Management of Excessive Daytime Sleepiness in Osmotic Demyelination Syndrome

Treatment of Residual Excessive Daytime Sleepiness

The American Academy of Sleep Medicine recommends modafinil for the treatment of residual excessive daytime sleepiness in patients with neurological conditions when other causes have been ruled out 1, 2
Before considering modafinil for ODS-related somnolence, clinicians should rule out other causes of sleepiness, including insufficient sleep 1, poor sleep hygiene 1, other sleep disorders 3, and depression 1, 2
Modafinil has shown efficacy in treating excessive daytime sleepiness in other neurological conditions, such as hypersomnia secondary to Parkinson's disease 4, dementia with Lewy bodies 4, and narcolepsy-like phenotypes in patients with Prader-Willi syndrome 5

For elderly patients or those with neurological conditions, modafinil can be started at 100 mg once upon awakening, with potential increases at weekly intervals as necessary 3
Modafinil is a Schedule IV controlled substance due to potential for abuse or dependency 4
Common adverse effects of modafinil include headache, upper respiratory tract infections, dizziness, nausea, sinusitis, and somnolence 4

Modafinil may cause fetal harm based on animal data, and human data are insufficient to determine risk 4
A 2018 report from the armodafinil/modafinil pregnancy registry showed higher rates of major congenital anomalies in children exposed to the drug in utero 4
Modafinil may reduce the effectiveness of oral contraception 4
Careful monitoring for side effects is necessary, especially in patients with neurological conditions 3