing a therapist with whom one feels comfortable, and a sense of connection, and who also participates in their insurance network, is essential. It may take a couple tries to find a therapist who feels like the right fit. If therapy didn't help the first time around, it can be helpful to give another therapist a try because therapeutic styles vary so much from therapist to therapist.

Where to start

Requesting one’s physician to make a referral is often a good place to start. Many health insurance cards have websites or 1-800 numbers to call for a list of in-network providers.

To find a therapist who takes your insurance, the National Institute of Mental Health offers a comprehensive list of resources.

Psychology Today also lists therapists by type, location and insurance.