considering nuvigil thoughts alternatives

I am having real problems adjusting to CPAP. Becasue of schedulein, I can not get the ASV Titration thatI hope will fix things for a few more weeks..... I am waking up 3-6 times a night since I started CPAP 101 days ago.

the DR will not giver sleeping pills, becasue I have a lot of centrals, and I have not yet gotten onto the ASV machine......
I am in the office, almost asleep.... the last time I talked to the DR about this, he said we could cionsider Nuvigil.....

I hate to take legal speed, but may have no choice..... It will be while before I can get the ASV machine..... I am tryingto track what wakes me up.... the only real clue is that it seems to align when my o2 is dipping doen to the 88 range for a while.

so the questions:

How well does NUVIGIL work?

How addictive is it?

Any thoughts out there on the general thought of taking speed, when the real problem is poor sleep???

wilsonTX,

First of all, Nuvigil (R-modafinil) isn't speed. Only amphetamines are speed.

There is significantly less medical and scientific experience with modafinil vs. amphetamines and other CNS stimulants such as methylphenidate (Ritalin), with which to make assertions about its long term safety. That said, there seems to be almost no indication that modafinil is dangerous or addictive if considered for intermittent short-term use. There are some scary reports of 1:1000000 serious skin rashes, but there are similar odds of getting hit by lightning. I myself was scared off by the stories of serious skin rashes, and just kept "modafinil" in my bookmarks for several years as another curiosity I read about on the internet. Until I began to get so fatigued that I literally can't work, then the benefit/risk ratio shifted in favor of being willing to ask my Dr. about it.

http://en.wikipedia.org/wiki/Modafinil

In terms of relative safety, based on the potentially neurotoxic effects of amphetamines (see note 1) "speed" should probably be considered a last resort. Ritalin is much safer, with some studies even indicating possible benefits (neurogenesis, protection from neurotoxicity of amphetamines, etc.)--though tremendous controversy and confusion muddies the waters in general due to its prevalent use in children.

But if you had to start somewhere, modafinil would probably be considered the "mildest" option, and thus the logical thing to consider first.

For me, Nuvigil can successfully power me through a full of day of work where I might otherwise be simply unable to work at all--I mean I can't even lift my head off the desk and would otherwise spend 50% of the day resting in bed and the remaining time vertical but just mindlessly passing time www surfing.

The effectiveness is inversely related to how initially impaired I am. If I am desperately fatigued, then the medicine will help to the point where it will still be a constant struggle, but I will be able to win the battle that I would otherwise have lost. I certainly won't be "zooming around like a white tornado."

However, if I'm only moderately fatigued, the modafinil will make me somewhat "speedy." It is overall a pleasant experience, because being able to "do" vs. "not do" is highly preferable. I don't consider this preference to be addictive. That is because, I am certain that if I felt naturally refreshed from sleeping properly, I would even more prefer to function normally and without a medication. Furthermore, knowing that I can feel much better by taking the med. never compels me to take it on days when I had scheduled to not take it (I don't take stimulants on a whim, but rather carefully plan ahead as to my most critical needs). There is also a mild mood elevating effect, though I'm not certain if this is just a result of being able to accomplish things and/or the moderate amount of anxiety that I feel on modafinil, that makes me feel like I "should" have energy.

Now for the bad news.

For me, the long 10-15hr elimination half-life of modafinil makes it interfere with getting to sleep at my normal time. Even if I take it at 6-7am, I will have trouble sleeping until 11pm to 1am, when normally I want to sleep by 10pm. Often I will give myself a concoction of natural sleep aids: a bowl of oatmeal cooked in milk, a calcium+magnesium+vitamin D supplement pill, a big spoon of omega-3 oil, and perhaps some L-theanine. This usually does the trick of getting me to sleep only about an hour later than average. Trouble is, oatmeal before bed every night isn't good for avoiding weight gain.

