Opinion
Video
Treatment Selection for EDS in Patients With OSA
Author(s):
Panelists discuss how they select between wake-promoting medications (modafinil, armodafinil, and solriamfetol) by explaining neurotransmitter mechanisms to patients while acknowledging that practical factors like insurance coverage and accessibility often drive treatment decisions more than theoretical mechanisms.
Video content above is prompted by the following:
When discussing wakefulness-promoting medications with patients, the panelists explain the underlying neurotransmitter mechanisms rather than simply prescribing. He educates patients about how chronic intermittent hypoxia and fragmented sleep from obstructive sleep apnea (OSA) can affect dopamine-producing brain cells, reducing the production of essential wakefulness neurotransmitters. This foundational understanding helps patients comprehend why medications targeting these specific pathways—dopamine, GABA suppression, and glutamate enhancement—can effectively address their residual sleepiness despite adequate OSA treatment.
The selection process between modafinil, armodafinil, and solriamfetol often depends on practical considerations including insurance coverage, cost, and medication access rather than purely clinical factors. Jones notes that certain high-risk populations, particularly commercial drivers whose livelihoods depend on maintaining wakefulness, tend to be more accepting of pharmacological interventions. The availability of solriamfetol samples in clinic settings provides a significant advantage, allowing physicians to assess medication effectiveness before navigating insurance approval processes.
Solriamfetol distinguishes itself through its dual-action mechanism as both a dopamine and norepinephrine reuptake inhibitor, compared to the more complex and less well-defined mechanisms of modafinil compounds. This dual neurotransmitter approach may explain why patients report different subjective experiences with solriamfetol, often describing improved cognitive clarity and mood alongside enhanced wakefulness. The medication selection ultimately relies on individual patient response, insurance considerations, and the practical aspects of medication acquisition, with all three available options demonstrating clinical effectiveness for treating excessive daytime sleepiness in OSA patients.
Newsletter
Keep your finger on the pulse of neurology—subscribe to NeurologyLive for expert interviews, new data, and breakthrough treatment updates.
