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Medications

Several classes of medications have proven to be useful in patients with certain sleep disorders. Although there are many medications that have been used successfully in patients with conditions such as restless leg syndrome and periodic limb movements of sleep (PLMS), other sleep disorders do not have any specific pharmacologic treatment. Perhaps of most disappointment is that there are no medications effective for patients with sleep apnea. Accordingly, the treatment for this disorder remains fairly complex and sometimes frustrating. Therefore, it is very important for patients who are on these medications to be followed regularly by their physician or sleep specialist.

Hypnotic medications (sleeping pills) as medications with much more favorable properties and less addictive properties have become available. These medications historically comprised of medications of the "benzodiazepine" category, including Valium (diazepam), Ativan (lorazepam), and Restoril (temazepam). Newer agents that have similar pharmacologic properties to these but with less addiction potential and less morning sedating effects are now available. These include Ambien (zolpidem) and Sonata (zaleplon), which is even shorter acting and usually helpful in patients that simply have difficulty initiating sleep.

Wake promoting agents are medications that improve the level of wakefulness through the day. The medications have become important additions to the list of medications to treat sleep disorders. Historically, these agents have included amphetamines, a class of drugs whose usefulness is limited by their addiction potential. More recently, Ritalin (methylphenidate) and Cylert (pemoline) have become good alternatives to traditional amphetamines in patients with narcolepsy and other conditions of excessive sleepiness. Provigil (modafinil), a wake promoting agent that does not show a significant propensity for addiction or dependence and which is associated with very few side effects has been clinically useful as a wake promoting agent.

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