For mainly the reason that it impairs my ability to get to sleep, I've concluded that regular use of modafinil is not a sustainable daily solution to not being able to work. Hence, these days I resort to it only 1-3 days a week, to get in one single day of "trying to keep my job" time vs. complete absence, to do something life critical like getting to a Dr. appt. to get treatment for my sleep disorder, and to shop for basic necessities and take care of my family. Unfortunately my wife doesn't drive, we have few friends due to being introverts and my lack of energy to socialize over the years, and I have a child to take to music school every Saturday. So my world would turn to true horror if it weren't for this med.--until I can get better sleep.

But it is not a panacea!

In the beginning, I had a few incidences of rather severe mood swings when taking modafinil. It might have been a consequence of coming off of mirtazapine for sleep at the time, as well as the fact that I was also in a "fog" from heavy caffeine use. I have since completely eliminated caffeine from my life, except for the small amount in my beloved dark chocolate.

Modafinil can also cause rather severe anxiety. For me, it produces quite a bit of anxiety, though as I mentioned, as I have gotten used to it, it has become more of a pleasant energizing anxiety similar to a coffee "buzz" rather than something unpleasant. I'm not sure if this is due to having developed a mild tolerance to modafinil, or because I'm just used to the effects.

What is very bad is if something happens in your life that would ordinarily cause a lot of anxiety! If you anticipate such an event, then avoid modafinil!

Also, don't take caffeine in combination with it, as this can lead to severe agitation. If you are already habituated to a constant daily dose of caffeine, then the science says you are completely tolerant to it, so it's probably Ok to keep consuming the same amount. But it might be preferable to consider detoxing from caffeine before taking modafinil.

Finally, initially modafinil also caused me to have some digestive disturbance. I think the reason is that it seems to make the normal pattern of digestive organ "rhythmic motion" change into a different beat or something. Ie., I feel like my stomach is tied in knots, and would poop more often than usual. This effect also diminished after a month or two, to being a mild annoyance rather than quite disconcerting.

A word of caution:

I am deeply concerned about people taking modafinil daily. Because of the long half-life, and though I lack the cognitive ability to back this up mathematically at this time, I do think that daily use will result in a continuous slow buildup of the medication in one's bloodstream.

Thus, I would expect one of two bad things: 1. up-regulation of the cytochrome P450 and related enzyme systems which metabolize and eliminate moda. from the body, or 2. toxicity from having too much in the bloodstream.

I am somewhat surprized that Drs. don't specifically prescribe this med. NOT to be used daily.

In the best case I would expect that if one uses it daily, it would simply cease to be effective. Ie, total tolerance would develop. This would be metabolic tolerance (the liver learns to clear it so fast that it doesn't produce a threshold response), rather than neuronal tolerance. But neuronal tolerance may develop too.

In the worst case I would fear that this would have some adverse long-term health consequence.

One last thing. Just think about the fact that if you are simply too exhausted to function normally, it can't be a good idea to chemically force the body to perform at a much higher level than it wants to given your present state of health.

So, if you conclude to take this med., like anything else that isn't natural to put in our bodies and with not completely understood effects, please take it only when absolutely necessary. You must be the ultimate judge. And ultimately, only you or any one of us adults, should be the judge of what to put in our bodies.

NOTES:

1. It is probable in my view, that the reported neurotoxicity of amphetamine is due to the abusive doses typically used by recreational users. Ie., it may be completely safe in therapeutic doses which are typically 1/20 to 1/5 of typical abusive doses. Even still, from what I've read about it's operating mechanism, it is critical to maintain good nutrition, antioxidants, etc. to reduce the likelihood of neurotoxicity. And amphetamine would be the most potentially addictive of any of the options. The individual likelihood of addiction depends on countless psychological and physiological factors. In general, the risk of addiction is very low if stimulant drugs are used medicinally under Dr. supervision, in recommended dosages, and in pill form. The risk is also drastically reduced in proportion to how many days a week you voluntarily choose to not take such a drug--for the explicit purpose of remaining comfortable with and "in touch with reality" as opposed to the drug's effect--even if reality is hard to bear. It's all about attitude!


