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Some Audience Responses To Date:
My Thoughts On These Comments:
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"The study sample was so small, it leads me to wonder if the subjects' sleep quality may actually have improved somewhat (mini-arousals are easily missed
as noted by you in a previous article). There are two reasons I think this could be true: (1) there is some evidence that another stimulent- nicotine improves nightime breathing response and (2) if modafinil is a vasoconstrictor (I don't know if it is, but other stimulants do have vasoconstricting effects), it may be helping to shrink nasal passages and thus promote a less resistant breathing passage. Could it be that modafinil is particularly good at promoting both these effects?"
The study sample is certainly small. The study has the character of a first trial of a drug for a certain indication. I presume that much more extensive trials in narcolepsy preceded the drug's marketing in France, but I am quite unfamiliar with this literature. My 1994 text on sleep medicine makes only passing reference to it as a stimulant drug used in a few countries for narcolepsy. The next time I visit the Biomedical Library, I will make a point of finding out more. From the sound of it, modafinil is a "non-amphetamine" in chemical structure but shares a lot of properties, although the authors identify it as a direct stimulator of adrenergic receptors whereas I think of amphetamine-like drugs as indirectly-acting, by displacing norepinephrine (and probably other neurotransmitters like dopamine) from their presynaptic storage into the synaptic cleft. What this would mean from a practical standpoint is quite unclear to me. Apparently it has less adverse effects on blood pressure and sleep than one would expect with amphetamine-like stimulants. To the extent that it is being described as having less "peripheral autonomic" effects than amphetamines, I would expect it to be less, not more, potent as a vasoconstrictor.
Until you pointed it out, I was also unaware of any beneficial effect of nicotine on sleep, though I was certainly aware of sleep disturbance as one symptom of nicotine withdrawal. My sleep text says only that nicotine "may increase the tone of the upper airway muscles during sleep, but the effect is not prolonged enough to be clinically useful in obstructive sleep apnea." I don't know whether that statement would still hold true for long-acting forms of nicotine, i.e., the nicotine patch.
Your comments are a good example of how reader responses can help me in leading me to questions I can't immediately answer but can follow up on and learn more myself. Thanks!
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