Hello

I will wait to see if you come online

Hello is it cold down there?

I'm in NYC, we're in a heat wave for a week or more

so let me ask you, have you tried medications to take for excessive daytime sleepiness (eds) ?

ok is there a history of narcolepsy? is that a possibility? family history?

ok

well the medicine we use here in the US for this has changed

it used to be called modafinil (provigil)

but now they have come up with a newer, improved version called eumodafinil (Nuvigil)

I don't know what version you would have in SA

here is a webpage on modafinil the older version

http://reference.medscape.com/drug/provigil-modafinil-343000

well not really, not if you have obstructive sleep apnea as this is a common side effect of that problem

now like I mentioned, if you feel that diagnosis could be wrong

then there is a MSLT or multiple sleep latency test

that checks if you have narcolepsy

or another sleep disorder like excessive daytime sleepiness (eds) or idiopathic hypersomnia

but the botXXX XXne to all of it is that you end up using the same drug

it would be good to have a diagnosis

for narcolepsy, sorry?

symptoms of what?

let me get you some webpages, on narcolepsy , hang on

http://emedicine.medscape.com/article/1188433-overview

Narcolepsy has a triad of symptoms.

excessive daytime sleepiness, hypnogogic hallucinations (vivid dreams at night) and sleep paralysis

you can have this with cataplexy, which is where an emotional disturbance during the day makes you fall instantly asleep

1/3 of people with narcolepsy have it with cataplexy.

anyway, the MSLT will test to see if you have narcolepsy if you have the clinical triad.

it is a special sleep study, where you stress yourself all night, and then come into the sleep lab in the morning and try to fall asleep

multiple times

they have also identified gene testing for narcolepsy, but it really isn't needed, unless you can 't be sure of the diagnosis, but there are criteria based on how you do on the MSLT

there are two medicinal ways to treat this, by keeping you up more during the day with stimulants, like modafinil, which promotes awakefulness without too much stimulation like amphetamines.

or by giving you a stronger sleeping aid at night to make you sleep deeper in non_REM sleep

do you have any questions?

are you there?

oh, no problem, I cannot tell if you leave or not

yes, my guess would be you have Obstructive SA, as that is more common

and that is what they told me,

yes, commonly Obs SA has EDS

the med is the same

one thing you have to consider is a fugue state

do you know what that is?

repetitive visual stimuli, like driving on the expressway the same trip over and over, do you aren't paying

attention lets you drift off into other thoughts, and you miss your exit,

that isn't it correct? you actually fall asleep?

no, you have EDS excessive daytime sleepiness.

if you fall asleep

so you need a medicine. Nuvigil, starting dose is 50 mg in the morning, and you increase to the 150 mg size if you don't feel awake enough.

usually the 50 mg works

if you don't have Nuvigil in SA, then it is Provigil

200 mg in the morning, increase to 350 mg if needed

I did give you a webpage that explains how the drugs work. they are safe, essentially non addictive

they are expensive here in the US because there is no generic

newer meds, no generics yet

the other drug is dexadrine or amphetamine, but that can effect your heart and is more addictive

you have to keep increasing your dose, so I would not recommend it

sure, please rate my service is you can as that is how I get compensation, come back anytime to discuss they

discuss this further, ok? Dr Frank T