Medication can and should be a last resort for many illnesses, due to side effects and the fact that most people don’t want to feel dependent on taking daily pills. Yet, sometimes a person has no choice but to take medications prescribed by a doctor on a daily basis. Narcolepsy is no different and patients should work closely with their primary care physicians and sleep specialists to determine whether they require medication.
To start off with, there are medications that work to promote wakefulness in a person with narcolepsy. These are Modafinil, Armodfinil, Amphetamines, and Sodium Oxybate, with the latter being the best tested and most commonly used. For those patients who have narcolepsy combined with cataplexy, amphetamines and antidepressants are usually prescribed.
Sounds strange taking an antidepressant for a sleep disorder? When you look at the neurological science behind narcolepsy, there are commonalities between brain processes occurring in sleep disorders and mental illnesses (specifically depression); particularly the brain areas affected and types of neurotransmitters involved are the same in both cases. Modafinil is usually prescribed because it creates a sense of alertness by increasing dopamine, which is a wake-promoting chemical in the brain – due to increased dopamine secretion, those with bipolar disorder can go days without sleep. It is also safe to mention that as dopamine increases, two other neurotransmitters also increase. These two are serotonin and norephinedrine with the former often being called “happiness hormone” and the latter being known for increasing an individual’s energy level. The main reason for prescribing an antidepressant, besides increasing one’s sense of alertness, is that it also suppresses REM (rapid eye movement) during sleep.
Modafinil works by increasing wakefulness in the individual with narcolepsy for up to eight hours; therefore, it works best if taken in the morning. Some patients take half their recommended dose in the morning and half after lunch and then make time for a brief power nap around two or three in the afternoon.
When compared to most other medications, Modafinil is known to produce the least side effects in individuals with narcolepsy. In addition to Modafinil being taken potentially twice a day (if you cut the dosage in half), a short acting amphetamine may also be prescribed to keep you going until a few hours before bedtime; the time when you start to wind down from the day’s activities and prepare to go to sleep. Amphetamine is a very powerful medication, you should not take an Amphetamine too close to bedtime, or take more than you are prescribed. An overdose of Amphetamine can cause serious brain injury.
Sodium oxybate is another common medication for patients who are diagnosed with narcolepsy. Although with sodium oxybate, the age of a patient can play a factor in determining if the medication is right for an individual or not. It is not generally a good idea for the elderly, who may also be diagnosed with dementia, to take sodium oxybate. Also, anyone diagnosed with heart problems or hypertension may not want to take sodium oxybate since they are more than likely on a low salt diet.
It goes without saying that one should not take any narcolepsy medication with alcohol, or at least within a few hours of each other.
Two other symptoms of narcolepsy, usually in those with cataplexy, are dream-like hallucinations and sleep paralysis which can occur upon falling asleep or waking up. While these two symptoms do not usually require taking a medication to control, the drugs will often help the person experiencing these symptoms to better deal with these often severe conditions. A couple of medications that are effectively used in patients who are diagnosed with cataplexy are Clominpramine (Anafinil) and Protryptaline (Vivactil). The side effects of these drugs can be dry mouth, constipation, etc.
In conclusion, the narcolepsy medications dodn’t work overnight. Medication may take months to take effect. Also, lifecycle and other metabolic changes throughout one’s life means the majority of people will not stay on the same medication for “the rest of their lives”. If you do decide to stop taking a medication, be sure to consult with your doctor and taper slowly; never just stop cold turkey, especially if you are diagnosed with cataplexy – this can lead to rebound cataplexy which may be even worse.
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