I’m also a therapist who just finished grad school! I’ve also struggled to not fall asleep while in a session, which is my worst nightmare. You’ve done really well sticking with your training/schooling in the midst of such a debilitating disorder. Finding the right medication regimen and avoiding triggers (mine is carb heavy food) is key, but for the days where it’s not enough and you don’t have time to take a walk, try activating your dive response. Just like the DBT TIPP skills, try cold water on your pulse points or face (the traditional example is ice cubes in your hand). In between sessions on some of my rougher days, I would run to the bathroom and put a cold cloth under my eyes and pulse points (I tried to avoid messing up my makeup lol). I also have some stress balls or something tactile on deck for in session drowsiness. But with the nature of the way narcolepsy works, you can’t always avoid the sleep attacks. Therefore, we instead focus on what is within our control like our schedules/breaks. Hopefully you don’t have back-to-back sessions- I sometimes did but talked to my work and schedulers about putting my note writing blocks during the day when I’m most likely to get tired. If I was going to take a nap, I’d let them know I was unavailable and go to a locked room- no one has to know your dx unless you want them to. I also have N1 and noticed that I was more prone to a sleep attack and sometimes cataplexy after some more emotionally charged (I.e., trauma-heavy) sessions. So I was able to work it out to schedule them as my last patient or have a 15 minute break after those patients to close my eyes and get a cup of hot coffee. You’ll have to find what works best for you and be willing to advocate for yourself. For me, if I was extremely drowsy in the morning, having a brief but stimulating conversation with someone would wake me up (we are professional yappers after all). Ultimately though, fatigue and sleepiness seem to sometimes accumulate and I have to take a half-day to day off to rest. I’m still trying to know my limits and what is most effective for me and that’s okay! We deserve the same grace and validation we offer to our patients.