Part 2: Certain Patients Could Benefit From High-Sodium Medications, Says Dr Michael Thorpy

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A subset of patients who have narcolepsy or daytime sleepiness, like those who have the condition of POTS (postural orthostatic tachycardia syndrome), may actually benefit from excess sodium, says Michael Thorpy, MD, professor of neurology at the Albert Einstein College of Medicine, and director of the Sleep Disorder Center at Montefiore Medical Center.

Transcript

How do low-sodium treatments impact how patients with sleep disorders are treated?

There is this low sodium formulation of oxybate, and, in general, clinicians feel that it is better to limit the salt intake for most patients. All new patients who have a diagnosis of narcolepsy or other forms of excessive daytime sleepiness that may require this medication would be put on the low sodium formulation on the basis that much less sodium is preferable. However, there are many patients who are taking the higher sodium formulation, and prefer to take it for various reasons, including the fact that they have less adverse effects than they might have if they were to take the low sodium formulation, or they may have some conditions where their actual salt intake may be beneficial. For example, there’s an orthostatic condition, that goes under the acronym of POTS [postural orthostatic tachycardia syndrome] in which these patients get hypertensive and some extra salt can be beneficial. This condition does appear to be more common in patients with narcolepsy. Some patients with narcolepsy prefer to take the salt formulation, but for other patients, there’s some specific reason why they can't take the low sodium formulation. It would be the first line recommendation now for any patient receiving oxybate to get the low sodium formulation.