Overview

Narcolepsy is a neurological disorder caused by autoimmune loss of hypocretin (orexin)-producing neurons in the deep brain, leading to problematic daytime sleepiness with sleep attacks, disrupted nocturnal sleep, and variable symptoms related to dysregulation of REM sleep: sleep paralysis, sleep-related hallucinations, and an unusual symptom called “cataplexy”. Cataplexy refers to a loss of motor tone—weakness that is—of muscles of the body (legs, arms, face could all be involved) in response to sudden strong emotion.

Health Consequences

Daytime impairment is universal, causing motor vehicle accidents, occupational injuries, and impaired school/work performance. Reduced physical activity and hypothalamic dysfunction are common precursors for obesity, which means that narcolepsy often co-exists with Sleep Apnea! Depression and anxiety are common. Cataplexy is not dangerous in itself, but can lead to significant injury. Restless legs syndrome and dream-enactment behavior (REM sleep behavior disorder) are common co-diagnoses for patients with narcolepsy.

Rebis Treatment Approach

Narcolepsy is not a fatal condition, but it usually requires lifelong management. Medications used to treat narcolepsy are considered controlled substances, so long-term management requires partnering with an ecosystem where these medications can be managed safely.

• Collaborative co-discovery for competing sources of sleep disruption, using the Five Finger Approach

• Wake‑promoting medications (modafinil, armodafinil, solriamfetol, pitolisant, traditional amphetamine stimulants)

• Sleep-consolidating medications (Xyrem, Xywav, Lumryz)

• Scheduled restorative naps

• Integrated medicine pathway for holistic nutrition and lifestyle coaching

• Immunomodulatory evaluation when clinically indicated

Benefits of Treatment

Treatment of narcolepsy must be customized to each patient to address symptoms of concern, while avoiding adverse effects associated with the medications. Effective treatment can improve the night time sleeping experience, eliminate cataplexy, and improve daytime waking alertness.