possible narcolepsy?

Diagnoses with severe OSA. Cpap helped alot but still excessive daytime fatigue, consentration/memory issues. Will fall asleep talking to someone. Driving any distance is not an option. Provagil  200mg twice a day helping. Ritalin did nothing. Adderall (adderrall) XR 30mg  and Adderall (adderrall) 40mg together twice a day had little or no affect. These were all taken with the Provagil and only the Provagil seems to help some. Enough to get me out of bed and from falling asleep driving for short distances. Just repeated MSLT test. Overnight showed alot of REM (I think more than normal) and also still moderate amount of PLM's. MSLT naps the longest time to fall asleep was 4 min and REM on 1 after falling asleep. Several other close REM's. Did dream light on most naps but not deep enough for REM. Sleep onset qualified for dx of Narcolepsy but only 1 REM. with all the other issue's could this still be Narcolepsy?

If this is then what are your thoughts on the best treatment. Xyrem mentioned but sounds scarry. Also does this have to be reported to the DMV if diagnosed?  I am also a nurse so what implications or issues would this be with my license.

[Steven Y Park, MD]

Sometimes sleep doctors will give you a diagnosis of narcolepsy without strongly positive findings on the MSLT. Obviously this is a sensitive issue which you need to talk over with your sleep physician. If you were a pilot of a bus driver and knew you had a sub-optimally treated condition that left you mentally and cognitively impaired, what would you do?