Management

General advice includes:

• adopt a regular sleep routine
• avoid excess caffeine and alcohol

If daytime sleepiness continues to be a problem then some patients may prefer to take regular naps.

If naps are not possible then most patients will require drug treatment.

• in general, in patients with narcolepsy, treatment is initiated by a specialist
• treatments used to increase alertness include dexamfetamine and modafinil, and methylphenidate
  • concomitant treatment with an antidepressant drug (usually clomipramine) may be given to prevent cataplectic attacks
  • in practice, management for idiopathic hypersomnia is similar to that for narcolepsy
  • pitolisant (a wake promoting histamine H3-receptor inverse agonist) may provide a further treatment option (2)

Reference:

1. Drug and Therapeutics Bulletin 2004; 42(7):52-6.
2. Brown J, Makker KM. An approach to excessive daytime sleepiness in adults. BMJ 2020;368:m1047