management

Last edited 04/2020 and last reviewed 04/2020

General advice includes:

  • adopt a regular sleep routine
  • avoid excess caffeine and alcohol

If daytime sleepiness continues to be a problem then some patients may prefer to take regular naps.

If naps are not possible then most patients will require drug treatment.

  • in general, in patients with narcolepsy, treatment is initiated by a specialist
  • treatments used to increase alertness include dexamfetamine and modafinil, and methylphenidate
    • concomitant treatment with an antidepressant drug (usually clomipramine) may be given to prevent cataplectic attacks
    • in practice, management for idiopathic hypersomnia is similar to that for narcolepsy
    • pitolisant (a wake promoting histamine H3-receptor inverse agonist) may provide a further treatment option (2)

Reference:

  1. Drug and Therapeutics Bulletin 2004; 42(7):52-6.
  2. Brown J, Makker KM. An approach to excessive daytime sleepiness in adults. BMJ 2020;368:m1047