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Management of Narcolepsy and Excessive Daytime Sleepiness - Episode 7

Nonpharmacologic Therapies for Narcolepsy

Michael J. Thorpy, MD: These days, people are very interested in holistic treatments, nonpharmacologic treatments, and behavioral treatments. What are some of these nonpharmacologic treatments that can be helpful, Eveline?

Eveline Honig, MD, MPH: I have heard from a lot of people that a gluten-free diet works for them. Also, just generally making sure that if they have to be alert after lunch, they don’t eat a lot of carbohydrates but, instead, have a protein-rich lunch or not much lunch at all.

Michael J. Thorpy, MD: Generally, proteins keep us more alert than carbohydrates? Is that what people find?

Eveline Honig, MD, MPH: Definitely. I think for the general population, we all get a little more sleepy from carbohydrates. Turkey is one of the things we should stay away from, especially people with narcolepsy. Usually it takes a little bit of experimenting to see what works. And I think it’s important to encourage a healthy diet.

Naps, of course, are very important. Most people with narcolepsy can function with 1 or 2 naps. It’s important that people in the environment of a child or adult in a work situation know about the narcolepsy so they cooperate. For children, it’s so important—they can take a nap in school. Right after lunch is usually a good time. People with narcolepsy function better when they have naps.

Michael J. Thorpy, MD: And it’s important to keep their naps relatively short, right? They shouldn’t have long naps.

Eveline Honig, MD, MPH: Right, right.

Michael J. Thorpy, MD: That takes away from their nighttime sleep. What would you recommend? How long should naps be?

Eveline Honig, MD, MPH: It’s a little bit different for everybody. Some people do well with a 10-minute nap. Others, half an hour. I hear very often, “I don’t want to go to my bed, so I just nap on the couch.” Or, “I have a couch at school.” That’s really very helpful.

It should be the same time every day. People should really try to stick with a regular schedule for medications, and naps, and eating.

Michael J. Thorpy, MD: How about vitamins? Are vitamins going to be helpful at all with this disorder?

Eveline Honig, MD, MPH: I think just like for the general population, it’s important to keep yourself healthy. Very often, I find that people with narcolepsy are affected more by things like the flu. So if vitamins work, that’s great. Exercise, I think, is important for people with narcolepsy. Staying fit. They tend to be a little bit overweight. For children, that’s sometimes one of the first symptoms—they gained a lot of weight. As long as they can do it, sticking with an exercise routine is very important.

Dr Rosenberg mentioned social life. I think that is extremely important for children and adults. Children should be encouraged to go to a sleepover and to have friends. Individuals with narcolepsy tend to become isolated and have problems with friendships. They are sleepy. They want to stay home. And, this can cause a lot of friction in marital situations.