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(Orally) Indwelling Chest CPAP machines were generally considered effective for reducing daytime and nighttime tiredness but more research needed to be done confirm this opinion.
(Orally and orally in an individual)
Some clinical trials have found that oral and enuretic agents (such as amiodarone or lopinavir) significantly reduced symptoms of excessive daytime sleepiness. Oral medications are best used to address excessive daytime sleepiness only when is excessive as this likely due to a combination of several factors such as insomnia and sleep apnea. However, oral agents have proven to be effective only among patients already having sleep apnea, or other conditions that may predispose or exacerbate sleep inertia such as obesity, certain medications, hypoglycemia, hypokalemia, and medications associated with cardiac irregularities. Oral medications are also not well tolerated in otherwise healthy patients and the benefits in these patients are generally limited.
(Orally in combination with other oral drugs)
In some cases additional treatment should be considered. Oral and in combination with other oral drugs (such as propranolol, metoprolol, and nafcillin) the antihistamine chlorzoxazone were effective in reducing daytime sleepiness, but they were generally not well tolerated in many populations such as young adults and patients with asthma.
(Orally with a sedative)
Several clinical studies have evaluated the effectiveness of oral drugs with amitriptyline, imipramine, and others which are commonly prescribed for insomnia. Most of these have reported significant decreases in insomnia symptoms including daytime sleepiness, wake after sleep onset (WASO), and inertia but few have studied the clinical relevance of drug response. Many the patients included in studies were treated for excessive daytime sleepiness that often has adverse side effects or is a symptom of deeper disorder which requires more intensive therapeutic attention.
Clinical trials of some amitriptyline and amitriptyline-containing drugs have been completed and published, but many remain underpowered because fewer patients enrolled than expected.
(Orally and a benzodiazepine)
Because benzodiazepine sedating properties are well established in the treatment of moderate daytime sleepiness, several studies have examined the effectiveness of these agents in improving insomnia symptoms. These studies have not, however, been adequately powered and they have yielded conflicting results. Also, no single agent is efficacious for all patients with insomnia, so each patient's combination of drugs has to be considered accordingly when prescribing such medications.
(Orally and an opioid)
Many of the opioid and benzodiazepine sedating properties are well established in the treatment of restless legs syndrome or (Dystonic) symptoms. However, it is unclear whether the effectiveness of opioid sedating drugs transdermal verapamil 15 percent gel cost in maintaining a stable level of sleep and achieving wakefulness is dependent upon an overall improvement in sleepiness due to its sedative effects.
(Oral antihistamines)
In a few trials of oral antihistamines, most have found benefit in treating daytime sleepiness and the associated signs symptoms. However, there have also been reports of significant side effects, including nausea, dry mouth and headache during this treatment approach.
(Orally and a benzodiazepine antagonist)
In several trials of oral antihistamines, benzodiazepine antagonists such as alprazolam and lorazepam have shown some benefit from increasing the sleep efficiency of a sleep-disordered patient. These agents are most frequently used if other sleep medications have not been effective, and, in most patients, may be associated with significant side effects such as headache and stomach discomfort. In these scenarios, oral antagonists should only be considered as an alternative in select situations.
(Orally, lorazepam, and clonazepam are combined with lorazepam to increase the efficacy)
In some clinical trials of combined oral lorazepam, clonazepam, and diazepam, most have found an increase in sleepiness and decreased sedation. Additionally, some patients are not satisfied with standard diazepam medications alone. These clinicians should be able to determine each patient's clinical need, and the efficacy of a combination lorazepam, clonazepam, and diazepam in each patient's individual situation. A combined dosage form (combination of lorazepam and diazepam) with a different delivery mechanism can be designed, and clinical trial data for this combination form can be compiled later.
(Oral propranolol and/or atypical antihistamines or plus a benzodiazepine antagonist)
Although oral propranolol can be administered.
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