How should I approach the management of narcolepsy in a patient who experiences cataplexy?

Management of narcolepsy with cataplexy should be comprehensive, targeting both excessive daytime sleepiness and cataplexy symptoms. Initial assessment involves confirming the diagnosis through clinical history and sleep studies, excluding other causes of hypersomnolence. Pharmacological treatment is the mainstay, with sodium oxybate considered the first-line therapy for cataplexy due to its efficacy in reducing cataplexy attacks and improving nocturnal sleep quality. Additionally, antidepressants such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) may be used to suppress cataplexy by modulating REM sleep mechanisms. For excessive daytime sleepiness, wake-promoting agents like modafinil or armodafinil are commonly prescribed to improve alertness. Lifestyle modifications including scheduled naps, good sleep hygiene, and patient education about safety (e.g., driving risks) are essential adjuncts to pharmacotherapy. Regular follow-up is important to monitor treatment efficacy, side effects, and adherence, adjusting therapy as needed. Specialist referral to sleep medicine services is recommended for complex cases or if initial treatments are ineffective. This integrated approach aligns with expert consensus and recent literature emphasizing individualized treatment plans combining pharmacological and non-pharmacological strategies to optimize quality of life in narcolepsy patients with cataplexy ¹ (Barateau et al., 2016).