Q. Do you treat many patients with multiple sleep disorders all at once – RLS, narcolepsy and sleep apnea?

People with narcolepsy often have other sleep disorders. Sleep apnea is very common in narcolepsy because people with narcolepsy have a slower metabolic rate, so they have a tendency for obesity, and therefore they will have a higher likelihood of sleep apnea. Patients with narcolepsy are more likely to have restless legs, although it’s unsure why.

Therefore, it's important to treat all sleep disorders because there will be improvements in both the restless legs and the narcolepsy with the treatment of sleep apnea. Similarly, there will be improvements in a patient’s narcolepsy with the treatment of restless legs.

Q. How is narcolepsy diagnosed if you have severe RLS and can't stay in bed long enough to do a lab sleep study?

In narcolepsy, it's common to have other sleep disorders, the most common one being obstructive sleep apnea. If we suspect someone may have narcolepsy, but they also snore loudly and their bed partner tells them they stop breathing, we have to diagnose them with sleep apnea first. After it is treated, we can then reassess their sleepiness. Similarly, I treat the other issues first before pursuing a narcolepsy diagnosis. If you can't stay in bed long enough to have a sleep study due to RLS, both RLS and sleep apnea should be diagnosed and managed first.

Q. In cases of severe RLS, can Mirapex be added on occasion for long-distance airplane trips?

While there are various treatments that could also be helpful, occasional use of Mirapex for an airplane trip could be effective.

Q. Can beta blockers have a negative impact on narcolepsy and/or RLS?

Generally, beta blockers can cause fatigue. A beta blocker will even make your ability to regulate your heart rate and blood pressure harder. Therefore, if you have narcolepsy and are experiencing side effects while on a beta blocker, take note of how you feel and then talk with your provider about whether it makes sense to continue the medication. Beta blockers likely have no negative impact on RLS.

Q. Any thoughts about Nidra therapy?

Nidra therapy is a newer therapy that stimulates the peroneal nerve. The clinical practice guideline developed by the American Academy of Sleep Medicine in 2025 gave a conditional recommendation for the use of tonic motor activation. It can be helpful as an adjunct to other medications and also helps provide the patient with a sense of control over managing their symptoms.

Q. Do any of these medications contribute to memory loss?

There are some studies that have shown an association between memory loss and medications like gabapentin and pregabalin. These studies, though, are associational and they do not show any causation. On the other side, if you don't take the medication, the RLS symptoms will endure. This will lead to sleep deprivation which is also not good for memory.

Q. Do you have a list of resource materials for physicians?

To learn more about the resources available, visit Wake Up Narcolepsy’s website at wakeupnarcolepsy.org and the RLS Foundation website at RLS.org.