Treatment for idiopathic hypersomnolence and narcolepsy
Treatment for excessive sleepiness is mainly symptomatic, and is normally started by an expert after confirming the diagnosis. Scheduled naps can help, but seldom suffice as primary therapy. Advise the patient to follow good sleep practices.
Modafinil is first-line drug therapy for increasing alertness. Other drugs that may be prescribed by an expert are dexamfetamine and methylphenidate. No studies directly compare modafinil with dexamphetamine and methylphenidate as treatment for sleepiness, but modafinil has fewer adverse effects. In Australia, legal requirements limit who can prescribe these drugs—check state guidelines as these vary. Use:
1 modafinil 200 mg orally, once daily in the morning, or modafinil 100 mg orally, twice daily, in the morning and at midday (maximum daily dose 400 mg) idiopathic hypersomnolence or narcolepsy modafinil
OR
2 armodafinil 150 to 250 mg orally, once daily in the morning. idiopathic hypersomnolence or narcolepsy armodafinil
Some patients may need higher doses under expert supervision, with the dose being titrated gradually until tests of daytime alertness (eg maintenance of wakefulness test) are normal.
If a patient with narcolepsy has cataplexy, sleep paralysis and hypnagogic hallucinations, the expert may prescribe a tricyclic antidepressant or a selective serotonin reuptake inhibitor.