Treating Excessive Daytime Sleepiness in Patients With Narcolepsy

​​ Excessive daytime sleepiness (EDS) is a hallmark symptom of narcolepsy. The second major symptom, cataplexy, is present only in a subgroup of patients with narcolepsy. Fortunately, existing pharmacologic interventions are effective in reducing EDS for many patients, but elimination of EDS for most patients has not been achieved. Some interventions also show efficacy in cataplexy. Nonpharmacologic strategies should also be discussed with patients to provide optimal narcolepsy management. Clinicians must monitor EDS during ongoing treatment so that residual symptoms can be addressed with adjustment to the regimen. Research suggests a causative role for hypocretin deficiency in narcolepsy, and treatments ameliorating this deficiency are needed.