Narcolepsy Diagnosis & Treatment Online

Narcolepsy can interfere with your ability to work, drive, or enjoy everyday life. You may be experiencing:

• Persistent daytime sleepiness, even after a full night’s rest
• Sudden muscle weakness triggered by emotions (cataplexy)
• Sleep paralysis or vivid hallucinations during sleep transitions
• Brief, uncontrollable sleep attacks during the day

The good news is, relief for these symptoms is possible with the right care.

Narcolepsy is a chronic health condition that impacts your brain’s ability to control your cycles of sleep and wakefulness. People with narcolepsy can feel very sleepy during the day, suddenly fall asleep, and have difficulty staying awake for a long time. They can also experience symptoms such as EDS, cataplexy (sudden loss of muscle tone), sleep paralysis, fragmented nighttime sleep, insomnia, and RBD.

There are 2 types of narcolepsy. With type 1 narcolepsy, people typically have cataplexy, while people with type 2 narcolepsy usually don’t have cataplexy. Cataplexy ranges from mild to severe. In mild cases of cataplexy, you typically only have muscle weakness in a few muscles, such as your facial muscles, which can lead to a sagging jaw. In more severe cases of cataplexy, you might lose control of all of your muscles and collapse.

There are multiple potential causes of narcolepsy. Narcolepsy can be caused by a lack of hypocretin, also called orexin, a brain chemical that regulates sleep. This hypocretin deficiency can be caused by your immune system attacking parts of your brain that create hypocretin.

There are also several factors that can boost your risk of narcolepsy or cause an autoimmune issue, including:

• An infection, such as a streptococcal infection or the swine flu
• A sudden change in your sleep patterns
• Major psychological stress
• Hormonal changes, including changes that happen during menopause or puberty
• Inherited genetic condition

There are 2 main kinds of treatment for narcolepsy, including lifestyle changes and medications. Providers usually recommend trying lifestyle changes first to treat narcolepsy, including:

• Stick to a sleep/wake schedule. Go to bed and get up at the same time every single day, including weekends.
• Take naps. Schedule short naps of about 20-30 minutes throughout the day.
• Avoid substances. Avoid nicotine,alcohol, and even caffeine, as using these substances, particularly at night, can make your narcolepsy symptoms worse.
• Regular exercise. Get regular, moderate exercise at least 4 hours before bedtime.

You can also try medications if lifestyle changes haven’t worked or your symptoms are more severe, including:

• Wake-promoting agents. This first-line medication option works well to improve alertness and reduce daytime drowsiness. Wake-promoting agents include:
  • Provigil (modafinil)
  • Nuvigil (armodafinil)
  • Sunosi (solriamfetol)
• Amphetamine-like stimulants. Providers sometimes prescribe these medications, such as Ritalin (methylphenidate), to relieve EDS, especially when modafinil doesn’t work, but they need to be monitored carefully for severe side effects.
• Antidepressants. Antidepressants are often prescribed to change your brain chemical levels and decrease the amount of REM sleep, which contributes to narcolepsy symptoms. Two classes of antidepressants work well in treating cataplexy, including tricyclics and SNRIs. Tricyclics include:
  • Tofranil (imipramine)
  • Norpramin (desipramine)
  • Anafranil (clomipramine)
  • Vivactil (protriptyline)

SNRIs are sometimes prescribed to suppress REM sleep and treat the narcolepsy symptoms of sleep paralysis, cataplexy, and hallucinations. Examples of SNRIs include:

• Effexor (venlafaxine)
• Prozac (fluoxetine)
• Strattera (atomoxetine)

• Sodium oxybate. Also called gamma-hydroxybutyrate salt (GHB), sodium oxybate is FDA-approved to treat EDS and cataplexy in people with narcolepsy.
• Histamine 3 receptor antagonist/inverse agonist. Wakix (pitolisant) treats cataplexy and EDS in adults with narcolepsy. The medication can help boost histamine levels in the brain.

Narcolepsy can disrupt your daily life. You may be struggling to function at home, at work, in school, and in your relationships. If you’re having a difficult time coping with narcolepsy, your provider may recommend therapy, like Cognitive Behavioral Therapy (CBT), to help, especially if you’re also experiencing anxiety or depression.

In therapy, your provider might use CBT to help you:

• Establish and maintain a consistent sleep schedule
• Stick with your medication schedule
• Manage symptoms of anxiety or depression
• Cultivate relaxation techniques

Narcolepsy can be safely treated online by licensed healthcare providers after an appropriate medical assessment.

Providers who can treat narcolepsy include:

• Primary care physicians (PCPs): Can diagnose narcolepsy and prescribe medications for narcolepsy
• Nurse practitioners (NPs): Licensed to prescribe narcolepsy medications
• Physician assistants (PAs): Qualified to diagnose and manage narcolepsy under physician oversight
• Telehealth providers: Trained to evaluate narcolepsy, prescribe narcolepsy medications, and coordinate follow-up remotely

To get a prescription online, you’ll need to provide information about your symptoms, medical history, and current medications. A healthcare provider who specializes in sleep disorders can help you figure out if medication, lifestyle changes, therapy, or a combination of these interventions is the right approach for your narcolepsy.