Sleep-related eating disorder after dose escalation of sodium oxybate in narcolepsy type 1

Sodium oxybate (SO) is an effective therapy for narcolepsy type 1 (NT1) but has been infrequently linked to complex sleep-related behaviors. We describe a case of NT1 who developed sleep-related eating disorder (SRED) after progressive gradual titration of SO. A 15-year-old female was diagnosed with NT1. Symptoms remained disabling despite high doses of modafinil and venlafaxine, and thus SO was initiated and titrated over months. After increasing to a dose of 4 g twice per night, the family reported episodes of partial arousal with altered consciousness beginning 1-2 h after the first dose, where the patient left the bed, ate large quantities of calorie-dense foods, and appeared unresponsive, before returning to bed again with complete amnesia. These episodes contributed to significant distress for the patient and her family, and notable weight gain. Gradual dose reduction to 7 g/night combined with structured behavioral interventions (dietary modification, bedside snacks, and environmental safety measures) successfully resolved SRED while maintaining excellent cataplexy control, demonstrating that combined management strategies can avoid medication discontinuation.