Seeking Sound Sleep?

I have been diagnosed with idiopathic hypersomnia/narcolepsy and have been prescribed Provigil. The medication helps, but since it is relatively new, I am concerned about long-term effects. Can you recommend a healthy, effective alternative?

– April 27, 2004

Idiopathic hypersomnia and narcolepsy are two different sleep disorders that sometimes overlap. Both cause excessive daytime sleepiness as well as poor quality of nighttime sleep. With narcolepsy, you can suddenly fall asleep at any time, a big danger if you happen to be driving. Other symptoms include cataplexy (the sudden loss of voluntary muscle tone, often triggered by strong emotions), hallucinations when you’re falling asleep or as you’re waking up, and brief episodes of total paralysis at the onset and end of sleep.

Hypersomnia leads to the urge to nap during the day, no matter what you’re doing. Other symptoms may include anxiety, increased irritation, decreased energy, restlessness, slow thinking and speech, loss of appetite, hallucinations and memory problems. Hypersomnia may be caused by narcolepsy (or sleep apnea, another sleep disorder), drug or alcohol abuse, a tumor, or injury to the head or central nervous system. Multiple sclerosis, depression, encephalitis, epilepsy or obesity can also be contributing factors.

Provigil (also known as modafinil) reportedly has fewer of the speedy side effects of older stimulants (amphetamines) used to treat hypersomnia/narcolepsy. According to Rubin Naiman, Ph.D., a sleep specialist here at the Arizona Center for Integrative Medicine, Provigil allows people with these sleep disorders to function more normally by masking the symptoms of sleepiness. However, it doesn’t treat the underlying causes of the disorders.

Along with the medication, Dr. Naiman suggests learning to sleep more healthily by optimizing general nutrition, eliminating alcohol, caffeine and nicotine, exercising regularly and napping routinely as needed. Nutrients that can help manage narcolepsy include calcium and magnesium, choline, chromium picolinate, coenzyme Q10, omega-3 fatty acids, B vitamins, vitamin C complex (including bioflavonoids) and vitamins D and E. Some research suggests that the supplement 5-HTP may help those with narcolepsy by reducing the duration of cataplexy and improving nighttime sleep.

In addition, food intolerances may be linked to narcolepsy. Ask your physician (or a nutritionist) about an elimination diet. Wheat, dairy products, corn and chocolate are the foods most commonly implicated. Dr. Naiman further recommends breathing exercises to manage stress, and encourages the recording of your dreams (in a journal) to better understand them and to explore the psychological and spiritual impact of your sleep disorders. You also might consider joining a narcolepsy/hypersomnia support group. For information, contact the Narcolepsy Network.

Andrew Weil, M.D.

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