Sleep-Wake Disorders
Narcolepsy
ICD-10-CM: G47.419
1. Criteria
DSM Criteria
Criterion A
- There are recurrent periods of irrepressible need to sleep, lapsing into sleep, or napping within the same day.
- These episodes occur at least 3 times per week over the past 3 months.
DSM Criteria
Criterion B
- At least one of the following is present: episodes of cataplexy, hypocretin deficiency, or REM sleep latency abnormalities on sleep testing consistent with narcolepsy.
2. Context
- Narcolepsy is a central disorder of sleep-wake regulation marked by chronic daytime sleepiness and, in some patients, cataplexy, REM-related hallucinations, sleep paralysis, or fragmented nighttime sleep. In practice, the story often comes out as irresistible sleep episodes and a lifetime of feeling abnormally sleepy.
- Core symptom: Excessive daytime sleepiness is the anchor symptom. The person is often sleepy even after what sounds like adequate nighttime sleep.
- Cataplexy matters: When present, cataplexy strongly shifts the differential and points toward narcolepsy type 1.
- Workup: Diagnosis usually depends on sleep medicine testing, especially polysomnography plus MSLT, and sometimes CSF hypocretin data.
- Clinical focus: Common office-based measure of subjective daytime sleepiness.
3. Validated scales
Epworth Sleepiness Scale
Common office-based measure of subjective daytime sleepiness.
Multiple Sleep Latency Test
Core specialist diagnostic test in narcolepsy evaluation.
Maintenance of Wakefulness Test
Useful in follow-up when ability to stay awake is the key clinical question.
4. FDA approved treatments
FDA-approved medications for excessive daytime sleepiness in narcolepsy
Several wake-promoting agents and alerting medications carry narcolepsy labeling, though product-specific indications and age ranges differ.
Common treatment side effects
Check drugs.com/sfx for common side effects. Direct side-effect links for the medications in this section are below when available.
FDA-approved medications for cataplexy or mixed narcolepsy symptoms
Oxybate products are important FDA-approved options when cataplexy or severe daytime sleepiness is part of the narcolepsy picture.
Common treatment side effects
Check drugs.com/sfx for common side effects. Direct side-effect links for the medications in this section are below when available.
Common off-label medications
Interventional psychiatry modalities
- Interventional psychiatry modalities are not standard treatments for narcolepsy.
- Management is usually behavioral plus medication-based within sleep medicine.
- ECT, TMS, and ketamine are not standard narcolepsy treatments.
Related Guides
5. Top management articles
- Management review for Narcolepsy PubMed search
- Narcolepsy treatment guideline PubMed search
- Narcolepsy pharmacotherapy or psychotherapy review PubMed search
When to seek professional help
- Seek urgent help if there are thoughts of suicide, self-harm, or feeling unable to stay safe.3
- Seek urgent help if there are thoughts of harming someone else, escalating violent urges, or loss of behavioral control.3
- Take hopelessness seriously, especially if the person feels trapped, cannot imagine staying safe, or is withdrawing from support.4
- Use emergency services if there is immediate danger, severe agitation, psychosis, intoxication, or inability to care for basic needs. In the United States, call or text 988 for crisis support and call 911 for immediate danger. Use emergency services in your region if you are outside the U.S.3