Narcolepsy is a chronic, lifelong neurological disorder characterised by the brain's inability to properly regulate sleep-wake cycles, leading to excessive daytime sleepiness (EDS) and involuntary "sleep attacks" that can occur at any time.
It is generally categorised into two types: Type 1, which includes cataplexy (sudden muscle weakness triggered by emotions) and low levels of the wake-promoting neurotransmitter hypocretin, and Type 2, which does not involve cataplexy. Other common symptoms include sleep paralysis, vivid hallucinations while falling asleep or waking, and fragmented nighttime sleep. The condition often stems from an autoimmune reaction that damages hypocretin-producing neurons in the hypothalamus.
Evidence-based treatment for narcolepsy focuses on symptom management, as there is currently no cure. Pharmacological treatment is commonly the cornerstone, typically involving wake-promoting medications (e.g., modafinils) to combat daytime sleepiness. Cataplexy and other REM-related symptoms are often treated with sodium oxybate or specific antidepressants. Non-pharmacological strategies are essential components of care, including maintaining a strict, consistent sleep schedule, taking scheduled short, strategic daytime naps, and improving sleep hygiene. Authors of a 2025 scoping review examined the benefits of behavioural and psychological treatments and concluded that, based on the few available studies (6), there was no benefit.
If we go back to the definition of narcolepsy, a chronic, lifelong neurological disorder and then look at the management options (i.e., medications), there are no treatment options advocating lifestyle factors other than sleep changes, like possible roles for nutrition, exercise and stress modification. Given our skill set as providers of exercise and knowing that exercise is the most powerful 'health pill' available, affecting cardiovascular health, mental health, and quality of life, it seemed a missing link not to include it in the management of narcolepsy, until recently.
In this recent study, authors included participants with Type 1 narcolepsy who undertook a low-intensity, six-week semi-supervised exercise program (light walking and cycling below their zone 2) with three sessions per week, only one session supervised. This was followed by a self-directed 18-week exercise period, with one motivational call every 6 weeks.
Even though this would be considered a very light-touch exercise program, the results were informative. Firstly, the severity of narcolepsy symptoms declined, and night sleep improved. Secondly, several cardiometabolic parameters (e.g., Triglycerides, C-reactive protein, glycaemia) improved. Thirdly, measures of mental health and attention improved. At 6 months, the improvement of narcolepsy symptoms was no longer significant, but patients still had less anxiety and depression, better attention and had a more favourable cardiometabolic profile. More than 80% of participants completed the program (which is fantastic for sedentary individuals starting a fitness program), and the confidence gained (reduced anxiety associated with cataplexy) could be leveraged to develop a more comprehensive, health-benefitting program.
In summary, designing a low-intensity exercise program would be an excellent adjunct to the current management of clients with narcolepsy, assisting them not only with sleep improvements but also with mental and cardiometabolic health. This is a feasible and safe program that benefits sedentary clients with narcolepsy, and as participants develop confidence, additional fitness elements could be added.