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to treat excessive sleepiness and not as treatment for the underlying obstruction if continuous positive airway pressure cpap is the treatment of choice for a patient a maximal effort to treat with cpap for an adequate period of time should be made prior to initiating nuvigil for excessive sleepiness if nuvigil is used adjunctively with cpap the encouragement of and periodic assessment of cpap compliance is necessary in all cases careful attention to the diagnosis and treatment of the underlying sleep disorder s is of utmost importance prescribers should be aware that some patients may have more than one sleep disorder contributing to their excessive sleepiness the effectiveness of nuvigil in long term use greater than 12 weeks has not been systematically evaluated in placebo controlled trials the physician who elects to prescribe nuvigil for an extended time in patients should periodically re evaluate long term usefulness for the individual patient nuvigil is indicated to improve 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