Z hypnotics in the management of narcolepsy: a case series

Here we report our experience treating patients with narcolepsy using benzodiazepine receptor agonists, zolpidem, or eszopiclone taken at bedtime for both excessive daytime sleepiness and cataplexy.

We reviewed the medical records of 53 patients diagnosed with narcolepsy, between 2002 and 2023. Twenty-three patients, 8 with narcolepsy type 1 (NT1), 13 with narcolepsy type 2 (NT2), and 2 with secondary narcolepsy, were treated with benzodiazepine receptor agonists (20 zolpidem and 3 eszopiclone).

Seven out of 8 (88%) with narcolepsy type 1, 9 out of 13 (69%) with NT1, and 2 out of 2 (100%) with secondary narcolepsy, treated with benzodiazepine receptor agonists, had good to excellent self-reported response in their symptoms of excessive daytime sleepiness and/or cataplexy; 5 patients, 1 of whom with NT1, had marginal or no response. Three of the responding patients remained on zolpidem in monotherapy (ie, no stimulants).

The benzodiazepine receptor agonists drugs may be effective to manage several of the cardinal symptoms of narcolepsy, regardless of the narcolepsy type. Placebo controlled trials are needed to confirm our observations.

Aboukasm A, Reffi AN, Drake CL. Z hypnotics in the management of narcolepsy: a case series. J Clin Sleep Med. 2025;21(5):753-756.