Sleep apnea is a common sleep disorder that may be life-threatening if left untreated. It may lead to diabetes, high blood pressure, stroke, heart disease, or even motor accidents caused by falling asleep while driving.
PAP is an effective treatment of choice for sleep apnea, especially when it comes to eradicating excessive diurnal somnolence (EDS) – a prevalent symptom of the disorder. However, sometimes it is ineffective for some reason not entirely understood. In such cases, modafinil is considered a potentially important tool. Let’s find out why.
What Is Sleep Apnea?
Sleep apnea is a potentially harmful sleep disorder caused by the repeated obstruction of the airways during sleep. It results in episodes of slow or completely stopped breathing in patients suffering from it. Snoring very audibly, feeling exhausted after a full night’s sleep, and excessive daytime sleepiness may be clear indications of the condition .
Types of Sleep Apnea
There are three types of sleep apnea: central, obstructive, and mixed (or complex).
- Central sleep apnea is a rare form of the disorder. It occurs when parts of the brain that regulate the muscles that control breathing temporarily fail to send proper signals. Individuals with problems having to do with their brainstem are more likely to develop it .
- Obstructive sleep apnea (OSA) is more common than the central sleep apnea. It has nothing to do with the brain and occurs solely due to the obstruction of the upper airway. Though it can affect individuals of any age group, it predominates in the aging population and the obese.
- Mixed sleep apnea is a combination of the symptoms of the first two types of disorder. A few of these cases occur when patients with OSA undergo the PAP therapy.
Sleep apnea can occur as a result of either medical conditions or the patient’s physical structure. In adults, OSA is usually caused by excessive weight gain or obesity. During sleep in overweight individuals, the muscles that support the soft tissues (soft palate and tongue) in the throat relax, causing a narrowing. Thus, the airflow is repeatedly cut off.
On the other hand, medical conditions such as neuromuscular disorders, large tonsils, premature birth, genetic syndromes, kidney or heart failure, and endocrine diseases may also increase the risk of sleep apnea .
Both central sleep apnea and OSA symptoms often overlap so much that it becomes hard to tell the patient’s type of apnea. The most common indications include :
- loud snoring;
- morning headache;
- morning tiredness after having a full night’s sleep;
- difficulty breathing during sleep;
- waking up with a dry mouth;
- extreme daytime sleepiness;
- difficulty concentrating during the day.
These symptoms arise from sleep deprivation and decreased oxygen levels in the body caused by poor breathing. It is advisable to see a doctor if one or more of these signs are experienced consistently.
What Is Modafinil?
Modafinil (marketed as Provigil) is a wake-promoting drug approved by the Food and Drug Administration (FDA) to treat extreme daytime sleepiness. Though approved mainly for combating three specific sleep disorders (narcolepsy, OSA, and shift work sleep disorder), it is commonly used off-label for its cognitive-enhancing effects. Thus, many individuals are looking to boost memory, promote alertness, focus, and ultimately improve productivity use it .
It is worth noting that modafinil’s actual mechanism of action in wake promotion remains a mystery. Unlike conventional stimulants of the central nervous system (CNS), it has no dopaminergic characteristics. As a result, it poses fewer side effects and is safe and well-tolerated. Modafinil is believed to work by tilting the balance of certain chemicals in areas of the brain that regulate the sleep-wake cycle .
Modafinil for Sleep Apnea
Several medical experts have taken an interest in modafinil because of its safe and unique wake-promoting properties. It is considered a very important piece capable of effectively treating excessive diurnal sleepiness (EDS) – a primary symptom of sleep apnea, among other sleep-depriving disorders .
Though PAP, the first-line treatment for OSA, eliminates EDS in patients effectively, the symptoms do not go for unknown reasons in some cases. While CNS stimulants such as methylphenidate or amphetamine are effective, they are considered unideal for use because of their low safety profile, especially in patients with cardiovascular problems.
Whereas two recent studies carried out to determine the effectiveness and safety profile of modafinil showed promising results. The participants of the trial were found to have experienced increased alertness with no effects on sleep. The second research revealed that modafinil appeared effective in patients who displayed residual EDS but complied with continuous positive airway pressure (CPAP) treatment.
In all, modafinil should not be used as the first-line therapy for sleep apnea but can complement it if EDS doesn’t go away. While using the drug on CPAP patients, it is essential that they are monitored closely .
Tips to Using Modafinil for Sleep Apnea
As with every other drug, modafinil should be administered correctly to achieve desired results and reduce the risk of side effects.
When using modafinil for sleep apnea, the recommended dosage is 200 mg. It should be taken orally once a day, early in the morning . There are cases where a dosage of up to 400 mg has been administered as a single dose without posing any health risks. However, doses higher than 200 mg have not proven to yield increased benefits.
