What are your preferred treatments for disrupted nighttime sleep in elderly patients with narcolepsy already taking sodium oxybate?

The treatment depends on what is causing the disruption. Before I consider any medication, I recommend a thorough investigation of possible causes of the disruption. For example, has sleep apnea been ruled out? Is the patient taking alerting substances close to bedtime? What is the sleep environment like? What other medical conditions could be contributing to nighttime disruption, etc. If no clear cause can be identified and it is felt that the disruption is due to narcolepsy, then one could try the newer long-acting formulation of sodium oxybate. Otherwise, I like to use pregabalin, gabapentin, or low-dose doxepin (no more than 6 mg) to help with sleep consolidation.