5. Approach to a Patient with Narcolepsy

  1. Douglas B. Kirsch MD, FAASM2,3
  1. Madala Ravichand MD and
  2. Rodney A. Radtke MD

Published Online: 11 OCT 2013

DOI: 10.1002/9781118764152.ch5

Sleep Medicine in Neurology

Sleep Medicine in Neurology

How to Cite

Ravichand, M. and Radtke, R. A. (2013) Approach to a Patient with Narcolepsy, in Sleep Medicine in Neurology (ed D. B. Kirsch), John Wiley & Sons, Oxford. doi: 10.1002/9781118764152.ch5

Editor Information

  1. 2

    Harvard Medical School, Boston, MA, USA

  2. 3

    Division of Sleep Neurology, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA

Author Information

  1. Department of Neurology, Duke University Medical Center, USA

Publication History

  1. Published Online: 11 OCT 2013
  2. Published Print: 7 OCT 2013

ISBN Information

Print ISBN: 9781444335514

Online ISBN: 9781118764152



  • behavioral therapy;
  • cataplexy;
  • excessive daytime sleepiness (EDS);
  • hypnogogic hallucinations;
  • narcolepsy;
  • pharmacological therapy;
  • rapid eye movement (REM)-suppressant medications;
  • sleep paralysis;
  • sleepiness


Narcolepsy is one of the most common hypersomnias of central nervous system origin. Its primary symptom is that of excessive daytime sleepiness (EDS). The clinical tetrad of narcolepsy includes EDS, cataplexy, hypnogogic hallucinations, and sleep paralysis. Fragmented nocturnal sleep is often part of the clinical syndrome as well. Sleepiness and cataplexy represent the primary sources of disability of this disorder. Treatment is focused on use of stimulants and other wake-promoting agents to promote alertness. Rapid eye movement (REM)-suppressant medications are used to suppress cataplexy and the other associated auxiliary symptoms of narcolepsy. Multimodal approach with pharmacological therapy and behavioral therapy is required to treat narcolepsy. Potential new therapies include medications that are histamine agonists to promote wakefulness and histamine antagonists for sedation. Newer therapies are being explored with the aim of replacing this deficient neurotransmitter.