Exploring Alternatives to Wakefulness Medications for Fatigue Issues

Medication consultation

Hello Doctor, I visited the outpatient clinic on January 11th due to issues with easy fatigue, frequent zoning out, and prolonged sleepiness.
Aside from Sjögren's syndrome, I have no other health problems.
The doctor prescribed Wakix (Pitolisant) hoping it would help with alertness and concentration.
I do feel more energetic, but as someone who has a habit of napping, I still struggle to fall asleep.
I feel physically exhausted in the afternoon and evening but can't sleep.
My profession is a teacher, and I'm worried this will affect my afternoon classes once school starts.
I would like to know if there are other medications with similar effects that I could try.
I found online that Lisdexamfetamine and Wakix have the same generic name; can you tell me if their efficacy and side effects are completely the same? Thank you for your response!

Xin Lei, 40~49 year old female. Ask Date: 2023/02/05

Dr. Wu Kunhong reply Psychiatry

Thank you for your question.
It can indeed be distressing and stressful to feel tired but unable to sleep during times when you should be resting.
I appreciate your efforts.
Regarding medication, I recommend discussing adjustments with a trusted healthcare professional.
Here are some suggestions to help improve your sleep quality, and I wish you all the best and peace of mind.
1.
Maintain a regular sleep schedule by going to bed and waking up at the same time each day.
2.
Do not force yourself to sleep; if you lie in bed for more than 30 minutes without falling asleep, get up and engage in a gentle activity until you feel sleepy again.
3.
Strictly limit the time spent in bed; avoid lying on the bed during the day and only go to bed when you feel sleepy at night.
Avoid watching TV, using your phone, or making phone calls in bed or in the bedroom.
4.
Create a comfortable sleep environment, including an appropriate room temperature, lighting, reduced noise, and a comfortable mattress.
5.
Avoid caffeine, tea, cola, alcohol, and smoking after dinner.
6.
Prevent nighttime frequent urination by limiting fluid intake after dinner.
7.
Engage in regular daily exercise, and perform gentle and relaxing activities before bed, such as taking a warm bath, muscle relaxation, and breathing exercises.
Avoid vigorous activities before sleep.
8.
Seek professional assistance from a physician and avoid self-medicating with excessive sleeping pills.
Dr.
Wu Kun-Hong

Reply Date: 2023/02/05

More Info

It sounds like you're experiencing significant challenges with fatigue and sleep, which can be particularly concerning given your role as a teacher. The medication you mentioned, 威克倦 (Wikwan), is known to help with wakefulness and concentration, but it seems that it's not fully addressing your sleep issues, especially since you find yourself feeling tired yet unable to sleep in the afternoons and evenings.

First, it's important to understand that medications like 威克倦 (Wikwan) and 慮舒妥 (Lushutuo) may have similar active ingredients, but they can differ in their formulations, dosages, and potential side effects. Both medications are typically used to promote wakefulness, but individual responses can vary significantly. Therefore, while they may share a common purpose, their effects and side effects might not be identical. If you are considering switching or trying a different medication, it is crucial to consult with your healthcare provider to discuss your specific symptoms and concerns.

In addition to medication, there are several non-pharmacological strategies you might consider to help manage your fatigue and improve your sleep quality:
1. Sleep Hygiene: Establishing a consistent sleep schedule can help regulate your body's internal clock. Aim to go to bed and wake up at the same time every day, even on weekends. Create a relaxing bedtime routine to signal to your body that it's time to wind down.

2. Limit Naps: While napping can be beneficial, long or irregular napping during the day can negatively affect your nighttime sleep. If you need to nap, try to limit it to 20-30 minutes and avoid napping late in the day.

3. Physical Activity: Regular physical activity can help improve sleep quality and reduce fatigue. Aim for at least 30 minutes of moderate exercise most days of the week, but try to avoid vigorous exercise close to bedtime.

4. Dietary Considerations: Be mindful of your diet, particularly in the hours leading up to bedtime. Avoid caffeine and heavy meals in the evening, as these can disrupt sleep. Instead, consider a light snack if you're hungry before bed.

5. Create a Sleep-Conducive Environment: Ensure your sleeping environment is comfortable, dark, and quiet. Consider using blackout curtains, earplugs, or white noise machines if necessary.

6. Mindfulness and Relaxation Techniques: Practices such as meditation, deep breathing exercises, or yoga can help reduce stress and promote relaxation, making it easier to fall asleep.

7. Limit Screen Time: The blue light emitted by phones, tablets, and computers can interfere with your ability to fall asleep. Try to limit screen time in the hour before bed and consider using blue light filters if you must use devices.

8. Consult a Specialist: If your fatigue and sleep issues persist despite these strategies, it may be beneficial to consult a sleep specialist or a psychologist. They can provide tailored strategies and therapies that address both your sleep and fatigue issues.

In summary, while medications can play a role in managing fatigue and promoting wakefulness, they are often most effective when combined with lifestyle changes and good sleep hygiene practices. Always discuss any changes to your medication or treatment plan with your healthcare provider to ensure that you are making the best choices for your health.

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