In addition, modafinil and armodafinil can sometimes result in headaches, which, if severe enough, can cause a user to reduce the dosage, thereby limiting the effectiveness of the medications.Ī new non-stimulant wake-promoting medication- solriamfetol-was approved in March 2019 by the U.S. (See HF’s journal article summary: Does Modafinil Improve Sleepiness in People With IH Without Long Sleep Time? See also Inoue 2021 and Maski 2021.) However, modafinil and armodafinil can interact with hormonal birth control to make it less effective (for further details, including birth control options, see Birth Control, Menstruation & Menopause: Considerations for People Who Have Hypersomnias ) and can result in a life-threatening rash. Modafinil has been studied in placebo-controlled trials that included PWIH and has been shown to help with sleepiness in people with this disorder. While it is not completely known how these medications work, they appear to influence the brain chemistry that increases wakefulness, particularly the neurotransmitter dopamine. Non-stimulant wake-promoting medications include modafinil and armodafinil. (Read more about dental side effects and how to manage them.) While stimulants may be effective, potential side effects include dependence, mood and behavior changes, dental problems, and heart problems. Stimulants approved for the treatment of sleepiness in narcolepsy include dextroamphetamine (e.g., Dexedrine) and methylphenidate (e.g., Ritalin). (The Patient Health Questionnaire-2 is preferred to other screening instruments such as the PHQ-9, which may be falsely abnormal due to questions related to fatigue, trouble concentrating, and fragmented sleep.) In addition, PWH are at increased risk for depression and anxiety and should be screened for depression at least every one to two years. For example, benzodiazepines, opiates, antipsychotics, and alcohol. Also, certain medications and substances should also be avoided, when possible, by PWH due to their potential to worsen daytime sleepiness. It is often helpful to treat these disorders first and then to focus on improving the sleepiness that is caused by the hypersomnia. Person(s) with hypersomnias (PWH) may also have obstructive sleep apnea, periodic limb movements of sleep, and/or rapid eye movement (REM) sleep behavior disorder that contribute to their daytime sleepiness. It is also important to consider how IH and its treatment may affect finances, work, school, self-care, etc. For example, behavioral approaches, including cognitive behavioral therapy ( CBT), can be helpful to learn coping skills. In addition, some PWIH have found that nonpharmacologic treatments can be beneficial. (Get it free HERE.) It is also important to consider how hypersomnias and their treatment may affect anesthesia/hospitalization, parenthood & pregnancy, etc. The Idiopathic Hypersomnia Severity Scale (IHSS) is a validated tool that can help to measure treatment response. “The goals of therapy are to obtain ‘normal’ alertness during conventional waking hours or to maximize alertness at important times of the day (eg, during work, school, or while driving)” (see UpToDate’s Treatment of Narcolepsy in Adults 2022, which also provides further details about treatment algorithms, dosing, side effects, etc., much of which is applicable to treating IH). Few person(s) with hypersomnias ( PWH), including both narcolepsy and IH, ever feel fully alert despite optimal therapy. Medications may sometimes be used in combination, especially in people who are treatment-resistant or have more severe symptoms. In some cases, medicines may stop working over time and/or have bothersome side effects. Response to medications can vary, and some people do not achieve adequate control of symptoms in spite of medications. Currently, all available treatments are symptomatic, as there are no disease-modifying therapies yet available for either disorder. However, researchers continue to test medications approved for other disorders, as well as novel treatments, for IH and narcolepsy. Many of these off-label treatments have not been studied extensively in person(s) with IH ( PWIH). There are also several treatments approved by the FDA (and similar international agencies) for use in narcolepsy and other sleep disorders, and it is common practice to use medications that are known to be effective in people with narcolepsy and other neurologic/sleep disorders to treat the sleepiness associated with IH (this is called “ off-label” use). FDA-approved treatment for idiopathic hypersomnia ( IH). In August 2021, lower-sodium oxybate (Xywav) became the first U.S.
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