Sunosi Can Help You Stay Awake For Up To 9 Hours*
Once-daily SUNOSI is a medication called solriamfetol, which is a wake-promoting agent. SUNOSI is not a stimulant medication.
SUNOSI does not treat the cause of obstructive sleep apnea or take the place of your CPAP.
*In clinical studies at 12 weeks. 75 mg dose did not show improvement across 9 hours in narcolepsy.
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Do not take SUNOSI if you are taking, or have stopped taking within the past 14 days, a medicine used to treat depression called a monoamine oxidase inhibitor .
Before taking SUNOSI, tell your doctor about all of your medical conditions, including if you:
- have heart problems, high blood pressure, kidney problems, diabetes, or high cholesterol.
- have had a heart attack or a stroke.
- have a history of mental health problems , or of drug or alcohol abuse or addiction.
- are pregnant or planning to become pregnant. It is not known if SUNOSI will harm your unborn baby.
- are breastfeeding or plan to breastfeed. It is not known if SUNOSI passes into your breast milk. Talk to your doctor about the best way to feed your baby if you take SUNOSI.
- SUNOSI does not treat the underlying cause of obstructive sleep apnea and does not take the place of any device prescribed for obstructive sleep apnea, such as a continuous positive airway pressure machine. It is important that you continue to use these treatments as prescribed by your healthcare provider.
The most common side effects of SUNOSI include:
Continuous Positive Airway Pressure
This is the most effective treatment for moderate or severe obstructive sleep apnoea syndrome. It may be used to treat mild sleep apnoea if other treatments are not successful. This treatment involves wearing a mask when you sleep. A quiet electrical pump is connected to the mask to pump room air into your nose at a slight pressure. The slightly increased air pressure keeps the throat open when you are breathing at night and so prevents the blockage of airflow. The improvement with this treatment is often very good, if not dramatic.
If CPAP works then there is an immediate improvement in sleep. Also, there is an improvement in daytime well-being, as daytime sleepiness is abolished the next day. Snoring is also reduced or stopped. The device may be cumbersome to wear at night but the benefits are usually well worth it. Comments like âI havenât slept as well for yearsâ have been reported from some people after starting treatment with CPAP.
Lifelong treatment is needed. Sometimes you can have problems with throat irritation or dryness or bleeding inside you nose. However, newer CPAP machines tend to have a humidifier fitted which helps to reduce these problems.
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Sleep Apnea Treatment Options
Continuous positive airway therapy is the most common treatment device for sleep apnea according to the U.S. Food and Drug Administration . This is because its safe and effective.
The optimal therapy is CPAP . This involves wearing a nasal or face mask connected to a small machine that delivers air pressure to the throat, thereby keeping one’s airway open during sleep, explains Ashgan Elshinawy, DO, the director of the Center for Sleep and Breathing Disorders at Saint Peters University Hospital, New Brunswick, New Jersey.
However, some people struggle to stick with the CPAP therapy, as it requires sleeping with a mask or nasal cannula and being tethered to a machine. However, when properly adhered to, these CPAP machines are extremely effective sleep apnea treatments.
Aside from recommending a breathing device, your doctor may also suggest making some lifestyle changes to reverse sleep apnea. Most commonly this includes exercising regularly and eating a healthy diet, losing excess pounds, cutting back on alcohol, and quitting smoking.
Other treatment options include:
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Effects On Excessive Daytime Sleepiness And Cognitive Behavioural Dysfunctions
Excessive daytime sleepiness
Daytime sleepiness is the most common complaint of patients with OSAHS. At first glance, there are two mechanisms by which OSAHS may produce sleepiness . 1) Breathing disturbances are accompanied by sleep arousals resulting in sleep fragmentation and 2) hypoxaemia occurs during apnoeic events and might result in repetitive brain oxygen desaturations. The importance of these mechanisms, their link with sleepiness and the impact of CPAP treatment need to be clarified.
Arousal versus hypoxia
FIGURE 4.
