"please keep me updated about oximeters "
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Nuvigil
Before today, I had not heard of this drug. http://www.nuvigil.com/pat/what_is_nuvigil/index.php
This medication is precribed to improve wakefulness during the day for those OSA patients who are successfully being treated with PAP therapy and still complain of day time sleepiness. And narcoleptic patients.
The cause for me to investigate this medication was because an APAP trial patient of mine used this medication during half of the trial and after splitting the results up, one while on and one while off Nuvigil, a signifant change was noticed in regards to his AHI. While using the Nuvigil during the first half of the 16 day trial his AHI was 5.6, AI 2.7, HI 2.9. After stopping the use of Nuvigil his AHI went down to 2.0, AI 0.1, HI 1.9. THe change in pressure requirements did not change. Before 9.8 after 9.4. Not a significant enough of a change. Which leads me to believe that there must be some nero effects of this medication causing more central episodes to occur while asleep.
Has anyone else seen this?
Neal
This medication is precribed to improve wakefulness during the day for those OSA patients who are successfully being treated with PAP therapy and still complain of day time sleepiness. And narcoleptic patients.
The cause for me to investigate this medication was because an APAP trial patient of mine used this medication during half of the trial and after splitting the results up, one while on and one while off Nuvigil, a signifant change was noticed in regards to his AHI. While using the Nuvigil during the first half of the 16 day trial his AHI was 5.6, AI 2.7, HI 2.9. After stopping the use of Nuvigil his AHI went down to 2.0, AI 0.1, HI 1.9. THe change in pressure requirements did not change. Before 9.8 after 9.4. Not a significant enough of a change. Which leads me to believe that there must be some nero effects of this medication causing more central episodes to occur while asleep.
Has anyone else seen this?
Neal
Views: 28
Replies to This Discussion
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Permalink Reply by Mary Z on
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Neal,
I would be real interested in you sleep therapist's thoughts on this. I have been on Provigil for continued daytime sleepiness (200 mg/day) and Nuvigil is the longer acting version. I continue to have a moderate amount of AHI events during the night and wonder now if I've gotten into a vicious cycle of taking Provigil and thus increasing the severity of my OSA. I just switched to a BiPAP machine and the object is to get my events down and get me off Provigil. Maybe I just need to tough it out for a few days and see if the events decrease (can get a report from the machine) and my conttinued daytime sleepiness improves.
Thanks,
Mary Zimlich
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Permalink Reply by Neal Buckner, LRCP on
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Like I said Mary. I am unfamiliar with the effects of Nuvigil, likewise Porvigil. But it does raise a question based on this one case. Since his AHI had a marked decrease once he stopped taking the Nuvigil. I have seen studies showing that children on Ritalin for ADHD have had increased sleep issues and it makes me wonder if there might be some correlation.
Mary Zimlich said:Neal,
I would be real interested in you sleep therapist's thoughts on this. I have been on Provigil for continued daytime sleepiness (200 mg/day) and Nuvigil is the longer acting version. I continue to have a moderate amount of AHI events during the night and wonder now if I've gotten into a vicious cycle of taking Provigil and thus increasing the severity of my OSA. I just switched to a BiPAP machine and the object is to get my events down and get me off Provigil. Maybe I just need to tough it out for a few days and see if the events decrease (can get a report from the machine) and my conttinued daytime sleepiness improves.
Thanks,
Mary Zimlich
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Permalink Reply by RockRpsgt on
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I have not seen anything to this effect as of yet. Currently I have not had a patient on either. I will keep an eye out for you though.
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This patient has been on CPAP for 9 years. The change was sudden. He is one of those 100% compliant patients. He had been complaining of day time sleepiness so his doc ordered an increase in his CPAP from 10 cmH2O to 12 cmH2O. When that didn't work we did an APAP trial. The trial showed his pressure requirements only needed to be at 10 cmH2O while both on and off the Nuvigil. However, the difference in his AHI was dramatic from week one while on Nuvigil and week two while off Nuvigil. There were no other variables like colds or other med changes in that time period. Otherwise I would have just chalked it up to coincidence or idiopathic. But, based on his previous downloads while on 10 cmH2O and other meds similar to Nuvigil his AHI was as high as 9. So it leads me to believe, with this patient especially, that stimulants can have an effect on central brain function during sleep.
Cindy Brown said:Just a few questions. Was the trend gradual or was there a marked decrease in AHI suddenly after the discontinuance of the Nuvigil? Why do you think there is an increase in central episodes while on the medication? One could say that perhaps the numbers improved merely because the patient became more acclimated to therapy. Untreated OSA can cause some irritation of the airway and will improve over time thereby decreasing respiratory events. Or it could just be a coincidence and there is no correlation between the two. One would have to look at many studies some with and some without the Nuvigil or Provigil in the mix. Both drugs do affect sleep architecture in that they inhibit REM sleep and are neurologically stimulating. I personally take Provigil because I work nights and it helps me to stay awake and more functional than coffee does and I feel I have fewer side affects.
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