How is narcolepsy managed during pregnancy?

What does the evidence show for narcolepsy?

• Narcolepsy can cause irresistible daytime sleep episodes. Some people also have cataplexy, a brief loss of muscle control associated with strong emotions while awareness is maintained. These features differ from ordinary tiredness and should be described clearly during assessment. 1
• Normal pregnancy sleep changes can overlap with central hypersomnolence disorders. A sleep specialist may need to consider sleep apnea, insufficient sleep, medicines and other explanations. The pregnancy context matters when interpreting symptoms and deciding which investigations would be useful. 2
• Planned naps, a consistent sleep schedule and adjustments to work or transport can be practical parts of care. Unpredictable sleep episodes make driving unsafe. Do not drive while sleepy or resume driving during a medicine change without discussing symptom control and the applicable clinical advice. 3
• Pregnancy evidence differs substantially between wake-promoting medicines, and much of it is observational. The choice to continue, change or withhold a medicine requires an individualized assessment. The absence of a large study is not proof that a drug has no pregnancy risk. 2
• New fainting, a gap in memory, severe headache or shortness of breath should not automatically be attributed to an established sleep disorder. These can be urgent maternal warning signs and need immediate medical assessment during pregnancy or after delivery. 4

When should I call my provider about narcolepsy?

Seek immediate medical attention for new fainting, loss of consciousness, severe headache, chest pain, breathing difficulty or an episode unlike your usual symptoms. Do not drive while sleepy or when sleep episodes are unpredictable.