Dr. Aida Abaz Quka
Neurology
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Patient's Query
Hello doctor,
I am a 24-year-old male. I take Xanax 500 mcg, Pregabalin 600 mg, Lansoprazole 30 mg OD, Sertraline 100 mg, Sumatriptan 50 mg, Piriton OD, and Propranolol 40 mg TDS, and I am taking all these medications for quite an extended period.
I am taking Prednisolone 30 mg OD, Co-Amoxiclav 500/125 mg OD, and Tiotropium Bromide for a severe lung infection.
At the moment, I am under immense stress from full-time work as a lawyer and master's study. I am having trouble sleeping, for which I am using Zolpidem 10 mg. I have also experienced excessive daytime sleepiness, sleep attacks i.e., falling asleep suddenly without warning, cataplexy (falling over/muscle weakness), sleep paralysis, and hypnopompic hallucinations.
In the past, I have been prescribed Modafinil. This solved all the problems I was facing in a similar fashion about six months ago. Will you recommend the prescription of Modafinil? Please recommend a referral to a neuro as required.
Hello,
Welcome to icliniq.com.
Your symptoms are suggestive of sleep apnea. For this reason, I would agree with Modafinil therapy.
But before that, I would recommend performing pulmonary function tests and a polysomnogram to confirm this diagnosis. I would not recommend the regular intake of Xanax or Sumatriptan.
Zolpidem should not be used for a long time because it can lead to addiction and tolerance. I would recommend Melatonin 5 mg or 10 mg instead, in order to regulate more naturally your sleeping hygiene.
I hope this helps.
Patient's Query
Thank you doctor,
I did suspect sleep apnea. I understand there are both CPAP machine options as well as less used surgery performed. I would actually prefer to have an operation. Do you think this would be possible? Zolpidem and Xanax with Sumatriptan are under close supervision (monthly) of a consultant psychologist. We have discussed the risks and deem it necessary.
Hello,
Welcome back to icliniq.com.
I do not think that surgery can make miracles with this condition. I recommend performing those tests to better examine your airways for possible obstruction and determine the exact type of sleep apnea. Modafinil can be a good treatment option.
Patient's Query
Thank you doctor,
Yes, that does seem to be the case from the literature available. I guess if the otolaryngologist makes a positive diagnosis, a CPAP device might be in order. Is there anything I should consider when choosing a device if needed? Do you tend to recommend a particular type? I have also heard about a BPAP device. Perhaps you could advise on this.
Hello,
Welcome back to icliniq.com.
There is no specific device for this purpose. Every CPAP (continuous positive airway pressure) device is fine. But, you should perform pulmonary function tests and a polysomnogram before.
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Neurology
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