P.S. I wish I didn't have so much time on my hands. But regurgitating the accumulated jibberish stored in my brain from years of www surfing is actually very stimulating! So this is my "drug" for days when I don't take a med.

Thank you.....

very good post. The DR is off for the weekend so it will be next week.

I am just making it through the day at work.... zombee by the time I get home. Have had to stay away from the power tools (I enjoy woodworking and clock repair that involves a lot of spinning shart things)

It looks like it is a pill, can you split it and take half of a tablet? maybe half awake for less time??

In some says I am lucky that I have an office, and it is not busy....

wilsonintexas wrote:Thank you.....

very good post. The DR is off for the weekend so it will be next week.

I am just making it through the day at work.... zombee by the time I get home. Have had to stay away from the power tools (I enjoy woodworking and clock repair that involves a lot of spinning shart things)

Yeah, I know the feeling. My boss has banned me from working with high-powered lasers since I'm going on FLMA leave. I don't mind much, because I am fed up with the lasers (scientific lasers are basically always broken), and we have a new guy to do that anyway. It's just that we haven't completely uploaded my knowledge into his brain yet, so I still have to get involved now and then.

It seems the general trend as you get older in your career is more toward management, even if you aren't a manager. I feel I'm most productive now telling others what to do. It's weird. Despite my present horrendous fatigue I still know clearly in my head what to do. But the details of actually doing it myself are mentally agonizing.

wilsonintexas wrote: It looks like it is a pill, can you split it and take half of a tablet? maybe half awake for less time??

In some says I am lucky that I have an office, and it is not busy....

Standard dose of R-modafinil (Nuvigil) is 150mg. This might be a little too hot for some people. There is a larger pill, 250mg, available as well.

If you take half of a 150mg pill, 75mg, it will probably be too weak. 100mg however, might be just right because Provigil, the older racemic modafinil preparation had a standard dose of 200mg, which is equivalent to 100mg of Nuvigil, since only the R stereoisomer is pharmaceutically active.

It would be difficult to precisely chop a 150mg Nuvigil into a 2/3 piece of 100mg, without crushing it and using a high precision balance, or doing something akin to what cocaine users do with a razor blade and mirror. I think that might feel incredibly awkward and anyway, it wouldn't be precise enough to recommend. Can you imagine if your spouse saw you doing that ?

You could ask your Dr. for a 15 day supply of the 250mg pills, and tell him it's your intention to take 1/2 of a pill at a time. Perhaps even pharmacies can split pills for you?

Good luck.

P.S. is your BP normal? It might not be recommended to take a stim. with high BP.

I have a sample of provigil 200 and thought that I would try it at home first.
So far very good. I was able to get up, did some shopping, and cut the grass. That is the most exercise I have had in a few weeks.

My BP has been normal recently. Last year it was high and we tried some BP meds, it dropped it to below 100.... that was the last time I felt like a zombie.

I just took it, 135/72 with a cat in my lap purring.

I am someone who never smoked a joint. I was not sure what I was expecting, but right now I simply feel normal. This is what I was hoping CPAP would do for me. Maybe next month when I get on ASV and get everything under control I will start sleeping again. Awake 3 times last night once was in the middle of a nasty cluster of centrals. Oh well, a few more weeks.


Thanks for the support.

wilsonintexas wrote: I am someone who never smoked a joint. I was not sure what I was expecting, but right now I simply feel normal. This is what I was hoping CPAP would do for me. Maybe next month when I get on ASV and get everything under control I will start sleeping again. Awake 3 times last night once was in the middle of a nasty cluster of centrals. Oh well, a few more weeks.
Thanks for the support.

I hope you succeed at getting restored to healthy sleeping. Keep us posted.