The treatment of Narcolepsy including Sodium Oxybate (Xyrem) and Modafinil
Narcolepsy is one of the most complex of non-respiratory Sleep Disorders, consisting of a tetrad was Excessive Daytime Sleepiness, Cataplexy, Sleep Paralysis and Hypnagogic Hallucinations. Once we’ve diagnosed Narcolepsy, treatment for your Narcolepsy comes in many forms including :
Good sleep hygiene is crucial in managing Narcolepsy symptoms in the long term. Adequate sleep at night is important, daytime timed-naps can be useful.
Many medications can be used to treat Narcolepsy, each with their own pros and cons.
CNS stimulants such as Methylphenidate (Ritalin, Concerta) and dextroamphetamine (dexamphetamine, dexamfetamine) work well but have long term complications. Pemoline is less commonly used due to the potential side effects.
Modafinil and Armodafinil (Modavigil, Nuvigil) are generally better-tolerated than amphetamine-based medications, and with less side effects. These still however require longterm vigilance.
Sodium oxybate (Xyrem, metabolite of gamma-aminobutyric acid) has been used in the USA since 2002, and has been used by our clinic since it’s Australian approval in late 2014. We have the largest known group of patients in South Australia on treatment, with impressive symptomatic results. We provide continuous regular clinical monitoring in conjunction with patients’ General Practitioners, to ensure optimal titration of treatment modalities based on the patient’s current clinical status.
At Adelaide Sleep, we routinely counsel, diagnose, and treat all aspects of Narcolepsy and Idiopathic Hypersomnia. We have experience in all medications used for Narcolepsy and Narcolepsy-like conditions. If you’d like to know more, contact us now.
© APSS 2018
The Diagnosis of Narcolepsy and the MSLT
Narcolepsy is one of the most interesting of Sleep Disorders in the International Classification of Sleep Disorders (ICSD-3). It is characterised by the classic tetrad was Excessive Daytime Sleepiness, Cataplexy, Sleep Paralysis and Hypnagogic Hallucinations. The addition of Sleep disruption makes the Narcolepsy pentad. The most often used test for this diagnosis is the in-hospital Multiple Sleep Latency Test (MSLT).
Whilst the symptom of sleepiness is helpful, sleepiness is a symptom of many sleep disorders. Some Narcoleptics are not aware of how sleepy they really are. Objective testing is crucial.
A Multiple Sleep Latency Test (MSLT) involves an overnight sleep study, followed by timed nap opportunities the following day. A urinalysis is also part of the testing process. Depending on the overnight and subsequent-daytime testing, and in the absence of another sleep disorder, a diagnosis of Narcolepsy (or Idiopathic Hypersomnia) can be confidently made.
A home sleep study (also known as an ambulatory sleep study) will never be able to diagnose Narcolepsy.
Measuring CSF Hypocretin levels are useful when an MSLT is not possible.
Here at Adelaide Sleep, we look after all aspects of Narcolepsy including the counselling, diagnosis, and treatment of all Narcolepsy symptoms. If you’d like to know whether you have Narcolepsy or one of the Narcolepsy-like conditions, call us now and see one of our doctors.
© APSS 2018
The History of Narcolepsy – Excessive sleepiness in evolution
Central Disorders of Hypersomnolence encompass conditions including Narcolepsy and Idiopathic Hypersomnia – at here at the best Adelaide Sleep clinic in Adelaide, we manage all these conditions.
Narcolepsy was first described the 1870’s were it was associated with Cataplexy and Postencephalitic Narcolepsy. With these reports from over a century ago, it was the first known primary sleep disorder to be described, identified and the symptomatology reported. It was from here that the classic tetrad was Excessive Daytime Sleepiness, Cataplexy, Sleep Paralysis and Hypnagogic Hallucinations was coined. Fragmented sleep is also a common symptom that is often overlooked.
Our understanding of Narcolepsy progressed with the development of treatments such as Methylphenidate in the 1950’s – known to ameliorate some Narcolepsy symptoms.
In the following decade of the 1960’s came tricyclic antidepressants (TCAs) and their use in cataplexy, at around the time we discovered sleep-onset REM periods (SOREMPs).
The first consensus for the definition fo Narcolepsy was ratified in the 1970’s under the International Classification of Sleep Disorders (ICSD). The following decade saw the first documented association of Human Leukocyte Antigen (HLA)-DR2 and Narcolepsy (Honda et al, Sleep 1986).
With the 1990’s came the discovery of Hypocretin 1 and the Hypocretin Receptor 2 Gene. Today we can diagnose Narcolepsy with the Multiple Sleep Latency Test (MSLT) and CSF Hypocretin levels.
At Adelaide Sleep, we have experts who are trained in specifically counselling, diagnosing, and treating Narcolepsy and all Sleep Disorders. We treat the whole spectrum fo sleep disorders, and pride ourselves on being able to differentiate and treat each of these separately.
If you believe you may have Narcolepsy or one of the Narcolepsy-like conditions, we can help. Call us now for an appointment.
© APSS 2018
- The treatment of Narcolepsy including Sodium Oxybate (Xyrem) and Modafinil
- The Diagnosis of Narcolepsy and the MSLT
- The History of Narcolepsy – Excessive sleepiness in evolution
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