Peer Exchange


Management of Narcolepsy and Excessive Daytime Sleepiness

Michael J. Thorpy, MD, leads a discussion on the diagnosis of excessive daytime sleepiness and tools used to diagnose the condition, such as the Epworth Sleepiness Scale and multiple sleep latency test.

Expert sleep specialists give an overview of narcolepsy, including the 2 types, causes, prevalence, and use of a sleep diary.

Alon Y. Avidan, MD, MPH, outlines the signs and symptoms of narcolepsy, including excessive daytime sleepiness, cataplexy, sleep paralysis, hallucinations, and insomnia, as well as the challenges in diagnosis.

Key opinion leaders discuss the 2 types of narcolepsy and the appropriateness of high-performance liquid chromatography analysis of cerebrospinal fluid for hypocretin-1 to confirm a diagnosis in certain patients.

Panelists agree that narcolepsy is a group of symptoms often misdiagnosed and/ or underdiagnosed, leading to a long delay in proper diagnosis.

Russell Rosenberg, PhD, DABSM, articulates the goals of therapy in treating narcolepsy, which include improving functioning, increasing safety of patients and others, and enhancing overall quality of life.

Eveline Honig, MD, MPH, highlights a variety of nonpharmacologic strategies for adults and children with narcolepsy, including a gluten-free diet, increased protein intake, short naps, and regular exercise.

Panelists discuss laboratory tests assessing vitamin D levels and thyroid function, as well as additional resources available to patients and family members to help them manage narcolepsy.

Key opinion leaders discuss the traditional treatments of narcolepsy— psychostimulants and sodium oxybate—for adults and children.

Panelists discuss pitolisant for treatment of excessive daytime sleepiness associated with narcolepsy, including its unique mechanism of action that increases histamine in the brain, its once-daily dosing, and its classification as a nonscheduled medication.

Expert sleep specialists discuss solriamfetol for the treatment of excessive daytime sleepiness associated with narcolepsy, including its novel mechanism of action as a dual-acting dopamine and norepinephrine reuptake inhibitor.

Alon Y. Avidan, MD, MPH, offers some useful strategies for determining the first-line treatment for narcolepsy.

Sleep disorder experts discuss another challenge facing patients with narcolepsy: navigating prescription drug insurance.

Panelists discuss the many resources offered through the Narcolepsy Network, including an annual conference for patients.

Panelists highlight drugs in development for the treatment of narcolepsy, including newer sodium oxybate formulations and orexin receptor agonists.

Sleep experts discuss unmet needs surrounding the treatment of narcolepsy, including the need for more medication options to give patients a choice and for medications that treat nonspecific symptoms and cognitive issues.

Panelists offer community physicians guidance on treating narcolepsy, emphasizing the need to consider narcolepsy in the differential diagnosis of patients who present with excessive daytime sleepiness.

Panelists discuss strategies to help community physicians work more effectively with sleep specialists to treat patients with narcolepsy.

Panelists wrap up their discussion by offering final thoughts and guidance on diagnosing and treating patients with narcolepsy. 
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