Narcolepsy is a chronic sleep disorder that primarily causes excessive daytime sleepiness. Other common symptoms include sleep attacks, sleep paralysis, and cataplexy — a brief, sudden loss of muscle tone often triggered by strong emotions.

Treatment for narcolepsy includes both medications and lifestyle changes. Medications like stimulants help manage daytime sleepiness, and other drugs address symptoms like cataplexy. The two main types of narcolepsy — type 1, which includes cataplexy, and type 2, which does not — are treated in different ways.

Before 2014, type 1 narcolepsy was known as narcolepsy with cataplexy, and type 2 narcolepsy was called narcolepsy without cataplexy. This classification was updated in the third edition of the International Classification of Sleep Disorders.

Doctors usually treat narcolepsy with medication and lifestyle changes to help promote healthy sleep habits. The best medication for your narcolepsy depends on your specific symptoms. Read on to learn more about new drugs for excessive daytime sleepiness and narcolepsy.

Treatment Options for Narcolepsy

Doctors use a variety of medications to treat narcolepsy. Some drugs are approved by the U.S. Food and Drug Administration (FDA) specifically to treat narcolepsy. Other drugs may be prescribed to treat narcolepsy off-label, which means they’re not approved specifically for treating narcolepsy.

FDA-approved drugs for narcolepsy are based on the type or on major symptoms. All the drugs discussed below are taken orally (by mouth). Some medications approved for treating narcolepsy are known as controlled substances. This means that the drugs could be misused.

1. Sodium Oxybate

Sodium oxybate is FDA-approved for treating cataplexy and excessive daytime sleepiness associated with narcolepsy. Sodium oxybate’s active metabolite occurs naturally in the brain and plays a role in sleep regulation. Common side effects include confusion, dizziness, and headaches.

Xyrem is the first brand of sodium oxybate approved for cataplexy associated with narcolepsy and excessive daytime sleepiness. The drug manufacturer of Xyrem also released a low-sodium version of sodium oxybate called Xywav, which may be better for people with health conditions that require them to reduce their intake of sodium (salt).

In 2023, the FDA approved an extended-release form of sodium oxybate, Lumryz, for treating excessive daytime sleepiness or cataplexy in people with narcolepsy. This medication is taken once at bedtime, which may help improve your sleep cycle. Potential side effects include nausea, vomiting, dizziness, and headache.

Researchers don’t fully understand how this sodium oxybate works to treat cataplexy. This treatment is available only through a restricted-access enrollment program. Another form of sodium oxybate, gamma hydroxybutyrate (GHB), is misused recreationally by some people.

2. Pitolisant

Pitolisant (Wakix) is approved to treat excessive daytime sleepiness and cataplexy associated with narcolepsy. This medication works by blocking histamine 3 (H3) receptors in the brain to help promote wakefulness. Side effects include nausea, insomnia, and anxiety.

3. Solriamfetol

Solriamfetol (Sunosi) treats excessive daytime sleepiness associated with narcolepsy or obstructive sleep apnea. Common side effects include headaches, dizziness, insomnia, and decreased appetite. Solriamfetol is considered a dopamine and norepinephrine reuptake inhibitor. Doctors and researchers don’t quite know how solriamfetol works to treat narcolepsy.

4. Stimulant Drugs

Modafinil (Provigil) and armodafinil (Nuvigil) are similar stimulants specifically known as eugeroics. These drugs are prescribed to improve wakefulness in people who have:

• Excessive daytime sleepiness associated with obstructive sleep apnea/hypopnea syndrome
• Narcolepsy
• Shift work sleep disorder

Common side effects of modafinil and armodafinil include headache, nausea, dizziness, and insomnia. It’s not well understood how these drugs work to promote wakefulness.

Amphetamines and other stimulants have been prescribed to treat narcolepsy-related excessive daytime sleepiness since the 1930s. Researchers believe that stimulants increase alertness by raising dopamine levels in the brain. Examples of stimulants for narcolepsy include:

• Amphetamine/dextroamphetamine (Adderall)
• Dextroamphetamine (Dexedrine)
• Methylphenidate hydrochloride (Concerta, Ritalin LA)

Amphetamines can cause serious side effects, such as increased blood pressure, mania, and psychosis. Be sure to take these medications exactly as prescribed. Stimulants are controlled medications given their potential for misuse.

