Medications are a core therapy for most people with narcolepsy, and they produce large improvements in alertness. Modafinil (Provigil and Nuvigil), armodafinil, and amphetamines are commonly used. Oxybates, such as once-nightly sodium oxybate (Xyrem) or the mixed oxybate salts, also improve sleepiness and cataplexy.

Modafinil is a wake-promoting drug that was shown to reduce excessive daytime sleepiness in controlled clinical trials of people with narcolepsy or shift work disorder, alone or in combination with CPAP for OSA.

How Does Modafinil Work?

It isn't clear how modafinil australia online improves sleep cycles to treat narcolepsy or sleep apnea. It may work by mimicking some of the brain's natural chemicals to increase wakefulness, or it may affect neurotransmitters to alter the sleep/wake cycle.

In narcolepsy patients, modafinil significantly improved objectively determined wakefulness on the MWT, reduced sleepiness on the ESS, and remediated a decrement in th and d power of vigilance-controlled EEG (measured by low-resolution brain electromagnetic tomography, LORETA). These effects on wakefulness were maintained through 136 weeks of open-label treatment with modafinil 200 mg to 400 mg/day.

Modafinil is sometimes used as a substitute for sleep to maintain alertness and performance during lengthy military missions, space flights, or business meetings. However, long-term use of this medicine can cause problems with health, including depression, and can lead to dependence. It also can be dangerous in people with certain medical conditions, such as liver or kidney disease. Talk to your doctor about this risk.

Dosage

Modafinil is administered orally as a single agent or in combination with other CNS stimulants. Dosage should be adjusted based on the severity of the sleep disorder, and it is usually not used in elderly patients or those with severe hepatic impairment.

The wakefulness-promoting effect of modafinil (Modvigil 200 mg) may be mediated by the orexin system, a set of peptides that stimulates neurons in the hypothalamus to promote waking and inhibit sleep (Czeisler 2005). Modafinil has been shown to increase activity in the lateral hypothalamic nucleus (VLPO) containing orexin neurons but not in neurons of the tuberomammillary nucleus (TMN), which provides inhibitory GABA-ergic input to cortical regions required for arousal.

In narcolepsy studies, mean sleep latencies improved but did not normalize with modafinil alone. However, a long-term open-label extension study of narcolepsy patients showed that improvements in objective and subjective measures of wakefulness, as well as improvements in functional status and health-related quality of life, were maintained with the addition of CPAP therapy and long-term use of modafinil.

Side Effects

GPs and sleep specialists prescribe medicines called stimulants, which help people with narcolepsy and sleep apnea to stay awake. They can also advise on how to get plenty of restful sleep, and how to avoid medicines that make drowsiness worse, such as some cold and allergy medicines.

Modafinil belongs to a group of medicines known as wakefulness-promoting agents, but it is chemically and pharmacologically unrelated to the central nervous system stimulants (eg, dextroamphetamine and methylphenidate). It has been shown to improve sleep cycles in patients with narcolepsy and other disorders that affect your brain's control of your sleep-wake cycle.

In double-blind placebo-controlled studies, modafinil 200 mg significantly reduced narcolepsy-related daytime drowsiness in narcoleptic patients and the level of sleepiness during night shift work in patients with shift work disorder. It did not significantly increase errors, accidents and near-accidents during the night shift or affect caffeine intake, sleepiness in patients traveling home after a night shift, or unplanned sleep episodes (Roth et al 2007). The most common treatment-emergent adverse event was headache (2%) with a rate of discontinuation of 8%.

Warnings

Modafinil can interact with several medications. Talk to your doctor before taking any other drugs, especially if you take birth control pills, a diuretic (water pill), or a monoamine oxidase inhibitor. It also may not work well with a few types of psychiatric medicines.

Modafinil is generally safe and well-tolerated in the clinical studies used to approve it. It is a relatively low-risk drug for abuse and dependence, although it does have some potential for addiction. Armodafinil, a similar wakefulness-promoting medication that requires a prescription and has different chemical structures and half-lives, is FDA-approved for treating narcolepsy, shift work sleep disorder, and obstructive sleep apnea.

It is also prescribed off-label for depression and fatigue associated with multiple sclerosis. Both medications are also effective in reducing excessive daytime sleepiness for patients with obstructive sleep apnea who are receiving treatment with continuous positive airway pressure therapy (CPAP). The drug is often given in combination with a behavioral intervention to promote better sleep habits.