Table 1.
Behavioral approaches to treat narcolepsy, adapted from Monderer [28].
| Technique used | Description of the technique |
|---|---|
| Structuring nocturnal sleep habits | Maintain a structured sleep schedule and set time according to need, despite the quality or continuity of nocturnal sleep |
| Avoid sleep deprivation and changes in sleep time; maintain a regular schedule of nocturnal sleep (e.g., from 10:30 p.m. to 7 a.m.) | |
| If patients awaken during the night and have difficulty returning to sleep, then they can take a short break and perform a sedentary activity such as reading for a short period of time. However, they should return to bed and attempt to sleep | |
| Relaxation techniques before nocturnal sleep prevent intense stimulation before sleep | The estimated time to sleep at night should be 8 h or more, depending on individual differences |
| Planning naps | Naps during the day are a fundamental aspect of the treatment of the daytime sleepiness associated with narcolepsy. Naps can range from 15 to 20 min to over 1 h. For many patients, short naps (<30 min) are helpful, but others require longer naps |
| Fifteen-minute naps between 12:30 p.m. and 5:00 p.m. are highly effective | Overall, people with narcolepsy show no significant effects related to sleep inertia after taking a nap; however, if the duration of the nap is longer (>15 min), then it does not provide additional benefits. |
| Take 15-min naps | A single nap (or even two) benefits virtually all patients with narcolepsy |
| Plan nap strategies before using drugs | Moreover, adding a brief morning nap can reduce deterioration in the morning (i.e., continual performance decreases since waking). |
| Diet | Little is known regarding the effects of diet with regard to alertness and sleep among patients with narcolepsy; overall, however, healthy eating habits are useful to ensure sleep hygiene |
| Over-the-counter stimulants (e.g., tea, coffee, mate, and so on) should only be used on a planned schedule and according to doctor׳s recommendations | |
| The caffeine content of six cups of strong coffee has the same stimulating effect as 5 mg of dexamphetamine | Certain over-the-counter stimulants (e.g., tea and coffee) are not accepted drug treatments; thus, these drinks should be consumed responsibly to allow for more accurate schedule tracking, and they should be alternated with accepted drug treatments |
| Sweets and carbohydrates should be avoided from the time of awakening in the morning until 12:00 noon. | |
| Abstinence or minimal use of alcohol | |
| Avoidance of REM suppressants and drugs that increase daytime sleepiness | |
| Counseling or other assistance | A recent study revealed that over 500 patients with narcolepsy suffered from declining quality of life, which is similar to the experience of patients with Parkinson׳s disease. Special considerations at work or school are required for most patients with narcolepsy |
| Counseling for lifestyle reorganization | It is extremely difficult for patients with narcolepsy who work late shifts or have changes in their working hours to maintain work productivity. Work during the day is highly recommended |
| Counseling to review the type of work or individual or group psychotherapy | |
| Help with programming the mental alertness required by everyday activities | Advice concerning the psychosocial effects of this syndrome should be provided so that patients can optimize their adaptation to the disease and are realistic in their expectations when making decisions regarding daily activities |
| Professional advocacy for office workers |