A national task force chaired by sleep neurologist Merrill S. Wise, M.D., Methodist Healthcare Sleep Disorders Center, has published a comprehensive, evidence-based review of the world’s literature regarding the treatment of narcolepsy. The paper appears in the December issue of the journal SLEEP, the official publication of the Associated Professional Sleep Societies (APSS), a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society.

The article, Treatment of Narcolepsy and other Hypersomnias of Central Origin, provides the basis for state-of-the-art recommendations by the American Academy of Sleep Medicine for the management of narcolepsy and related disorders. Narcolepsy is a neurologically-based sleep disorder that causes excessive sleepiness regardless of the amount of sleep obtained. This sleep disorder is associated with impaired productivity, numerous vocational and social difficulties and an increased risk for accidents.

“The impact of untreated sleepiness is immense and affects not only the lives of patients who experience this disorder, but also their families, co-workers, and the general public,” explained Dr. Wise.

The treatment of narcolepsy involves a combination of lifestyle changes coupled with medication to improve alertness.  The task force led by Dr. Wise performed a systematic review of the literature and graded the quality of evidence using standardized evidence review methods.  Results indicated that both older (traditional stimulants) and more recently developed  medications, used alone or in combination, improve alertness to a significant extent.  However, Dr. Wise says much work remains to develop even more effective treatments that are well tolerated by patients.  This is especially true for unique populations such as children, older individuals and women who are pregnant or breast feeding.

Dr. Wise notes that perhaps one day we will have effective strategies to modify or even prevent the development of narcolepsy symptoms by targeting the underlying pathological process.  Recent investigations indicate the presence of selective degeneration of a small group of neurons in the hypothalamus of individuals with narcolepsy.  This is most likely due to a selective auto-immune attack on neurons that produce a neuropeptide known as hypocretin, leading to the appearance of severe sleepiness and other symptoms.  Until a primary preventive strategy is developed, sleep medicine specialists must focus on the diagnosis, treatment, and support of individuals with narcolepsy and their families.