Narcolepsy gives rise to a complex picture of symptoms that range from daytime sleepiness and REM-associated cataplexies, hypnagogic hallucinations and sleep paralysis into severe sleep disturbances, metabolic disturbances and psychological as well as social problems. The compound symptoms influence the well-being of the growing and maturing young person in a way that may impair the development of the personality, self-confidence and esteem. It is of great value if the treatment can be run within a multi-disciplinary team including neuropaediatrician, endocrinologist, dietician, nurse, physiotherapist, social worker and psychologist.
Treatment of narcolepsy is best started with wake-supporting steps. Sleep hygiene and power naps are part of the strategy but central stimulant medication is most often needed. The cataplectic attacks are the symptoms considered most disturbing by the patients. They may improve by reduced daytime sleepiness but specific treatment is needed and is difficult to make efficient. Night sleep disturbances may respond well to sodium oxybate, a drug that also influences daytime wakefulness and cataplexies.
This far no curative therapy has been found. Future development may lead to specific agents that can influence the hypocretine/orexine system and ways to influence the autoimmune mechanism underlying the disease.