Excessive Sleepiness - Treatment
The best way to treat excessive sleepiness is to address its underlying cause. Often this means making changes to your sleep schedule, habits and routines, stress management, or sleeping environment. If you are diagnosed with a sleep disorder such as sleep apnea, a treatment course that involves a continuous positive airway pressure machine (CPAP) is often the most effective course.
There are cases, however, in which medication can be helpful in treating excessive sleepiness. For example, if you have sleep apnea and use a CPAP machine, but continue to feel drowsy during the day, your doctor may suggest a medication to make you more alert. Medication can also be prescribed for patients with narcolepsy to help them remain awake and productive during the day. Shift workers who persistently feel sleepy during work hours may also benefit from medication if adjusting sleep habits does not help, or if rotating schedules make it difficult to sleep sufficiently. If you have worked with a sleep specialist and tried behavioral changes to improve sleep, medication may be an option.
Modafinil (Provigil) and armodafinil (Nuvigil) are possible medications to treat excessive sleepiness. These medications work by changing the action of certain chemicals in the brain, and have "monoaminergic" effects (altering neurotransmitters like dopamine and serotonin). Other possible medications are stimulants such as methylphenidate (Ritalin). Read more about medications, side effects, and safety.
It's very important to work closely with your doctor to determine if a medication is right for you. This will depend on your unique situation, schedule, sleep habits, and medical history, as well as any further tests your doctor needs to understand the root of your excessive sleepiness. Talk to your doctor or ask for a referral to a sleep specialist to discuss your excessive sleepiness and work on a treatment plan.
If your doctor recommends taking medication for excessive sleepiness, there are a number of different options that may be considered. It's important to know that medication will not take the place of healthy sleep. Most often, medication for excessive sleepiness will complement or supplement other forms of treatment, both behavioral (such as improving sleep habits or managing anxiety) and medical (such as treatment for sleep apnea).
One option for people with excessive sleepiness—often prescribed for patients with narcolepsy—are stimulants such as methylphenidate (Ritalin). These are compounds that are activating to the central nervous system and increase a person's alertness. These medications can have side effects such as an increase in blood pressure, irritability, tremors, and insomnia. It's important to take them exactly as directed. Modafinil (Provigil) and armodafinil (Nuvigil) are medications that can also make a person feel more alert. These are non-amphetamine drugs. The common side effects of these medications are headaches, nausea, nervousness, dizziness, stuffy nose, upset stomach, diarrhea, back pain, and difficulty sleeping. There are also more serious, but less common, side effects like rashes, fever, trouble breathing, chest pain, or abnormal heartbeats. No matter what wake-promoting medications you take for excessive sleepiness, it's important to tell your doctor about any side effects you experience. Caffeine is one of the most popular stimulants people use to self-treat excessive sleepiness. Caffeine increases mental alertness and can make for a faster train of thought. It may work well for the average mildly sleepy person, but caffeine often does not work enough to counteract the excessive sleepiness of a clinical sleep disorder like narcolepsy or sleep apnea.
If your excessive sleepiness is the result of difficulty sleeping (as in the case of insomnia), a sleep-promoting medication such as zolpidem (Ambien) or eszopiclone (Lunesta) could be an option to discuss with your doctor. These medications are called benzodiazepine receptor agonists, and they can cause side effects like headaches, dizziness, unsteady walking, stomach pain, and constipation.
Sodium oxybate (Xyrem) is a medication usually prescribed for narcolepsy, and has been shown to improve the quality of sleep and the symptoms of excessive sleepiness in patients with this sleep disorder. Particularly if you are diagnosed with narcolepsy, your doctor may prescribe this medication in conjunction with a wake-promoting medication mentioned above. Sodium oxybate can have side effects such as headaches, dizziness, bedwetting, upset stomach, back pain, sweating, and more, so it's important to take it exactly as indicated and talk to your doctor about any physical or psychological symptoms you notice.
Before you start taking a medication for excessive sleepiness, make sure your doctor has a complete picture of your mental and physical health. Be very clear about any psychological issues (such as a history of depression, anxiety, psychosis, personality disorders, and so forth) and physical issues (such as heart problems, kidney or liver problems) you may have, if you are pregnant or breastfeeding, as well as any medications you are currently taking—including prescription and nonprescription drugs, vitamins, and birth control pills.
Your doctor will decide on the proper dose of medication for you, and you should follow these directions precisely. Your doctor will also discuss the timing of these medications. Medications for excessive sleepiness are meant to increase your level of wakefulness and alertness, but it's still important to hold off on driving and doing anything else that could be potentially dangerous until you have enough time to see how the medications work for you.