Modafinil can be taken with or without food but should be swallowed with a substantial amount of water. Do not lie down for at least 10 minutes after taking the drug.
Note that this medication is not meant to replace getting enough sleep. It should not be used by individuals who do not have OSA or any other sleep disorder.
Report any severe signs of discomfort immediately to a healthcare provider.
What Are the Side Effects of Taking Modafinil for Sleep Apnea?
- stuffy or runny nose;
On rare occasions, more serious adverse effects such as mood swings, chest pain, confusion, fever, memory loss, and fast heartbeat may occur. Others include depression, high blood sugar, change in vision, decreased appetite, and vomiting.
This is not a comprehensive list of the possible side effects that may result from using modafinil. Refer to the drug leaflet and consult a doctor for a more inclusive one. Report to a doctor immediately if some adverse reactions persist.
Other Things to Consider for Reducing Sleep Apnea Symptoms
Besides modafinil, some other things may be done to reduce the signs of sleep apnea.
Positive airway pressure (PAP) therapy is an important means of managing the symptoms of the condition. It involves providing sleep apnea patients with a stream of pressure to keep their airways open while they sleep. A doctor may recommend a special device to provide the pressure automatically. PAP is the recommended primary treatment for cushioning the effects of the disorder .
Surgery is yet another form of therapy often employed to reduce sleep apnea symptoms. Available procedures include :
- uvulopalatopharyngoplasty (UPPP);
- anterior inferior mandibular osteotomy;
- maxillomandibular advancement;
- lingual tonsillectomy;
- midline glossectomy and base of tongue reduction;
- genioglossus advancement;
- hyoid suspension;
- septoplasty and turbinate reduction;
- hypoglossal nerve stimulator.
Though surgery is an option, it should be the last resort, as it poses high risks such as additional breathing problems, infection, urinary retention, and deep vein thrombosis.
Making specific lifestyle changes may also be useful in reducing the associated symptoms; however, this cannot replace medical treatment. Limiting alcohol intake and quitting smoking will go a long way to encourage better sleeping habits, improve health and quality of life. Alcohol is a prime factor that increases the risk of obstruction of the upper airway, as it relaxes the throat muscles .
Other lifestyle changes, such as doing yoga and altering a sleep position, may also help ease sleep apnea symptoms. For starters, regular yoga breathing exercises can reduce the blockage in the throat by strengthening and toning the muscles in the upper airways. On the other hand, the sleepy soldier position (sleeping on one’s back) can cause snoring, as the tongue falls back easily and obstructs the upper airways. Thus, it is advisable to sleep on the sides or in a prone position, as it can reduce or even completely prevent snoring.
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Modafinil is a highly effective medicine for treating sleep apnea symptoms. It has a high safety profile and poses few side effects, and this makes it preferred to other drugs used for similar purposes (mostly CNS stimulants).
Modafinil can be taken alongside PAP therapy to manage sleep apnea, especially in patients with persisting EDS. However, it should only be used based on recommendations and under the supervision of a doctor.
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- Obstructive Sleep Apnea Causes. Medically reviewed by Carol DerSarkissian. Retrieved: September 3, 2020. Webmd.com.
- Sleep Apnea | NHLBI, NIH. Retrieved: September 3, 2020. Nhlbi.nih.gov.
- Obstructive sleep apnea – Symptoms and causes. By Mayo Clinic Staff. Retrieved: September 3, 2020. Mayoclinic.org.
- Modafinil. Retrieved: September 3, 2020. Wikipedia.org.
- The Role of Modafinil in Treating Sleep Disorders | Sleep Review. By Sleep Review Staff. Retrieved: September 3, 2020. Sleepreviewmag.com.
- Modafinil Oral: Uses, Side Effects, Interactions, and Warnings. Retrieved: September 3, 2020. Webmd.com.
- Excessive diurnal somnolence-causes, mechanisms, therapeutical approach. By Ștefan Mihăicuţă, Danina Muntean, et al. Retrieved: September 3, 2020. Pubmed.ncbi.nlm.nih.gov.
- Provigil (Modafinil): Uses, Dosage, Side Effects, Interactions, and Warning. Retrieved: September 4, 2020. Rxlist.com.
- Common and Rare Side Effects for Modafinil Oral. Retrieved: September 4, 2020. Webmd.com.
- What is PAP Therapy? By Kevin Asp, CRT, RPSGT. Retrieved: September 4, 2020. Aastweb.org.
- Surgery for Sleep Apnea: Procedures, Success Rate, and Risks. By Kristeen Cherney. Medically reviewed by Nancy Moyer, M.D. Retrieved: September 4, 2020. Healthline.com.
- 6 Lifestyle Remedies for Sleep Apnea: What Works? By Kiara Anthony. Medically reviewed by James Keith Fisher, M.D. Retrieved: September 4, 2020. Healthline.com.