Reasons for such a lack of data are numerous: (1) perceived markets for relevant drugs are too small to warrant research support by drug manufacturers (2) narcolepsy is misperceived to be a rare and nondisabling disorder (3) there have been no testable scientific hypotheses concerning the relationship between the pathophysiology of narcolepsy and modes of pharmacologic action and (4) the symptom of somnolence has been too poorly characterized to warrant studies of drug-related change. There is very little research on the efficacy of pharmacotherapy for narcolepsy. The treatments of choice for narcolepsy in current practice involve central nervous system (CNS) stimulants alone or in combination with rapid-eye-movement (REM) sleep-suppressing drugs, such as tricyclic antidepressants ( Mitler et al., 1988 b). Narcolepsy (ICD-9-CM 347) is probably the most clearly understood diagnostic category within the population of patients who complain of excessive somnolence ( Guilleminault et al., 1976 Coleman et al., 1982 Coleman, 1983). ![]() Until satisfactory symptom control is achieved, the patient should be advised not to drive or engage in other activities in which safety requires sustained attention.Įxcessive daytime somnolence has been related to various social problems ranging from marital difficulty to death in traffic accidents. The policy is that excessively somnolent patients should not automatically or precipitously be reported to public health or motor vehicle authorities because (1) sleep is a reversible and normal behavioral state, (2) most forms of excessive somnolence are readily treatable, and (3) a report can be filed at the clinician’s discretion in cases of noncompliance or treatment failure. For example, what is the physician’s duty to the patient and to society in connection with an excessively somnolent airplane pilot or bus driver? The American Sleep Disorders Association (formerly known as The Association of Sleep Disorders Centers) formulated a policy concerning the reporting of patients whose somnolence may represent a public safety risk ( Association of Sleep Disorders Centers, 1984). Clinicians frequently face difficult clinical and medicolegal decisions associated with the treatment and management of sleepy patients, regardless of their specific diagnosis. A recent review underscored the considerable impact sleepiness can have on public safety, ranging from transportation to nuclear power ( Mitler et al., 1988 a). sleep disorders centers each year present with this complaint ( Coleman et al., 1982 Coleman, 1983). Over half of the 250,000 or so patients who come to U.S. Data suggest that: (1) methylphenidate and dextro-amphetamine objectively improve somnolence (2) pemoline, at doses up to 112.5 mg, is less effective in controlling somnolence but may improve certain aspects of performance and (3) protriptyline and viloxazine are effective anticataplectic agents that produce little improvement in somnolence.Įxcessive somnolence is a major health problem in the United States. Sleep laboratory studies on the treatment efficacy of methylphenidate, pemoline, dextroamphetamine, protriptyline, and viloxazine are presented. Treatment modalities involving central nervous system stimulants for somnolence and tricyclic drugs for REM-sleep abnormalities are discussed. ![]() The phenomenology of narcolepsy is discussed, and diagnostic procedures are reviewed. The condition is strongly associated with the HLA-DR2 and DQw1 phenotype. Associated features include the pathological manifestations of rapid-eye-movement (REM) sleep: cataplexy, sleep paralysis, hypnagogic hallucinations, and abnormal sleep-onset REM periods and disturbed nocturnal sleep. Narcolepsy is a neurological condition with a prevalence of up to 1 per 1,000 that is characterized by irresistible bouts of sleep.
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