Ask the Sleep Doctor – Bariatric Surgery, Narcolepsy Medications

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Dear Dr. Rosenberg,

I am very obese and have severe sleep apnea. I am contemplating bariatric surgery. Can you give me some idea as to whether the surgery might cure my sleep apnea?


That is a great question. Most studies show that about 60% of those who undergo bariatric surgery no longer need CPAP devices for sleep apnea when they achieve their target weight.

Dear Dr. Rosenberg,

My 18-year-old daughter was recently diagnosed with narcolepsy. The medication she takes to help her stay awake is Adderall. However, it makes her very anxious and is not helping with her cataplexy. She still gets very weak if she laughs or gets angry. Any ideas?


Yes. First, I hope she is seeing someone who specializes in sleep medicine. Adderall would not be my first choice to help her stay awake. It is an amphetamine derivative and can cause anxiety in some people. The drugs Provigil and Nuvigil would probably be preferable. As for her cataplexy, neither of these medications address that problem. There are several options to treat cataplexy including some of the antidepressants, as well as a medication called Xyrem. I would address these concerns with her healthcare provider and if not, request a referral for a specialist in narcolepsy.

Dear Dr. Rosenberg,

Is there any value to taking magnesium for sleep? I’ve had trouble falling and staying asleep for several years and friends have told me magnesium helps.


Yes, there is some benefit. Several studies have shown that as we age, our magnesium levels fall. This is in part due to decreased bone mass and dietary intake. Magnesium plays a role in decreasing the ability of the stimulating neurotransmitter glutamate to activate areas of the brain that would keep us awake. At the same time, it facilitates the action of GABA A receptors that promote sleep and decrease anxiety. It has also been found to increase deep slow wave sleep and decrease nighttime cortisol levels. Dietary sources include nuts, whole grains, green leafy vegetables, seeds, and seafood. However, for most of my patients I suggest a supplement with 250 to 400mg of magnesium before bedtime.

Dear Dr. Rosenberg,

My son sleeps about six hours a night. He is 15 and is on his computer and cellphone until very late. He has put on 60 lbs. in the last year. Can this be related to his sleep?


Yes, most definitely. We know that teenagers his age should be getting 8 to 10 hours of sleep. When they don’t, the body responds by putting out excessive amounts of the appetite-stimulating hormone Ghrelin and insufficient amounts of the appetite-suppressing hormone Leptin. Thus, obesity is very common in teens who do not get enough sleep. I hope you share this information with your son and get him to turn off those sleep-preventing blue light emitting electronics devices.

Dr. Robert Rosenberg, D.O., FCCP, DABSM

Robert S. Rosenberg, DO, FCCP, is the medical director of the Sleep Disorders Center of Prescott Valley, Arizona and sleep medicine consultant for Mountain Heart Health Services in Flagstaff, Arizona. Dr. Rosenberg is board certified in sleep medicine, pulmonary medicine, and internal medicine. He is a contributing sleep expert blogger and his advice has appeared in Women’s Health, Prevention, Ladies’ Home Journal, Parenting, and O Magazine, among others. Dr Rosenberg is a weekly newspaper columnist addressing sleep Q&As. Dr. Rosenberg appears on TV and radio and lectures throughout the country on Sleep Medicine. His book Sleep Soundly Every Night, Feel Fantastic Every Day  is a best seller. Dr Rosenberg’s latest book is The Doctor’s Guide to Sleep Solutions for Stress & Anxiety. Visit Dr Rosenberg’s website which is a wealth of information on sleep topics.

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11 thoughts on “Ask the Sleep Doctor – Bariatric Surgery, Narcolepsy Medications

  1. Tara Conrad Reply

    I am a 40 yr old women and have been diagnosed with narcolepsy with cataplexy since my early 20’s. At the time of my diagnosis, I did not have ANY measurable hypocretin in my CSF. In 2011, I had a Roux-N-Y gastric bypass performed. Even in consultation with the surgeon, prior to my procedure, he was not sure if the surgery would help me as much as other pts (if at all). You see, if I have none of the molecules that assist the hypothalamus with metabolism (among many other things), would it matter how small my stomach pouch was?

    It turns out that I only lost about 25lbs even though I feel as if I have done as much as I can to eat well and exercise. I even cut out 6 cans of coke a day to zero right before the surgery and never looked back!

    Now, my health is suffering due to the obesity (I gained it all back plus some) and I have been unable to work bc I cant stand without horrible back pain and I get sweaty and SOB so easily.

    I want to attempt bariatric surgery again. Do you think that the surgery has any chance of doing what it’s supposed to do despite my neurological deficiencies? Should I simply revise the bypass or opt for a gastric sleeve? Does it even matter?

    Thank you so much for your time and help!

  2. Robert cruz Reply

    My fiancé is 32 years old, she has been diagnosed with her narcolepsy at a young age 16 years old, she is starting to sleep more frequently, my question is there any kind of surgery that will minimize her affects of this terrible sickness?

  3. Karla Gonzalez Reply

    Hello doctor
    I have narcolepsy and cataplexy I am about 50 pounds overweight would getting a Gastric sleeve to lose weight help my symptoms? And would it cover with hmo insurance?

  4. Fred Wysoki Reply

    I had bariatric sleeve surgery 16 months ago and have had awake bruxism ever since. I’m looking for a solution to this. Any ideas?

  5. Jose Carmona Reply

    Dear Dr Rosenberg
    What do yo think about a patient with narcolepsy type 1, obese (BMI 40), metabolic syndrome (Hypertension, Dyslipidemia) and OSA (Using CPAP), have an sleeve gastrectomy?
    Would you recommended or contraindicated?
    What perioperative measures would increase safety and quality care for these patients?

  6. Christine Reply

    Hi my name is Christine I am 53 years old I had a gastric bypass about 15 years ago. I also suffer from sever depression,bipolar disorder and the worst of them all a sever compulsive disorder and just these last couple of years narcolepsy. Because of the gastric bypass surgery my medication is absorbing in a way that requires Me to take more than the average person.i don’t know what kind of doctor would specialize in helping all that is wrong. Please help me.

    • dee Reply

      did you ever get this resolved? i have the same issue with narcolepsy but can get more meds




    • Robert Rosenberg Reply

      Yes, I would suggest you consult with a sleep specialist. What you are describing is sleep paralysis associated with hallucinations. It is the overlapping of REM sleep into wakefulness, which can be a symptom of narcolepsy. It is also seen with increasing frequency in untreated sleep apnea, anxiety disorders, and when we are not getting enough sleep. In most people, there is no cause. However, with your history of epilepsy, as well as the frequency with which these episodes are occurring, I think a consultation with a board certified sleep specialist is a good idea.

  8. Louise Eddington Reply

    I grind my teeth at night – which gives me constant daytime migraines. I have tried lots of different nigth guards to no avail. It has been suggested I try nose clips so I will therefore breathe through my mouth hopefully the with my mouth open I will not be able to grind. I did try a clothes line peg which actually seemed to work but longterm I want to find a proper nose clip. What is your advice please. I am desperate. THanks Louise.

    • Robert Rosenberg Reply

      What you are describing is called sleep bruxism. It can be due to many reasons. These include hereditary, anxiety, excessive caffeine, smoking, and alcohol. Even some antidepressants and sleep apnea may be the cause. As for the nose clip idea, I doubt that will do anything for you. There are numerous therapies including dental splints, medications, relaxation techniques, hypnotherapy, biofeedback, as well as treating sleep apnea if existing. At this point, I would recommend you see a board certified sleep specialist, as you have not responded to a dental device.

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