Functional magnetic resonance imaging of brain activation during a working memory task in healthy subjects versus patients with obstructive sleep apnoea/hypopnea syndrome before and after continuous positive airway pressure treatment. Group activation map comparing a) 10 healthy subjects, where activation is more extensive and bilateral, with b) 16 patients with OSAHS without treatment and c) 16 patients with OSAHS on treatment, where there is recovery of activation in the posterior parietal, but not the prefrontal areas. Reproduced from with permission from the publisher.
Cardiovascular Risk Assessment Prior To Initiation Of Stimulants
A large retrospective study showed no evidence of increased serious cardiovascular events in patients with ADHD aged 2 to 24 years receiving stimulant medicaitons.68 Similar results were seen in another retrospective cohort study in patients with ADHD aged 25 to 64 years.69 Based on the aforementioned trials, the FDA concluded that there was no strong association between ADHD pharmacotherapy and adverse cardiovascular events.70 Nonetheless, patients should be cautioned about potential changes in heart rate and blood pressure. In general, stimulants should be avoided in patients with cardiovascular disease if needed, they should be prescribed in consultation with a cardiologist. The American Academy of Pediatrics, American Heart Association, and American College of Cardiology recommend a cardiovascular evaluation in children prior to the initiation of stimulants.71
Clinical Dilemma
Clinicians are faced with challenging questions because studies of stimulant medications and cardiovascular risk did not include patients above 65 years thus, the effect of pre-existing cardiac conditions in the elderly population is unclear. These studies are also confounded by healthy user bias, which limits generalizability. There is a need for further research on use of stimulants in the elderly population, especially in patients with OSA on CPAP with residual daytime sleepiness.
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Pharmacotherapy Options In The Treatment Of Obstructive Sleep Apnea
Kimberly L. Tackett, PharmD, BCPS, CDEAssociate ProfessorSouth University School of PharmacySavannah, Georgia
South University School of PharmacySavannah, Georgia
US Pharm
Obstructive sleep apnea is a form ofsleep-disordered breathing that is characterized by frequent episodes ofsnoring and a cessation in breathing for greater than 10 seconds,resulting in disrupted sleep.1 It has an estimated prevalenceof 3% to 7% in males, 2% to 5% in females, and up to 78% in morbidlyobese patients. OSA results from decreased motor tone of either thetongue or airway dilator muscles, causing complete or partialobstruction of the upper airway during sleep.1,2 Patientswith OSA frequently suffer from daytime sleepiness and reduced qualityof life, as well as cardiac, metabolic, and psychiatric disorders. OSAaffects people of all ages and is most prominent in middle-aged obesemales, with a higher incidence as age increases. Obesity is the primaryrisk factor and contributes to the other disorders commonly diagnosed inthis population.3
Depression Stress And Anxiety
Adjusting to a chronic, debilitating illness sometimes leads to other problems, including depression, stress, and anxiety. Many patients with ME/CFS develop depression during their illness. When present, depression or anxiety should be treated. Although treating depression or anxiety can be helpful, it is not a cure for ME/CFS.
Some people with ME/CFS might benefit from antidepressants and anti-anxiety medications. However, doctors should use caution in prescribing these medications. Some drugs used to treat depression have other effects that might worsen other ME/CFS symptoms and cause side effects. When healthcare providers are concerned about patients psychological condition, they may recommend seeing a mental health professional.
Some people with ME/CFS might benefit from trying techniques like deep breathing and muscle relaxation, massage, and movement therapies . These can reduce stress and anxiety, and promote a sense of well-being.
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Treating Chronic Fatigue Syndrome : Obstructive Sleep Apnea
In obstructive sleep apnea throat passages become closed thus preventing normal airflows to the lungs . As the throat closes and oxygen levels decline the brain signals the throat muscles to contract and reopen the airway. Thankfully they do, letting the air rush in and usually causing a distinctive gasping sound. In some cases of obstructive sleep apnea this can happen hundred of times a night. The hallmark symptoms of OSA are excessive snoring punctuated by gasping sounds.
The constant partial wakening keeps the people with OSA from reaching the deeper, more restful stages of REM sleep. The process usually takes place below the level of awareness with OSA patients usually experiencing fatigue, the desire to sleep during the day, problems concentrating and thinking, moodiness and/or high blood pressure. Untreated sleep apnea in combination with high blood pressure can lead to heart and lung damage.
