Nuvigil

[janalee]

Is anyone currently taking Nuvigil to help with extreme fatigue? My numbers continue to be great but I continue to experience extreme fatigue & brain fog & my Neurologist is suggesting Nuvigil to see if that helps with the extreme fatigue?

I'm currently having many tests performed, mostly blood work to check for a possible autoimmune issue & previous Lyme issues. I recently had an MRI performed & the report indicated possible demyelinating illness (MS?) & I'm probably going to be scheduled for more tests, depending upon what this resent round of blood work shows?

I have severe OSA, Insomnia & Alpha-Delta or Alpha Intrusions. I've been using a CPAP machine since 12/08, recently changed my CPAP machine in 6/10 (new sleep studies & new sleep doctor), now using Auto feature w/great numbers, using Neurontin for the insomnia (keeps me from waking up all night long) & nothing for the alpha intrustions (yet)?

Any insight?

Thanks,
Janalee

[Desperate_in_DM]

I'm currently taking Provigil, which is very similar to Nuvigil. It was working last fall, but is no longer helping with fatigue. I'm having some adverse side effects, so I'm hesitant to continue it if it doesn't really help anyway. Provigil does not help with my brain fog and I feel it is contributing to my vertigo and feeling disconnected from my body. Also, it was causing shaking in my hands and arms.

[SleepingUgly]

I have taken Provigil for many years in the past, I tried Nuvigil, and I am currently on 800mg of Neurontin (down from 1200mg). Do you have pain? Alpha intrusions can be associated with pain syndromes. I also had a history of alpha intrusions, but at that time no pain syndromes (maybe they were prophetic signs?! Now I have more pain than I did then). I tried Gabitril at one time for the fragmented sleep, but didn't find it incrementally improved things over and above the Neurontin. My understanding is that Neurontin can help with the fragmented sleep. How many mgs of Neurontin are you on?

[davecpap]

Are you healthy enough to exercise? There was a large meta-study showing exercise to be more effective than Provigil (modafinil).

http://researchmagazine.uga.edu/winter2 ... ercise.htm

I'm not sure why, but recently the European equivalent of the FDA said that Provigil should NOT be used to treat residual excessive daytime sleepiness in OSA patients:

http://www.sleepreviewmag.com/news/2010-08-18_05.asp

[torontoCPAPguy]

I had all those symptoms and was taking all those drugs and still having all those symptoms so I changed doctors and he prescribed another new pill for me. Still having all the symptoms but now at least I can make a meal with a couple of slices of rye bread and some mustard!

Jeez, guys, just when I think I'm approaching my silver bullet with an oxygen concentrator you have to go and throw this stuff at me? I've got to go and dig out my dictionary again.

[janalee]

Thanks so much for the responses, I really appreciate it!

I'm seeing my Neurologist on Wednesday & he should have blood work & an MRI to review with me & I'll see where that leads me?

I'm taking 600mg Neurontin for the insomnia (fall asleep fine but wake up often throughout the night) & that seems to be working well. My Neuro. claims that the Nuvigil is supposed to counteract the alpha intrusions since there's no way to stop them & he says that there are some people with OSA who continue to have extreme fatigue even with successful treatment with CPAP? Because of the other possible health issues, I haven't been quick to try another drug & I'm not happy about taking the Neurontin in the first place! UGH!

I have the best intentions to exercise more...but my fatigue seems to get the better of me, but I can try a bit more each day & hope that it makes a difference?

Thanks again,
Janalee

[roster]

I'm not sure why, but recently the European equivalent of the FDA said that Provigil should NOT be used to treat residual excessive daytime sleepiness in OSA patients:

http://www.sleepreviewmag.com/news/2010-08-18_05.asp

Thanks for the link. In the article they do state why they recommend Provigil not be used to treat OSA patients:

For all other indications, the Committee found that the risk for development of skin or hypersensitivity reactions and neuropsychiatric disorders outweighed the evidence for clinically important efficacy.

They also say:

... recommended that use of the medicine be contraindicated in patients with uncontrolled moderate to severe hypertension and in patients with cardiac arrhythmias.

Before taking any drugs to treat daytime sleepiness, patients should have data capable machines and check that their therapy is effective. Excellent sleep hygiene should also be practiced.

[SleepingUgly]

Are you healthy enough to exercise? There was a large meta-study showing exercise to be more effective than Provigil (modafinil).

http://researchmagazine.uga.edu/winter2 ... arexercise.

This article says:

The study, published in the November 2006 issue of the journal Psychological Bulletin, found that the effect of exercise was stronger than treatment with stimulants such as the narcolepsy drug modafinil. Specifically, exercise increased energy and reduced fatigue by 0.37 standard deviations when compared to control groups, whereas participants in a previous study taking the narcolepsy drug modafinil had an improvement of 0.23 standard deviations.

From reading this, it sounds as if they are comparing one study in which subjects exercised or didn't with another study in which subjects took modafinil (or didn't?). They don't say whether subjects in one or both studies were normal, healthy subjects or whether the subjects who took modafinil were narcoleptics or another group.

[jonquiljo]

I take Adderall for ADD, though I am way past school age. I've been "sleepy" for 20 or more years and snore a lot. But I've had a concentration problem my whole life. The adderall changed my life for the better and while it does not make me speedy, I can concentrate much better and therefore stay awake longer and more consistently.

