Treatment of Narcolepsy


[MACHINE WHIRRING] [LAUGHTER] When I was in high school, I
didn’t want to take medication. I realized that I have to. See for me, I like just
having natural sleep. It’s just that– There’s a dramatic difference. Since diagnosis, it
took a little bit to really know which
drugs work best. If I don’t go to bed early,
I’m more sleepy during the day. And no matter how
tired or groggy I feel, I drag myself out of bed and
I go for a run for at least 20 to 25 minutes. It changed my life. [BIRDS TWEETING] I’m Audrey Cross. And I have narcolepsy
and cataplexy. I love plants or
really pretty trees. That’s made me cataplectic. Because I get excited
about plants a lot. And it’s kind of weird. And people don’t know what
the trigger is sometimes. Because other people aren’t
as excited about that tree as I am. Getting the diagnosis meant
that there was something that could be done about it. My mom found a
great doctor for me. And it’s been helpful. Hi. I have an appointment
Dr. Kirsch. Come in, Audrey. Have a seat. Thank you. Audrey is a
college-aged student who presented with
sleepiness and episodes of falling that weren’t
really well understood. And she underwent sleep testing. And that demonstrated
that she had narcolepsy. It’s really
important for anybody with a sleep
disorder, particularly people who have narcolepsy, to
get enough sleep at night time. OK. A person with
narcolepsy should aim for at least eight hours
of sleep every night and on the same schedule. Number two is
napping when you can. Because at some basic level, we
know you’re going to be sleepy. But a lot of caffeine– Generally, good
health is important. Trying to minimize
the amount of alcohol. Keep in a good exercise pattern. Limiting smoking and drugs. Leading that healthy
lifestyle will lead to potentially
improvement in sleepiness. Even with a good
behavioral program, they’re going to require
some amount of medication to be well controlled in
terms of their sleepiness and/or their cataplexy. OK. There are two problems
that people with narcolepsy typically have. One is the sleepiness
during the daytime. And the other is the falling
episodes, the cataplexy. So let’s talk about
the sleepiness first. OK. There are two medication
classes that are typically used to help people stay awake. One are kind of
standard stimulants. The problems with the stimulants
are that people sometimes get some side effects. They get a little jittery. They get some palpitations
in their heart. We also have a
second class which is modafinil and armodafinil. And these are stimulant
medications which work a little bit differently. But they do tend to
have less side effects. And often that’s where
I might start with using that kind of medication first. And if it’s not effective,
coming back to this older classification of medications. On a personal level, I try
to find a medication that works in a long-acting way
as a baseline for alertness during the daytime
and then spot treat with short-acting
stimulants if I need to. Then we have the cataplexy. If cataplexy is happening
a couple times a day– which it sounds
like it is– to me, that sort of defines
that we should think about trying to
treat you for cataplexy. And there are a couple kinds
of treatments for that. When you’re talking
about cataplexy, you’re often talking
about using either an antidepressant medication,
tricyclic antidepressants, or SSRIs or SNRIs. The newer ones tend to have
less side effects than the older ones. The last medication that we have
to potentially try and get you under treatment is a medication
called sodium oxybate. It’s a very specific
medication that we only use for narcolepsy. It also seems to make
people’s cataplexy much better controlled. And it makes their sleepiness
a little bit better. It knocks you out so that you
can get a really deep sleep that narcoleptics
don’t tend to get. With any of these
medications, it really is an individual treatment. It’s something that you
would start as low as you can and slowly move up, trying to
manage the symptoms as best you can. Do I have to take a
medication forever? You’re going to need to have
probably some medication. Yeah. What I would say is these
medications, not necessarily. Remember that we
constantly evolve in terms of our
understanding of disorders. And things change over time. So I never tell
anybody that you’re going to do anything for
the rest of your life because medicine continues
to evolve over time. With medication and
better sleep habits, is there a way that– am I
going to be normal again? You’re going to have
to adapt your living a little bit to having a
diagnosis of narcolepsy. But what I would
say is many people with narcolepsy, when
adequately treated, can live fairly normal lives. The doctors that
I’ve had have really tried to help me be able to live
my life the way that I want to. I need to get eight hours
of sleep at night minimum. And I need to have a
regular sleep schedule. And I need to have a 20 to
30 minute nap every day. I’m just in sync now with
carrying medication with me. I have a keychain container. And I keep it in my wallet. And it has backups of whatever
medication I might need. And that has managed my
sleepiness really well. I’ve been able to stay
awake through some classes that the average person
falls asleep through. And that feels really good. Because I look around and
all my peers are asleep. But I’m able to stay awake.