How is narcolepsy treated?

-It is best managed with a combination of medications and common sense! Treatment must be tailored to the needs of the individual patient, and medications alone are not the answer. One must also eliminate aggravating factors that would make the symptoms worse and the prescribed medications less effective.

-For example: one does not manage diabetes by giving insulin and then informing the patient that since they now have medicine, they can do whatever they please...such as eating entire pies and cakes and drinking a case of beer every day! It would be illogical to use such a "medications only" approach for any illness--including narcolepsy.

-The physician treating the patient with narcolepsy should be experienced in its management and also take the time needed to educate the patient about the condition and factors that can make it worse--empowering the patient and enabling him or her to "outsmart" the disorder as much as possible.

 

Are there other disorders of impaired brain alertness mechanisms beside narcolepsy?

-Yes. Even if one excludes causes of their impairment by sedating medications, hormonal imbalances such as hypothyroidism and the like, there are individuals with severe "brain sleepiness" not secondary to problems (such as sleep apnea) occurring during overnight sleep--and who do not have either cataplexy or a tendency to enter REM sleep too rapidly. The term "idiopathic hypersomnia" has been used to describe such individuals.

-Idiopathic hypersomnia is a diagnosis that is made by excluding other possible causes. Idiopathic is a polite way of saying that the doctor has no idea what caused the problem!--which does not mean that it cannot be effectively treated.

-IT IS IMPORTANT TO KNOW THAT MANY PATIENTS WHO HAVE BEEN DIAGNOSED AS HAVING IDIOPATHIC CNS HYPERSOMNOLENCE IN FACT HAVE UPPER AIRWAY RESISTANCE SYNDROME--WHICH CAN READILY BE MISSED BY CONVENTIONAL SLEEP MONITORING TECHNIQUES.

--Upper airway resistance syndrome is treated much differently than idiopathic CNS hypersomnolence--and it is inherently treatable!

--Hence, one should not hesitate to ask whether a sleep center possesses the special monitoring capabilities needed to detect and document upper airway resistance syndrome if it happens to be present.