Behavioral Interventions and Adaptations in Narcolepsy
In this custom video series, Debra Stultz, MD, leads a discussion on behavioral interventions for the treatment of narcolepsy and adaptation of patients in lieu of seeking treatment.
EP: 1.Orexin and the Destabilization of Wakefulness in Narcolepsy
EP: 2.Symptoms of Narcolepsy: Excessive Daytime Sleepiness
EP: 3.Symptoms of Narcolepsy: Cataplexy
EP: 4.Symptoms of Narcolepsy: Sleep Paralysis & Hallucinations
EP: 5.Testing and Criteria for Narcolepsy Diagnosis
EP: 6.Psychiatric Comorbidities & Differential Diagnosis in Narcolepsy
EP: 7.Behavioral Interventions and Adaptations in Narcolepsy
EP: 8.Pharmacological Treatment Options for Narcolepsy
EP: 9.Pitolisant and the Role of Histamine in Narcolepsy
EP: 10.Role of Neurologists and Psychiatrists in Narcolepsy Management
Debra Stultz, MD: We’re going to talk in a minute about what medications we would use, but there are also behavioral therapies we need to use with these patients. We need to talk to them about naps and how refreshing a 20-minute nap can be and keeping their sleep schedule regular. With the naps, 1 of the important things is to time their daily naps when they have their sleepiest period. If 2 o’clock is when they get really sleepy, then you plan the naps at 1 o’clock. Having a nap is necessary for patients with narcolepsy. In my mind, it’s the same as a person with who has to have frequent small snacks and has to keep something with them. The narcolepsy patient must plan on the naps and try to keep their sleep schedule regular.
Stephen Stahl, MD, PhD: One of my old professors of biochemistry, who I worked with when I was in medical school, eventually was diagnosed with having narcolepsy because he was taking naps at work. But he was older, so maybe people thought he had it. He probably had a mild case his whole life, but what he would do is he’d have in his hand a big stack of keys that had a big metal name on it, and he was on this very hard floor that had a drain next to his chair, which was metal. He would take a nap as long as it took for him to lose the tone in his hand and drop the keys and wake up, and then he would go back to work.
Debra Stultz, MD:Alarm clock.
Stephen Stahl, MD, PhD: I don’t know [how long it was]—about 20 minutes—but he used that as his own alarm clock. That was a form of excessive daytime sleepiness. You’d find all sorts of odd stories like this if you actually look for them, and people find adaptive ways to try to deal with it and not get treatment.
Debra Stultz, MD: They’ve had to live with it forever. They go to their car at lunchtime and take a nap or know which restaurants have a place where they can safely take a little nap after they get.
Transcript edited for clarity.
Disclosures:
Dr Stephen Stahl is clinical professor of psychiatry and neuroscience at the University of California Riverside, adjunct professor of psychiatry at the University of California San Diego, and honorary fellow in psychiatry at the University of Cambridge. Over the past 12 months (January 2020 - December 2020), Dr Stahl has served as a consultant to Acadia, Alkermes, Allergan, AbbVie, Arbor Pharmaceuticals, Axovant, Axsome, Celgene, Concert, Clearview, EMD Serono, Eisai Pharmaceuticals, Ferring , Impel NeuroPharma, Intra-Cellular Therapies, Ironshore Pharmaceuticals, Janssen, Karuna, Lilly, Lundbeck, Merck, Otsuka, Pfizer, Relmada, Sage Therapeutics, Servier, Shire, Sunovion, Takeda, Taliaz, Teva, Tonix, Tris Pharma, and Viforpharma; he is a board member of Genomind; he has served on speakers bureaus for Acadia, Lundbeck, Otsuka, Perrigo, Servier, Sunovion, Takeda, Teva, and Vertex; and he has received research and/or grant support from Acadia, Avanir, Braeburn Pharmaceuticals, Eli Lilly, Intra-Cellular Therapies, Ironshore, ISSWSH, Neurocrine, Otsuka, Shire, Sunovion, and TMS NeuroHealth Centers.
Dr Debra Stultz is the Director and Owner of Stultz Sleep and Behavioral Health in Barboursville, West Virginia. Dr Stultz earned her medical degree from Marshall University School of Medicine in Huntington, West Virginia. She completed a residency in psychiatry and a fellowship in child and adolescent psychiatry through West Virginia University at their Charleston Division through Charleston Area Medical Center in Charleston, West Virginia. She is board certified in psychiatry, sleep medicine, and behavioral sleep medicine. With a special interest in Narcolepsy, she treats a variety of sleep disorders and psychiatric issues. She is also the editor for the Clinical TMS Society newsletter, on their Board of Directors, and the chairman of the TMS and Sleep Disorders Affinity Group. Dr Stultz is on the advisory committee for Harmony Biosciences and is a speaker for Harmony Biosciences and Jazz Pharmaceuticals.
