Opinions on use of wake-promoting meds like provigil?

I was diagnosed in August (my original take-home sleep study listed an AHI of 31 and O2 desaturation to 62%), and I haven't experienced much relief since then. I used CPAP (Resmed S9) for about 7 weeks and just switched over to ASV 2 days ago (starting on Respironics, soon to switch to Resmed VPAP). From everything I've read, it could be another month or more before I adjust to the ASV therapy. I am struggling horribly at work. I work as a scientist, primarily writing, but I can't focus long enough to put together a critical-thinking-based sentence. I essentially accomplish next to nothing every day - my brain just feels like a (painful) lump of clay. My productivity has been so low, I am truly worried about my job. I feel like a total imbecile most of the time too - it's uncertain if that's the truth or not ;-P. Anyway, I've been thinking about asking my sleep doc if I could try a medication for a while until I start improving from the ASV therapy - is this a good/bad idea? I definitely don't like the idea of taking another medication, but I'm feeling so depressed and anxious from my inability to focus at work. It's hard to say if the pro's outweigh the con's in this instance.
Are there any forum members who have used a med like this and had positive results? What sort of risks should I be aware of associated with a wakefulness med?

Hi mossy, I have used Provigil in the past and still do, occasionally. I have experienced no adverse effects, but of course everyone is subject to some possible side effects from every drug. I found it to be effective, but I became dose tolerant rather quickly (in weeks), which seems to be fairly common. I found it had little effect on my sleep pro or con, but found that it allowed me to be more alert and better focused during the day. After it seemed to lose it's efficacy for me, I stopped taking it on a regular basis, but occasionally, if I have something important for which I must be alert and focused and haven't had a restorative night's sleep, I will take one and do benefit from it. If your treatment is optimized, yet you are still fatigued or unfocused, I think you could possibly benefit by taking something like Provigil. As far as I know and in my experience, it is not addictive or, at least in my case, habit forming.
Best of luck to you.

Provigil saved my life. I was falling asleep while driving!. I took Provigil until I could get a sleep study, then kept using it for a while after I got my bipap. Pretty soon I didn't need it.

I have been on ProVigil for over 10 years. It has made a world of difference for me. I don't feel safe driving without it. I would live to sleep without it. ProVigil is not a substitute for several hours of sleep. It is interesting that my doctor only suggested a cpap machine a couple of months ago.

I can also share my experience. My sleep doctor started me on Ritalin before I even started down the sleep study road, as I was having extreme daytime sleepiness, including the dangerous situation of nodding off while driving. My doctor actually brought up the idea of a stimulant medication after our discussion of my symptoms and my Epworth Sleepiness score. However, we knew from the start that any potential sleep disorder/s were compounded by my medical conditions and medications, so that was another factor (ie. it was unlikely from the start that CPAP would come even close to fixing my daytime alertness issue). I've been lucky and most days can just take one short acting pill on weekday mornings, and by the time it is wearing off my energy is up enough I am ok. I'll take a half a pill as needed though (such as long driving trips and long work meetings or classes).

We chose Ritalin as my insurance doesn't cover alertness meds off-label (I wasn't yet diagnosed with apnea, nor do I have narcolepsy or ADHD or anything), so I needed to pay cash and it is apparently the cheapest. Also, it apparently may interfere with hormonal birth control pills, and I just didn't want to deal with that long term. I've since gone through several sleep studies which found mild apnea (treated with CPAP) & severe PLMD (treated with Gabapentin). However I've stuck with the Ritalin as I haven't seen enough reason to try something new, despite the cost.

Although I've made some improvements, they haven't been enough to stop the med or reduce the dose. However, I attribute that to my health conditions & meds. Luckily I have not had to increase the dose, although that could be as I actually don't take it much (vs. some people who have a stimulant in their system 16 hours a day, 7 days a week). My doctors are ok with my using the medication long term, even at higher doses or frequencies than I am. Another benefit of something like Provigil (vs. Ritalin) is that it is Schedule IV instead of Schedule II, so it can be prescribed normally (vs. needing a new paper script each time like you would for a strong pain med).

I have heard of others using stimulants for a short time until their apnea treatment is working. For folks who are struggling, especially putting themselves in danger, its a good idea to bring up your concerns with the doctor. One way to do it (vs. flat out asking for a prescription for a stimulant) would be to say you are concerned with your level of function with the daytime drowsiness and difficulty concentrating/focusing in situations such as driving and at work. Ask if anything can be tried in the meantime until your apnea treatment is successful. Mention you are concerned it could be weeks or months for the full effect, etc. Risks for Provigil (and Nuvigil) aren't too high, lower than standard stimulants like Ritalin and Adderall. Common side effects of Provigil are headache, insomnia, nausea, and anxiety. They are less with lower doses taken early in the day. Like any med there are some rare but serious side effects, in the psych and heart categories.

So, like any health concern, I'd talk to your doctor about it. Note that it may however take more than one med and/or dose trial to see any benefit. From what you said it sounds like you could be a candidate for short term use of a med like this. I hope your doctor is helpful! If you are seeing a sleep specialist for your apnea but they have a long wait, even your primary care doctor may be able to help in this area. Best wishes.

Thanks to all of you for the input. I do feel a bit better today, so I'm going to keep my fingers crossed that this improvement will continue. I need to schedule an appointment to follow up after starting ASV treatment, so I may bring it up with my doctor. There is definitely a lot to consider.