Z hypnotics in the management of narcolepsy: a case series

Study objectives: Here we report our experience treating patients with narcolepsy using benzodiazepine receptor agonists (BzRA), zolpidem (Zol) or eszopiclone (Esz) taken at bedtime for both excessive daytime sleepiness (EDS) and cataplexy.

Methods: We reviewed the medical records of 53 patients diagnosed with narcolepsy, between 2002 and 2023. Twenty-three patients, 8 with type1 (NT1), 13 with type 2 (NT2) and 2 with secondary narcolepsy, were treated with BzRA's (20 Zol and 3 Esz).

Results: Seven out of 8 (88%) with NT1, 9 out of 13 (69%) with NT2 and 2 out of 2 (100%) with secondary narcolepsy, treated with BzRA, had good to excellent subjective response in their symptoms of EDS 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).

Conclusions: The BzRa 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.