Now I wouldn't suggest something as powerful as Adderall for anyone unless their Dr recommended it. It basically is Amphetamine - but I believe it is safe for me to take it and I am in my late 50's. My cardiologist even told me that he thought it was OK for me to take. Then again, I have been physically active my whole life.

I've tried Provigil and it seemed like it was more "speedy" than simple old Adderall. The problem can be that Amphetamine has a bad reputation for abuse, so it is highly restricted. It is a lot easier for a Dr. to give a patient Provigil. I guess people need to talk to their Dr.'s and decide what is best and wade through all the politics.

[SleepingUgly]

I've tried Provigil and it seemed like it was more "speedy" than simple old Adderall.

It's not clear how well Provigil works for ADHD relative to stimulants, and who knows how well it worked for you. So you might have experienced its alerting properties without as much of the attentional ones. Just a guess.

[jonquiljo]

I've tried Provigil and it seemed like it was more "speedy" than simple old Adderall.

It's not clear how well Provigil works for ADHD relative to stimulants, and who knows how well it worked for you. So you might have experienced its alerting properties without as much of the attentional ones. Just a guess.

Well, it's actually amazing. I could easily sleep after taking enough Adderall to make a normal person run around the block for a few hours. Unless I take more than prescribed, which isn't a small dose - I rarely feel energized from it. But if you don't have ADHD, you get quite energized from adderall, which is why so many kids in college want it to study.

What I do see as I look back is that I have always been easily bored and so easily distracted. When I am bored I tend to want to tune out or go to sleep. I've been that way since I was a little boy. I just happened to have developed apnea also later in life. Lots of people with ADHD have said that Provigil helps them, but that they develop a tolerance.

The reason I mentioned Adderall at all is that it can be stimulating for those who need a daytime boost, comes in small doses so you can easily control it (the half life is not that long like Provigil), and it's inexpensive compared to Provigil. The major downside is the stigma associated with amphetamines and the politics of a highly controlled med. If you find a good and understanding doctor (harder than you think), you can get a script and try it out. The only drawback is that it is schedule II so a new script ( and presumably a Dr's visit) is required each month - it is not refillable.

[roster]

What I do see as I look back is that I have always been easily bored and so easily distracted. When I am bored I tend to want to tune out or go to sleep. I've been that way since I was a little boy. I just happened to have developed apnea also later in life.

I am a betting man and if there were a way to check it, I would bet a large sum of money that you had sleep-disordered breathing (maybe sleep apnea) as a child.

I am sure I had it when I was 23 and likely much earlier. It took decades to get a diagnosis.

Do you know that some pediatricians have figured out something about ADD and ADHD? That something is that many of the kids have sleep-disordered breathing (SDB) and need CPAP, tonsillectomies, or other therapies instead of drugs. The drugs were only treating the symptoms. The root cause was SDB.

[jonquiljo]

Perhaps - we will unfortunately never know as no one looked for ADHD or sleep apnea back then. Instead we ate margarine thinking it was better for you!

Seriously though, I am not sure about the ADHD part. I have had a focus problem all my life - and did well in school despite it, but had to go the radical way. I can get things done since I started taking ADHD meds that I wouldn't have even thought about before. And these are basic things.

For instance I was a biotech scientist (molecular biologist) when I was younger. I worked in a lab for a long time, but could never keep coherent notes. I worked for hours and hours on end - but the organizational stuff always baffled me. I am far more organized today, though my life is infinitely more complex (others to worry about - i.e. - family), etc. I've grown more weary in my 40's and now 50's - which is why I sought help for sleep issues. But only in the last 5 years or so (since I started ADHD treament) have I really been able to multi-task like everyone else. If I were to bet, I would say that they are two distinct issues, at least in my case.

[roster]

Do you have any hypotheses about the cause of your ADHD?

[SleepingUgly]

Do you know that some pediatricians have figured out something about ADD and ADHD? That something is that many of the kids have sleep-disordered breathing (SDB) and need CPAP, tonsillectomies, or other therapies instead of drugs. The drugs were only treating the symptoms. The root cause was SDB.

SDB should be ruled out when a child presents with ADHD-like symptoms. However, it is not the case that many of the children with ADHD-like symptoms have SDB and not ADHD. Some have both ADHD and SDB, and a handful of those with ADHD-like symptoms have SDB that is masquerading as ADHD. It's a good thing to rule out, though, and some people get lucky. We didn't. When our son presented with ADHD-like symptoms, we had sleep studies done. He had PLMS (which are more common in kids with ADHD) and eventually was said to have SDB when the negative studies were reread by those with a more lenient scoring system. We hoped that treating his SDB would "cure" his ADHD-like symptoms, but it did not. Still, I would do it all over again, as I felt a T&A is a small price to pay for a crack at not having a life-long disability.

I would expect someone with OSA with EDS to have a great deal of overlap in symptoms as someone with ADHD, but certain symptoms would be unexpected in an adult without significant EDS. If you don't have significant EDS, I can't think of any good reason an adult without ADHD would have significant organizational issues that would interfere with work performance (unless they have something else). ADHD is a disorder that begins in childhood, so there's a certain degree of guesswork involved in diagnosing it for the first time in adulthood, unless there are good records or good memories for childhood. Of course it's always easy to say that maybe someone had OSA in childhood, and that accounted for the symptoms, and it's hard to disprove that hypothesis.