Steering Committee
Profiles
Richard P Knudsen, MD,
(Chair)
Dr. Knudsen is dually Fellowship
trained in Pediatric Neurology
and Advanced Clinical Neu-
rophysiology. He is with the
University of California Davis,
Sacramento, CA in the Depart-
ment of Neurology. His primary
interests are in pediatric sleep
medicine and epileptology. He
is especially invested in the
central hypersomnias and the
nocturnally activated epilepsy
syndromes. He is published
regarding Hypersomnias and is
invited to speak internationally
regarding Narcolepsy.
Vyes Dauvilliers, MD, PhD,
(Vice Chair)
Dr. Dauvilliers Professor of
Neurology and Physiology, and
Head of the clinical and research
activity of the sleep laboratory
at the University of Montpellier,
France since 2005. He obtained
his MD in neurology in 2000
(Montpellier) and his PhD in
neurosciences in 2004 (Mont-
pellier). He has been involved in
several international projects on
sleep disorders with the Depart-
ment of Sleep at the Montreal
University Hospital-Canada (Pro-
fessor J. Montplaisir) and with
2013 - 2014
chair
Richard P. Knudsen, MD
vice-chair
Vyes Dauvilliers, MD, PhD
members
Sam Dzodzomenyo, MD
Alan Hoffman, MD
Louis Tartaglia, MD
AASM Membership Sections Newsletter
■
Issue # 4
15
Narcolepsy
Medication Choices For Patients With Hypersomnia
And Anxiety
Alan G.D. Hoffman, MD, PhD, FRCPC, FCCP
Dr. Hoffman has no conflicts of interest to disclose.
Primary treatment for the Central Hypersomnias including narcolepsy
and idiopathic hypersomnia include several oral stimulant medications.
While nonaddictive central stimulants (Modafinil® and Armodafinil®)
can be very effective in the treatment of pathological daytime sleepiness,
other choices including standard release and slow release dextroamphet-
amine, and standard release and slow release methylphenidate are also
widely used. If cataplexy is also present, then sodium oxybate (Xyrem®)
may be a very effective treatment choice for this particular group of
patients.
While many patients can be treated safely and effectively with these
medications, some of them do have significant side effects which limit
their ability to take medications and it is not unusual in the early stages
of treatment of hypersomnias, to find that patients have taken themselves
off all of their medications because of unwanted side effects or intoler-
ance.
Over the past 18 months, we have been treating a 36-year-old dietitian
who presented with hypnagogic hallucinations, sleep paralysis and
sleepwalking/talking parasomnia. Her initial Epworth score was 17/24,
consistent with significant pathological daytime sleepiness, her overnight
diagnostic polysomnogram was unremarkable, but her multiple sleep
latency study was consistent with mild daytime sleepiness. She was
started on Modafinil at an initial dose of 100 mg twice a day and on
the maximal dose of 600 mg daily, was still extremely exhausted in the
evenings and was unable to take care of her young child, raising the
concern of child welfare officials. She was switched to a combination of
short acting and extended release dextroamphetamine tablets and up to
No part of this publication may be reproduced without the permission of the American Academy
of Sleep Medicine (AASM). The statements and opinions contained in editorials and articles in
this newsletter are solely those of the authors and not of the AASM or of its officers, members or
employees. The Editor and Managing Editor of the Membership Sections Newsletter, the AASM and
its officers, members and employees disclaim all responsibility for any injury to persons or property
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