5. Antidepressants

Antidepressants have been prescribed for many decades to help treat cataplexy. This symptom is unique to narcolepsy type 1. Researchers believe that antidepressants may relieve cataplexy by suppressing rapid eye movement (REM) sleep. Antidepressants sometimes prescribed off-label to treat type 1 narcolepsy include:

• Clomipramine (Anafranil)
• Fluoxetine (Prozac)
• Protriptyline hydrochloride (Vivactil)
• Venlafaxine (Effexor XR)

6. Good Sleep Hygiene

Most doctors recommend a combination of medication and lifestyle changes to treat narcolepsy. The National Institute of Neurological Disorders and Stroke recommends:

• Sticking to a regular sleep schedule, even on weekends
• Taking short naps when you feel sleepiest during the day
• Exercising daily for at least 20 minutes
• Avoiding caffeine, alcohol, or heavy meals before bedtime
• Not smoking, especially in the evenings
• Keeping your sleeping space comfortable and maintaining a cool temperature
• Taking time to relax before bed

Your doctor may ask you to keep a sleep log to record your sleeping patterns and narcolepsy symptoms. These details can help them accurately diagnose your narcolepsy. Sleep logs also help measure how well your treatments work by tracking changes in your sleep and wakefulness.

A small study of eight people who had narcolepsy with cataplexy found that skin temperature may affect alertness and sleepiness. The results suggested that people with narcolepsy felt more awake after having cold food or drinks, which caused their body temperature to drop. On the other hand, the participants felt sleepier when their temperature rose after they consumed warm food and drinks.

7. Mental Health Treatments

Along with medications, psychotherapy is effective for treating narcolepsy. Cognitive behavioral therapy (CBT) can help people with narcolepsy change many behaviors that affect their condition, such as practicing good sleep hygiene and sticking to their medication schedule.

CBT is also effective for improving sleep paralysis and may help manage hypnagogic hallucinations, symptoms that occur as you’re falling asleep.

Depression is the most common mood disorder in people with narcolepsy. It’s important to make sure that you address your mental health as part of your treatment plan. In addition to CBT and antidepressant medications, support groups can be beneficial for people with narcolepsy. Online and in-person groups can help you find a community and avoid isolation.

8. Management of Related Conditions

People with narcolepsy are more likely to develop related health conditions such as sleep apnea, obesity (high body weight), and type 2 diabetes. Managing all your health conditions is crucial, not just for your overall well-being, but also to help you feel your best while managing narcolepsy. By staying on top of your treatment plan, you can boost your health and improve your quality of life.

Drugs and Substances That Can Worsen Narcolepsy Symptoms

Some medications and substances worsen cataplexy or excessive daytime sleepiness or make your narcolepsy treatment less effective. Depending on your narcolepsy symptoms and their severity, you may have to avoid these substances or medications. Your doctor may also recommend taking them only at certain times during the day.

Examples of medications and substances you may want to avoid or limit include:

• Caffeine
• Nicotine
• Alcohol
• Cannabis
• Over-the-counter allergy and cold medications that cause drowsiness
• Diuretics (water pills), a common treatment for high blood pressure
• Some heart medications used to treat high blood pressure or heart rhythm disorders
• Certain anti-anxiety medications

Be sure to talk with your doctor if you think your medication is making your narcolepsy symptoms worse. Don’t make any changes without consulting a professional first.

Find Your Team

MyNarcolepsyTeam is the social network for people with narcolepsy. On MyNarcolepsyTeam, more than 11,000 members come together to ask questions, give advice, and share their stories with others who understand life with narcolepsy.

Have you or someone you care been diagnosed with narcolepsy? Have you found treatments or other strategies to manage the condition? Share your experience in the comments below, or start a conversation by posting on your Activities page.