How can I effectively manage a patient with narcolepsy in primary care, and when should I consider referral to a specialist?

Effective management of narcolepsy in primary care involves initial recognition of symptoms such as excessive daytime sleepiness, cataplexy, sleep paralysis, and hallucinations. A detailed sleep history should be taken to assess the impact on daily functioning and safety, including driving risks.

In primary care, non-pharmacological advice includes maintaining good sleep hygiene, scheduled naps, and lifestyle modifications to improve alertness. Pharmacological treatment initiation is generally not within primary care scope; however, modafinil may be considered for excessive daytime sleepiness if reversible causes are excluded and under specialist guidance.

Referral to a sleep specialist or neurologist should be considered when:

• Diagnosis is uncertain or complex, requiring specialist sleep studies (e.g., polysomnography and multiple sleep latency test).
• There is significant impairment in daily functioning or safety concerns (e.g., risk of accidents due to sleep attacks).
• Pharmacological treatment is needed or needs adjustment.
• There are comorbidities or complications requiring specialist input.

Specialist referral ensures comprehensive assessment, diagnosis confirmation, and tailored management including medication options such as sodium oxybate or other narcolepsy-specific treatments.