(FDA approved in bold)

• Reducing excessive sleepiness in patients with narcolepsy or shift-work related sleep disorder
  
• Reducing excessive sleepiness in patients with obstructive sleep apnea (OSA)/hypopnea syndrome

• Unlike traditional stimulants which act directly via dopaminergic pathways, it may also act in the hypothalamus by stimulating wake-promoting areas, or inhibiting sleep-promoting areas
  
• It may also have effects on dopamine transporter pathways similar to other stimulants, hypothetically inhibiting the dopamine transporter
  
• Increases neuronal activity selectively in the hypothalamus and activates tuberomammillary nucleus neurons that release histamine
  
• It also activates hypothalamic neurons that release orexin/hypocretin
  
• Armodafinil is the R-enantiomer of modafinil (a mixture of R- and S-enantiomers)

• Typically 2 hours, although maximal benefit may take days-weeks

• Continue to use indefinitely as long as symptoms persist. Complete resolution of symptoms is unusual. Does not cause insomnia when dosed correctly

• Change to most effective dose or alternative agent. Re-evaluate treatment of underlying cause (i.e., OSA) of fatigue. Consider other causes of fatigue (i.e., anemia, heart disease) as appropriate. Screen for use of CNS depressants that can interfere with sleep, i.e., opioids or alcohol

• In treating OSA, armodafinil is an adjunct to standard treatments such as continuous positive airway pressure (CPAP), weight loss and treatment of obstruction when possible
  
• In narcolepsy, tricyclic antidepressants or SSRI may be of some help. Sleep hygiene is also important. As a last resort, the CNS depressant sodium oxybate can be used

• None required