You May Have a Sleep Disorder If...
Wake up refreshed? Alert throughout the day? If not, you may have a sleep disorder.
Other Sleep Disorders continued...
RLS generally responds well to medication, but since it may
occur sporadically with spontaneous remissions, the continuous use of
medications is generally recommended for symptoms occurring at least three
nights per week. Sleep experts use three types or classes of medications for
RLS and PLMD:
Dopaminergic agents: This class enhances a brain chemical known as
dopamine. Mirapex and Permax have become first-line medication, over older
drugs like L-Dopa with Sinemet.
Benzodiazepines are generally sleep experts' second-line medication.
They must be used carefully due to the potential for addiction and the negative
impact on sleep. This class includes such drugs as diazepam (Valium, Diastat),
Klonopin, Restoril, and Halcion.
Opioids represent the third-line of preferred medication generally
and is reserved for those with more severe symptoms. They may be used alone or
in conjunction with other medications. This class includes codeine (active
ingredient in Tylenol #3), oxycodone (active ingredient in Percocet), Darvon,
and methadone (in very severe cases only).
As one would expect, all of these medications are available by
prescription only and should be taken only while under a doctor's care.
Falling asleep spontaneously may indicate the syndrome of narcolepsy.
Excessive daytime sleepiness is typically the first symptom. It's the
overwhelming need to sleep when you prefer to be awake. Narcolepsy is
associated with cataplexy, a sudden weakness or paralysis often
initiated by laughter or other intense feelings, sleep paralysis, an
often frightening situation, where one is half awake yet cannot move, and
hypnagogic hallucinations, intensely vivid and scary dreams occurring at
the onset or end of sleep. One may also experience automatic behavior,
in which one performs routine or boring tasks without full memory later.
There are both behavioral treatments and medications for this
situation, which can make life livable again.
General behavioral measures include:
- Avoiding shift work
- Avoiding heavy meals and alcohol intake
- Regular timing of nighttime sleep
- Strategically timed naps
Medications typically involve stimulants in attempt to increase the
level of alertness and antidepressants to control the associated conditions
noted above. The effects of stimulant medications vary widely and their dosing
and timing must be individualized.
Provigil is a relatively new medication that improves alertness but
does not act as a stimulant for other body systems. It has few side effects and
low abuse potential.
Stimulants include dextroamphetamine sulfate (Dexedrine,
Dextrostat), methylphenidate hydrochloride (Ritalin, Concerta, others), and
- Multicyclics like Tofranil, Norpramin, Anafranil, and Vivactil.
- Selective serotonin re-uptake inhibitors (SSRIs). These include Prozac,
Paxil, and Zoloft.