Obstructive Sleep Apnea is Caused by several factors, not all of which are known. Some cases of OSA may occur because the the brain is not signaling the body to breath deeply enough. Because fatty throat deposits narrow the airway being overweight is a high risk factor for OSA. Other risk factors included large neck circumference, loud snoring, high blood pressure or a family history of sleep apnea. About twice as many men as women have OSA.
Treatments for Mild Sleep Apnea
Treatments for Moderate to Severe Sleep Apnea
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Lifestyle Approaches To Managing Sleep Apnea
There are a variety of lifestyle changes you might consider to reduce your sleep apnea symptoms, including exercise, changing sleep position, and avoiding certain substances. These steps can be helpful on top of PAP treatment, too.
- Exercise regularly: Your doctor may recommend exercise and weight loss. Losing excess weight can help improve blood pressure, make you less sleepy during the day, and reduce your risk of developing diabetes and heart disease.
- Sleep on your side: Studies have shown that sleeping on your back can make sleep apnea symptoms worse. Sleeping on your side is recommended to help improve symptoms.
- Avoid alcohol: Alcohol can exacerbate sleep apnea by potentially contributing to weight gain, making you sleepier than normal, and worsening airway obstruction.
- Quit smoking: Smoking can cause irritation and swelling of the airway, which can contribute to difficulty breathing.
- Avoid certain medications: Some medications can worsen sleep apnea, directly or indirectly. Benzodiazepines, for example, should generally be avoided if you have untreated sleep apnea. Make sure you check with your doctor first before starting or stopping any medications.
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Side Effects Of Sleep Apnea
Some side effects of sleep apnea can be snoring, dry mouth and headache upon awakening, trouble staying asleep, high blood pressure, depression, and possible heart failure. .
This is not a complete list. Talk to your healthcare provider to learn more about the complications associated with sleep apnea.
Where The Research Goes From Here
Looking forward, Prof. Eckert says:
Next, we will look at the effects of these and similar medications over the longer term. We will assess whether we can harness the benefits of one drug without needing to use them both. Equally, we will test whether we can combine these treatments with other existing medications to see if we can improve their efficacy even more.
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Effects Of Cpap On Metabolic Outcomes In Patients With Osahs
The first aspect of the effects of CPAP on metabolic outcomes is insulin resistance, a very important topic discussed later in the current issue of the ERR .
A second intriguing metabolic dysfunction of OSAHS is the change in leptin and ghrelin levels. Leptin and ghrelin represent the yin and yang of a regulatory system that has developed to inform the brain about the current energy balance state in addition, leptin and ghrelin levels play a role in cardiovascular physiology and pathophysiology . The impact of sleep loss on this regulatory system is quite intriguing.
Who Does Sleep Apnea Affect
Sleep apnea can happen to anyone, ranging from infants and children to older adults. Obstructive sleep apnea is more common in certain circumstances and groups of people:
- Before age 50, its more common in men and people assigned male at birth . After age 50, it affects women and people assigned female at birth at the same rate.
- People are more likely to develop it as they get older.
- Having excess weight or obesity strongly increases the risk of developing it.
- Its more common in people who are Black, Hispanic or of Asian descent.
Central sleep apnea is most common in certain groups of people:
- People who take opioid pain medications.
- Adults over 60 years old.
- People with heart conditions such as atrial fibrillation or congestive heart failure.
- For some people using CPAP or who have obstructive sleep apnea, this can trigger the development of central events knowns as treatment-emergent central sleep apnea.
- When people live at high altitudes, this can cause central apneas to occur.
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Upper Airway Surgery For Sleep Apnea
If you have exhausted other sleep apnea treatment options, surgery to increase the size of your airway may be a possibility.
The surgeon may remove tonsils, adenoids, or excess tissue at the back of the throat or inside the nose, reconstruct the jaw to enlarge the upper airway, or implant plastic rods into the soft palate. Surgery carries risks of complications and infections, and in some rare cases, symptoms can become worse after surgery.
Effects Of Cpap On Cardiovascular Outcomes In Patients With Osahs
CPAP treatment in OSAHS patients might result in the reduction of blood pressure, and data on the positive effects of CPAP treatment on cardiac ischaemic disease or cardiac failure also appear quite convincing. Consequently, the present working group decided to address these issues in two supplementary articles also published in the current issue of the ERR .
