Overcoming obstructive sleep apnea

Sleep apnea is a disorder in which a blockage in the throat causes reduced airflow during sleep. Snoring is the most common symptom, but pauses in breathing, insomnia, or morning headaches can also be symptoms. The condition is very common, with some studies estimating that one in two women have sleep-disordered breathing. The most common kind of sleep apnea is obstructive sleep apnea, or OSA. It occurs when the throat muscles intermittently relax and block the airway while a person sleeps. Complications from this condition can include heart problems, reduced ability to recover after surgery, and daytime sleepiness. The second, less common type is central sleep apnea, in which there is no obstruction in the airway, but the brain and/or heart are not regulating the breathing properly.

OSA can be treated and even cured, often with lifestyle changes. Losing weight, changing sleeping positions, and limiting alcohol consumption before bedtime may provide relief. Some patients find that using a continuous positive airway pressure (CPAP) device allows them to breathe properly as they sleep. For some, surgery such as removing tonsils can remedy the OSA. The best treatment will be recommended after a patient has undergone a sleep study or test.

Drug Treatments
While no medication has been approved specifically to treat OSA, two medicines have been approved to treat daytime sleepiness associated with obstructive sleep apnea (OSA). These two medications are both made by the company Cephalon and have essentially the same chemical formulation. The newer one, Nuvigil, came out close to the time that its sister drug Provigil was about to go off-patent and therefore eligible for generic production. Both drugs now are available as generics.

Provigil (modafinil) (click for image of tablet)

PROVIGIL is approved to improve wakefulness for excessive sleepiness caused by OSA and not as treatment for the underlying obstruction (the cause of the sleep apnea). If a CPAP device is the treatment of choice for a patient, "a maximal effort to treat with CPAP for an adequate period of time should be made prior to initiating and during treatment with PROVIGIL for excessive sleepiness."

The drug was originally approved in 1998 for excessive daytime sleepiness associated with narcolepsy. In 2004, the label was changed and it was approved for the additional indications of daytime sleepiness associated with "shift work disorder" and also obstructive sleep apnea. It is not approved for pediatric use in patients under the age of 18. Warnings include: Serious risks of skin reactions, including Stevens-Johnson syndrome.

Provigil (modafinil) is a Schedule IV controlled substance because of its psychoactive and euphoric effects, alterations in mood, perception, thinking, and feelings typical of other CNS stimulants. Because of these effects, it is sometimes used off-label for ADHD, weight loss, mood disorders, and even as a "brain drug" for cognitive enhancement.

Patient opinion about Provigil

Click here to read patient reviews of Provigil taken for obstructive sleep apnea. Overall, patients are fairly satisfied with the drug. It has an average patient satisfaction rating score of 3.5 for its use in conjunction with OSA.
Common side effects are headache, nausea, insomnia, loss of appetite, and anxiety.

Nuvigil (armodafinil) (click for image of tablet)

NUVIGIL is approved to "improve wakefulness in adult patients with excessive sleepiness associated with obstructive sleep apnea (OSA), narcolepsy, or shift work disorder (SWD)". In the original drug application, Cephalon had also asked the FDA to approve the drug improve wakefulness due to "jet lag resulting from eastbound travel." The FDA did not approve the drug for the jet lag indication.

The drug was originally approved in 2007. Like Provigil, it is a Schedule IV controlled substance because of its psychoactive and euphoric effects, alterations in mood, perception, thinking, and feelings typical of other CNS stimulants. Because of these effects, it is sometimes used off-label for ADHD, weight loss, mood disorders, and even as a "brain drug" for cognitive enhancement.
Like Provigil, warnings include Serious risks of skin reactions, including Stevens-Johnson syndrome. (Link goes to drug label; scroll to review drug warnings.)

Patient opinion about Nuvigil
Click here to read patient reviews of Nuvigil taken for obstructive sleep apnea. Overall, patients are fairly satisfied with the drug. It has an average rating of 3.3 by patients using it in conjunction with OSA treatment.
Common side effects are headache, nausea, insomnia, loss of appetite, and anxiety.

Sources and more reading:
- Sleep Foundation article on snoring: https://www.sleepfoundation.org/sleep-disorders-problems/other-sleep-disorders/snoring
- Ask the Dentist web site has an article on the high incidence of obstructive sleep apnea in women and what they can do about it.
- National Institutes of Health had a 2-day conference in October 2018 on sleep disorders in women. Click here to view the video: https://videocast.nih.gov/Summary.asp?File=26121&bhcp=1
- Sleep apnea article at the National Heart, Lung and Blood Institute: https://www.nhlbi.nih.gov/health-topics/sleep-apnea