To the Editor.—
I read with interest the article in the Archives by Kales et al (36:650-651, 1979) regarding treatment of narcolepsy with propranolol, particularly in view of demonstrated hyperresponsiveness to β-adrenergic stimulation in patients with primary disorders of impaired wakefulness.1 I have found propranolol to be occasionally helpful in such patients in reducing their tendency toward anxiety states and panic attacks. However, it has seemed beneficial for somnolence and sleep attacks only in occasional patients whose intermittent symptoms of "overstimulation" were extreme to the point that they seemed to "burn themselves out" via agitated hyperactive behavior. Other patients receiving propranolol have complained of consequent fatigue and increased lethargy, with improvement following reduction in dosage or discontinuation. It should be clarified as to whether the patient of Kales et al demonstrated this type of "off or too fast" behavior prior to propranolol. Also, whether he represented a typical case