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Treatment of narcolepsy and effect of CPAP

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I am 63, male, and have had a case of narcolepsy developing for the last 5 years or so and this last year it has been getting much worse. I will be listening to a blaring TV and doze off, then immediately start dreaming like I am in a movie. This is disruptive to my work as a CPA, and is embarrassing when it happens in meetings while listening to speakers and I start snoring. It does not happen when I am active or driving around town. It can happen driving on long trips, especially on hot afternoons, so I caffeine up when its risky. I have been diagnosed with sleep apnea, which I am still not convinced of. I use a CPAP mainly because my sinuses tend to clog up when I lay down, and it does keep me from waking up too often. I get 7 hours sleep a night--sleeping more does not help. I really don't think my daytime sleepiness is related to my nightime sleeping, which people automatic infer. It seems to be just another symptom of aging. Since there is no cure, I am willing to treat it with drugs.

100-200 mg caffeine helps some, but I am told that too much caffeine can raise my blood pressure to risky levels. Lately I have been taking modafinil 200mg tablets, but for it to really help, I need to take 800 mg at a time, and taking that much regularly must be bad for my health as well. I wanted to try taking dexedrine spansule/dextroamphetamine sulfate, but the cost is ridiculously high for long term use. What drug do you think would be best, and not too terribly bad for my health? Each day I also take lisinopril 40mg, metformin 2000mg, simvastatin 20mg, glipizide 20mg, amlodipine 10mg, levothroxine 100mcg and aspirin 80mg for high blood pressure, cholesterol, diabetes, and an aging thyroid. Plus I take a long list of vitamins and supplements.

I consulted about this with my usual doctor, and he ratted me out to the DMV, and I almost lost my drivers license over it. So I have learned that I cannot talk to a physician about this unless it is anonymous or totally confidential, which is why I come to you for advice. By the way, my doctor said that it is more likely “excessive daytime sleepiness” than narcolepsy, but I don’t see the difference. Also, I do not have symptoms of cataplexy. I can find ways to buy drugs online without prescriptions, so you can just suggest recommendations.


Category: Psychiatrist

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Expert:  Dr. Srikanth Reddy replied 4 Days.

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Hello
I have gone through your question in detail and I can understand what you are going through.
I understand that you have hypersomnolence and sleep attacks during day time. And this can be very disabling. Following are the suggestions I can think about which can be done further.:
1) Your thyroid profile needs to be re-checked. I understand that you are already on 100micGm of eltroxin but you will require a recheck of the thyroid profile to see if hypothyroidism is the culprit.
2) You have tried modafinil and are requiring high doses of the same. I would suggest that you should try Armodafinil which is more refined form of modafinil and you may require a lesser dose in that case. The same can be started at 50mg.
3) Excess coffee can help initially but in the long run it will lead to burn out and I would advice you to go off caffeine ones ina while to help give your body a break.
4) Bupropion is another drug which can help in this regard. This will increase the alertness and reduce your day time sleepiness.
You may discuss these option with your treating psychiatrist who can help you with these new prescriptions.
Thanks and regards,

Dr. Srikanth Reddy MD


Dr. Srikanth Reddy
Category: Sexologist
Experience: 
Doctor of Medicine (MD), Psychiatry Residency Program,2001 – 2012
M.B.B.S,Mahatma Gandhi Institute Of Medical Sciences, Sevagram

Certificate Course in sex Therapy and Counselling, Sexology and Counselling, A
Sexology,Medikon Sexual Sciences, Mumbai

Training in Advanced Neurology at a leading corporate hospital (CARE hospital) in Hyderabad

Child Psychiatry Training in National Institute of Mental Health and Neuro-Sciences, Bangalore

Sex Therapy and Counsellingat MEDIKON Sexual Sciences, Mumbai.
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