AMPHETAMINES AND NARCOLEPSY .3. THE TREATMENT OF EXCESSIVE SOMNOLENCEWITH STIMULANT-DRUGS

Controlling the symptom of excessive sleepiness is an important respon sibility of sleep medicine. Our group has reported that methamphetamin e, given in the morning at doses of 40-60 mg, allowed narcoleptics to function throughout the day at normal levels of sleep tendency and psy chomotor functioning as measured by multiple sleep latency and perform ance testing. These findings are important because they are the first to show normalization of function in narcolepsy with pharmacotherapy a nd because the dose of stimulant utilized was more than twice the maxi mum recommended by the manufacturer. Because it is possible to essenti ally eliminate the disabling sleepiness of narcolepsy, at least in the short term, we suggest that the following principles be applied in th e therapeutic use of stimulant drugs: 1) Pathological sleepiness warra nts aggressive treatment when sustained alertness is necessary for ind ividual or public safety; 2) Stimulant drugs are important in the ther apeutic approach to patients with pathological sleepiness; 3) The prim e goal, although sometimes unachievable, should be symptom-free daytim e functioning. It is important that, during therapy, a period of sympt om-free daytime functioning be achieved for a frame of reference for e valuating future treatments; 4) Treatment efficacy should be assessed periodically with objective techniques such as the multiple sleep late ncy test or the maintenance of wakefulness test; 5) In some cases, sti mulant doses may exceed the manufacturer's recommendations. However, t he clinician should be guided by the prime goal of therapy, the patien t's needs and the patient's ability to tolerate the chosen therapy.