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Often antidepressants, such as SSRIs are used, not just for depression or anxiety, but because these drugs like Prozac Paxil, Sotralapram, also have the ability to treat cataplexy that sudden loss of muscle movement. In addition, they suppress REM sleep. And what we know is that REM sleep is exaggerated and in too much quantity in patients with narcolepsy and sometimes REM sleep can even sneak through during wakeful hours and cause some of that cataplexy or cause some of the sleep attacks that occur during the day. it used to be that we use tricyclic antidepressants for this purpose, but the newer drugs, the SSRI also do the same with fewer side effects.
Often antidepressants, such as SSRIs are used, not just for depression or anxiety, but because these drugs like Prozac Paxil, Sotralapram, also have the ability to treat cataplexy that sudden loss of muscle movement. In addition, they suppress REM sleep. And what we know is that REM sleep is exaggerated and in too much quantity in patients with narcolepsy and sometimes REM sleep can even sneak through during wakeful hours and cause some of that cataplexy or cause some of the sleep attacks that occur during the day. it used to be that we use tricyclic antidepressants for this purpose, but the newer drugs, the SSRI also do the same with fewer side effects.
There are a few behavioral treatments that may work for narcoleptics. The first is simply sleep hygiene. This is good for everybody, but more so for narcoleptics what this simply means is that there's attention to good nighttime sleeping. So going to bed at the same time at night, waking up at the same time in the morning, having a bedroom environment, that's free of interruptions. So it's cool. It's quiet. It's calm, it's comfortable. It makes sense to avoid excess alcohol, which can certainly have an effect on our nervous system and be moderate about caffeine and use it judiciously. It makes sense the body likes to have regularity. So if there's going to be caffeine involved, it should be about the same doses every day. Not too much one day, not too little another, because this will affect the mood and the energy of a narcoleptic. Even more than the average person. One thing that's very important for narcoleptics is scheduled naps which can be very restorative and really bust that excessive daytime sleepiness. So if naps are built into the day, they can have a burst of energy and feel good for quite a few hours. Those naps may be hard to come by in our busy lives, but sometimes they need to be negotiated into the work schedule and the life schedule. So the rest of the day functions well.
"The final drug that's used is called Xyrem or sodium oxidate. It's a mineral salt that is dry from GHB. And this was actually used in popular in the news several years ago, as the date rape drug, very controversial drug, but it's actually marketed specifically for narcoleptics with excessive daytime sleepiness, even though they may be treated in other ways or narcoleptics with cataplexy. And it's given as a liquid preparation, that's very salty. So it's taken first thing before bed and then four hours later, a second dose is actually administered. So there's an alarm and one actually wakes up out of sleep and takes a second dose. Nobody's going to be able to put it into your cocktail because it's so salty. So we feel that it's safer that way everybody would taste it. So it can't be really used as a drug of abuse, the person taking it will absolutely know, but it's short acting. It only lasts for 20 to 40 minutes and the goal is to make sleep better quality. Even though we actually wake up people in the middle of the night to take the second dose, they get more consolidated sleep at night. So they have a better daytime functioning. They're more rested. So it's kind of an unusual thing to do. It's a considered an orphan drug. It's only provided by a centralized pharmacy and you have to enroll in a complicated program to get it, but it's a unique way of treating narcolepsy by making the nighttime sleep better. So the daytime functioning is better too."
"There's some exciting research in narcolepsy. There's some drugs that are being developed that are targeting particular neurotransmitters in the brain that control alertness and energy. One of these is histamine, and we know about anti-histamines when we take a Benadryl for some seasonal allergies, and we know the side effect of that type of drug makes us very sleepy. So it turns out the histamine receptor in the nervous system is very stimulating. So what we're looking at these days are drugs that can stimulate the histamine receptors and give us more alertness and more energy. Exactly the opposite of a Benadryl. There's also medications that are targeted to GABA. GABA is the most inhibitory and common neurotransmitter, the entire nervous system. And it's relaxing. It's calming. A lot of seizure. Medications are targeted to that because seizure medications will calm down the nervous system to prevent seizures. Well, here, we're doing the opposite. We're stimulating GABA and creating more energy. So exactly the opposite of what we do in the seizure case. One of the drugs we're looking at is L-carnitine, this is an amino acid. We find it in food. We can buy it at health food stores to help with muscle mass and energy. And in fact, what we see in narcoleptics is low levels. So this is being targeted as well to give back if there's a deficiency of L-carnitine, unfortunately right now, we only have it as an V form and it needs to cross the blood-brain barrier to actually get into the head. But scientists are working on doing that exact thing. Finally, we're looking at things that may help the levels of hypo creatine in the nervous system. That's what gets attacked by the immune system and gets destroyed creating narcolepsy in the first place. If we can find a way to stimulate those receptors and really rev them up, we may have better energy and improvements in daytime functioning in patients with narcolepsy."
Certified in Sleep Medicine by the American Board of Internal Medicine
Certified in Obesity Medicine by the American Board of Obesity Medicine
Certified in Sleep Medicine by the American Board of Internal Medicine
Certified in Obesity Medicine by the American Board of Obesity Medicine
Certified in Sleep Medicine by the American Board of Internal Medicine
Certified in Obesity Medicine by the American Board of Obesity Medicine
Certified in Sleep Medicine by the American Board of Internal Medicine
Certified in Obesity Medicine by the American Board of Obesity Medicine