Provigil

(image from Belle Isle conservatory by me)*

This is day four. I think. I'm so tired I can't think right. Dr. Guyer started me on Provigil. It took a long time—about three weeks, from the time he prescribed it until I actually began taking it, because it is a controlled substance. I had to get prior authorization, which took a while, and give out my precious social security card to the state and so on. What a pain.

I asked why it was a controlled substance and was told at the Pharmacy that it was "a super speed." This annoyed me—why would someone give a super speed to an insomniac? I can't drink coffee or tea or eat chocolate or even ginger or mint tea, all of which are stimulants, so why would Provigil, which is a super stimulant, be a good choice for me? I was not at all eager to take it. Dr. Guyer had repeatedly suggested it and I had repeatedly refused it and finally he told me to try it. So I am.

The first day I started it, I re-researched it, after having done so before, when he'd first suggested it. What is PROVIGIL, and what does it do? PROVIGIL is a medication to treat excessive sleepiness caused by certain sleep disorders. These sleep disorders are narcolepsy, obstructive sleep apnea/hypopnea syndrome (OSAHS), and shift work sleep disorder (SWSD). I have obstructive sleep apnea. I used to think I had narcolepsy, because I fell asleep at the drop of a hat. That was before I got the CPAP.

When I read the THE GOOD DRUG GUIDE (a good place if you want positive information about drugs), I had some ideas why my doctor prescribed it.

1. " ...modafinil ('Provigil', 'Alertec', 'Vigicer', 'Modalert', etc) is a memory-improving and mood-brightening psychostimulant. It enhances wakefulness and vigilance, but its pharmacological profile is notably different from the amphetamines, methylphenidate ( Ritalin) or cocaine. Modafinil is less likely to cause jitteriness, anxiety.
2. Current research suggests modafinil, like its older and better-tested analogue adrafinil, is a safe, effective and well-tolerated agent.
3. Modafinil is used experimentally in the treatment of "atypical" depression. Atypical depression is marked by hypersomnia, hyperphagia [over-eating], low energy, and rejection-sensitivity. The syndrome is actually quite common. The results of preliminary studies have been encouraging, but large-scale trials are needed.
4. It is used "off-label" to treat fatigue, depression, attention deficit hyperactivity disorder, and sleepiness caused by other prescription medications

Notes on the notes:

1. I could use some memory enhancement and mood-brightening (who couldn't?), but I think my memory failures and mood depression is due primarily to LACK OF SLEEP! And I am experiencing jitteriness, nervousness.
2. If it's so safe, why is it a controlled substance?
3. I may have hyperphagia (overeating), but I do not have hypersomnia: Hypersomnia is characterized by recurrent episodes of excessive daytime sleepiness or prolonged nighttime sleep. Different from feeling tired due to lack of or interrupted sleep at night, persons with hypersomnia are compelled to nap repeatedly during the day, often at inappropriate times such as at work, during a meal, or in conversation. I was tired during the day but not sleepy. I was never sleepy, day or night. (Before Provigil.) I almost never nap, because I never feel sleepy.
4. I do have ADHD!! But this drug so far seems to make it worse, not better. Maybe because I am sleeping so poorly.

I also have insomnia and am very sensitive to stimulants. Dr. Guyer told me that Provigil works by releasing histamine in the brain. Histamine wakes you up. Antihistamines make you sleepy. He said it was fast-acting. The literature says it normally takes 12-15 hours to clear the system. If I take it at 8, I should be able to sleep at 11. But I may be overly sensitive.

I also worried the histamine would make my allergies worse, and maybe my fibromyalgia, too, because there is a histamine link with fibromyalgia.

The first day I took it, I basically didn't sleep all night. I slept a little better the second night, but not well, and a little better last night, but still not well. Overall, though, it's been a long time since I've had a good night's sleep and I'm starting to get stupid with it.

My fibromyalgia, which Dr. Guyer repeatedly insists, like my other doctors, is linked to sleep (yes, we do know that, theoretically), but my fibromyalgia, in spite of very bad sleep, has been generally improved. Not good, but better.

The most common side-effects observed with modafinil, as compared to placebo, when prescribed in the recommended doses for the approved indications, are as follows:

• Common
• Headache (34% vs 23%)
• Nausea (11% vs 3%)
• Uncommon
• Nervousness (7% vs 3%)
• Insomnia (5% vs 1%)
• Anxiety (5% vs 1%)
• Anorexia (4% vs 1%)
• Dry mouth (4% vs 2%)
• Rare
• Chest pain (3% vs 1%)
• Hypertension (3% vs 1%)
• Tachycardia (2% vs 1%)
• Vasodilation (2% vs 0%)
• Dizziness (5% vs 4%)
• Paresthesia (2% vs 0%) (pins and needles)
• Somnolence (2% vs 1%) (drowsiness)
• Pharyngitis (4% vs 2%) (sore throat)

Additionally, gastrointestinal distress, which may be alleviated by taking the drug after a meal, aggressiveness and skin irritation have been reported, but are rare.

Most side-effects subside after a few weeks without reducing the dose. Only headaches and anxiety have been shown to be proportional to dose, and these may benefit from a temporary reduction.

I have definitely been experiencing nervousness, anxiety and fairly severe insomnia. And some dry mouth. I was a little worried about the tachycardia because I've had some scary incidents of that. But so far none with the Provigil, but a little flutteriness. The first day was the worse with also a tight chest and the worst nervousness. That part seems to be settling down a little. My allergies do seem to be remotely worse, but insufficiently worse to be a real problem.

The drug seems to wake me up as it takes effect in the morning, but I am still tired from lack of sleep and I feel and behave differently than I would if I just had a good night's sleep. I'm grumpier and can't think as clearly. It wakes me up in the sense of making me a little more alert, but being awake was NOT the problem I had in the first place. I wasn't sleepy during the day. I was tired. Once the drug takes affect, I do feel somewhat less tired. But I'm not sure that the benefit is worth filling myself with controlled substances.

When I started this piece, the drug hadn't taken effect. I said, I'm so tired I can't think right. I do feel better now. However, in the past few days, my thinking has been impaired by tiredness (unless it was impaired by the drug itself.)

If Rozerem, which I am still on, is a downer of sorts and Provigil and upper, than I am on uppers and downers and that doesn't seem so cool.

*(image to represent the strangeness of artificial uppers and downers compared to the real thing of normal healthy sleep and waking.)(an example of how my brain is failing to function properly is that I cannot think of the name of this flower right now, even though I know it perfectly well. tiredness or early alzheimers?)