Resolution of Sleepwalking Behavior after Initiation of Sodium Oxybate in a Patient with Narcolepsy Type 2

A 44-year-old male veteran with long-standing excessive daytime sleepiness was diagnosed with Narcolepsy Type 2. The patient was unable to tolerate effective doses of methylphenidate, due to mood disturbances, or modafinil, due to adverse gastrointestinal effects. Although the patient also reported an ongoing history of sleepwalking with potentially injurious behaviors, a cautious trial of sodium oxybate was initiated. The combination of sodium oxybate and low dose methylphenidate resulted in significant improvement in patient-reported subjective daytime sleepiness. Additionally, self-report of the sleepwalking behaviors markedly improved. This case shows that patients with narcolepsy and sleepwalking may still safely benefit from a cautious trial of sodium oxybate.