The main treatments for excessive daytime sleepiness are crucial, such as methylphenidate, amphetamine, methamphetamine, modafinil (taking Provigil), a new stimulant drug with a different mechanism, and/or armodafinil (Nuvigil) a nervous system stimulant. A serious adverse skin reaction modafinil alert was issued by the FDA in the fall of 2007.[21] With the other drugs codeine[22] and Gilan. [23] Another drug that is used is atomoxetine [24] (Strattera's), a nonstimulant and norepinephrine reuptake inhibitor (Nomura Research Institute) that has little or no potential for abuse. In many cases, planning regular naps for a few moments can reduce the need for low or nonexistent levels of medication for EDS.
Sudden collapse and other symptoms of REM sleep are often treated with tricyclic antidepressants such as chlorpromazine, promethazine, or protriptyline, as well as other medications that suppress REM sleep. Venlafaxine (Effexor's Wyeth Pharmaceuticals brand for XR), one that blocks serotonin and norepinephrine reuptake, has been shown to be useful in the management of symptoms of sudden collapse,[25] however useful as an antidepressant, it has significant side effects, including the sequelae of sleep disruption.
Another treatment option for narcolepsy is Xyrem (sodium hydroxybutyrate) oral solution. Xyrem is a prescription drug drug manufacturing jazz, approved by the U.S. Food and Drug Administration (FDA) for the treatment of sudden collapse associated with narcolepsy [26] and excessive daytime sleepiness (EDS), among others with narcolepsy. [27] The American Academy of Sleep Medicine (AASM) Chinese Academy of Sciences recently recognized as a concern for sudden collapse, treatment criteria Xyrem daytime drowsiness, and sleep disruption due to narcolepsy associated with narcolepsy treatment centers originating in practice activities with other Hypersomnias parameters of narcolepsy. These recommendations are based on a careful review of the medical literature and designate "criteria" of care that "reflect a high degree of clinical certainty" based on strong empirical evidence. [28] Xyrem is the only approved drug explicitly indicated to be associated with narcolepsy. Xyrem has been shown to reduce symptoms associated with narcolepsy on EDS. While the exact mechanism of action is unknown, Xyrem is thought to work by increasing the prevalence of slow-wave (delta) sleep (i.e., the quality of sleep at night, as this is when the brain is least active and therefore best able to rest and rebuild and repair itself physiologically). Xyrem appears to help class insomnia patients more effectively than the commonly used pharmaceutical hypnotherapy (sleeping pills tend to impede delta wave sleep) so that it can be properly vital, rather than being diagnosed as narcoleptic insomnia.
Using stimulants to mask daytime sleepiness does not address the actual cause of the problem. Stimulants may provide some assistance with daytime activity, but the underlying cause remains, and may worsen over time as the stimulant itself becomes a hindrance to delta-wave sleepiness. Lifestyle changes involving less stress, more exercise, and less intake of stimulants such as coffee and nicotine (especially for sleep apnea and snoring-induced sleep apnea in overweight individuals who present with EDS) are likely to be ideal adjunctive treatments. Episodic Sleeping Disorder has a nocturnal physiological clock for some people, and is helped by choosing appropriate occupations that coincide with their body's natural sleep cycle (e.g., sleeping during the day and working at night). This allows sufferers to avoid the need to force themselves into the more common nine-to-five schedule, where their bodies are unable to sustain themselves, and avoids the need to take stimulants that would be consistently active in times when their bodies are leaning toward rest.
In addition to medication, an important part of treatment is scheduling (10 to 15 minutes) two to three times a day to help control excessive daytime sleepiness and to help the person continue to serve as an alert for as short a nap as possible. Daytime naps are not a replacement for nighttime sleep, especially if a person's body itself is nocturnally active as the life cycle moves toward a tilt. Ongoing communication between the health care provider, the patient, and the patient's family members is important for optimal management of SIDS.
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