Narcolepsy and other central disorders of hypersomnolence

Behavioural advice forms the starting point for the treatment of all central disorders of hypersomnolence. It is also increasingly recognised that the narcolepsy phenotype is broad, including symptoms such as metabolic disturbances potentially fuelling obesity, eating disorders, depression and anxiety. Cataplexy is the most specific symptom of narcolepsy and in combination with excessive daytime sleepiness (EDS) virtually pathognomonic for Narcolepsy type 1. Besides improving night‐time sleep quality, probably by enhancing the slow wave component, sodium oxybate is also very efficacious for cataplexy. Hypnagogic hallucinations are realistic dream‐like experiences around sleep onset whereas the term 'hypnopompic' is used if they occur from awakening. Sleep paralysis can occur during arousals from sleep or, typically for narcolepsy, at sleep onset. Pharmacotherapy for sleepiness should be tailored towards the individual patient. For most patients, modafinil is a first‐line agent, especially as it provides a background level of increased alertness and has relatively few side effects.