The treatment of narcolepsy

Narcolepsy is a sleep disorder characterized, in its classical form, by excessive daytime sleepiness (EDS) with irresistible episodes of sleep, cataplexy, disrupted nocturnal sleep, hypnagogic/hypnopompic hallucinations and sleep paralysis. It is often underdiagnosed, but if it is suitably diagnosed, symptoms can be well treated by means of targeted drugs, such as: 1) modafinil, to treat EDS; 2) sodium oxybate, for cataplexy, but also for EDS and disrupted nocturnal sleep; 3) tricyclic and newer antidepressants, for cataplexy. Hallucinations and sleep paralysis can be treated with the same drugs used for cataplexy. Amphetamines and amphetamine-like stimulants are less prescribed nowadays. Behavioural measures are also important and useful. The discovery of hypocretin deficiency in narcoleptic patients opens new perspectives for the development of new therapeutic approaches for both EDS and cataplexy. Therapy for narcolepsy is chronic, hence symptomatic. However, a correct use of available drugs enables patients gaining a better quality of life, keeping under control the symptoms, that are heavily disabling, mainly from the social point of view.