Several studies have demonstrated a very high prevalence of sleep-disordered breathing following stroke, and have suggested that obstructive apnoea predominates . Establishing whether SDB in the post-stroke period pre-dated, or was caused or worsened by the stroke is difficult. Indeed, it may not actually matter what matters is whether the presence of OSAHS in patients with stroke has an important effect on functional outcome, recovery from stroke, and if OSAHS in stroke is amenable to intervention. Consequently, the present working group focused the discussion on the question is it useful to treat SDB after stroke?, and posed the following questions.
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Selecting The Right Treatment For You
After being diagnosed with sleep apnea, your doctor will help you determine the best treatment approach. Treatment will vary based on other medical concerns you may have, what you are able to tolerate, your lifestyle, and other factors.
The goal is to choose the right treatment based on what works best for you and what you will continue to use long enough to see your symptoms improve or completely resolve.
Make Sure Your Mask Fits Correctly
When it comes to CPAP therapy, one size does not fit all. Its very important to get a mask that fits correctly and is comfortable for you.
There are many different types of masks available, including ones that cover the full face and ones that cover only the nose. Masks also come in a range of sizes, to accommodate different face shapes. There are also options that allow you to sleep in any position, accommodate glasses, and stay on if you toss and turn.
Be sure to discuss your options with your doctor and schedule follow-up appointments to check the fit, evaluate your treatment progress, and adjust or switch your mask if necessary.
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Anatomy Of A Sleep Apnea Episode
As airflow stops during a sleep apnea episode, the oxygen level in your blood drops. Your brain responds by briefly disturbing your sleep enough to kick start breathingwhich often resumes with a gasp or a choking sound. If you have obstructive sleep apnea, you probably wont remember these awakenings. Most of the time, youll stir just enough to tighten your throat muscles and open your windpipe. In central sleep apnea, you may be conscious of your awakenings.
Obstructive Sleep Apnea/hypopnea Syndrome
Vitalsleep mouthguard review sleep apnea hope to deal with fatigue i had a condition called osa for the majority of my youth, which triggered. Chronic fatigue syndrome , also called myalgic encephalomyelitis and systemic exertion intolerance disease , causes people to experience severe fatigue and. Sleep apnea also is a threat to your.
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Scores For Osa Dont Always Correlate With Symptoms
Regardless of the criteria for categorizing OSA as mild, moderate, or severe, the severity of disease does not always correlate with the extent of symptoms. In other words, some people with very mild disease can be extremely symptomatic, with excessive sleepiness or severe insomnia, while others with severe disease have subjectively good sleep quality and do not have significant daytime impairment.
Sleep disorders also tend to overlap, and patients with OSA may suffer from comorbid insomnia, circadian disorders, sleep movement disorders , and/or conditions of hypersomnia . To truly improve a patients sleep and daytime functioning, a detailed sleep related history is needed, and sleep issues must be addressed via a comprehensive, multidimensional, and individualized approach.
Other Stimulant Therapies For Narcolepsy
Methylphenidate
Methylphenidate is a derivative of amphetamines. It is a non-competitive dopamine reuptake blocker with some inhibiting action on serotonin-noradrenaline reuptake. In patients with narcolepsy, methylphenidate improves objective and subjective sleepiness but shows mixed results on performance tests.61 The starting dose is 10 mg per day, with a recommended maximum dose of 60 mg per day. Side effects include nausea, reduced appetite, headache, insomnia, and psychosis. Due to its adverse reactions and abuse potential, it is a second-line treatment or add-on therapy for more stressful situations.62
Dextroamphetamine Sulfate
Dextroamphetamine is a competitive dopamine transporter blocker and is considered third-line therapy due to abuse potential.
Pitolisant
Sodium Oxybate
Sodium oxybate is the sodium salt of g-hydroxybutyrate and considered a standard therapy for EDS with or without cataplexy by the AASM.47 It has been shown to decrease attacks of cataplexy, increase sleep latency, and reduce sleep attacks.64 The mechanism of action remains incompletely understood, but it is partially believed to act on the GABA-B receptors.51,62
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