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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 46. This is the beginning of the thread.
Posted by alesta on August 26, 2004, at 11:47:50
y'all taking or considering taking provigil, *please* check out this 4-page dialog....
amy
Posted by alesta on August 26, 2004, at 11:54:29
In reply to um.....interesting dialog on PROVIGIL.......oh my, posted by alesta on August 26, 2004, at 11:47:50
ahhhhhhh! forgot the link! here it is:
http://www.talkaboutsleep.org/cgi-local/ultimatebb.cgi?ubb=get_topic&f=2&t=000948&p=
Posted by SLS on August 26, 2004, at 12:16:50
In reply to Re: um.....interesting dialog on PROVIGIL.......oh my, posted by alesta on August 26, 2004, at 11:54:29
> ahhhhhhh! forgot the link! here it is:
>
> http://www.talkaboutsleep.org/cgi-local/ultimatebb.cgi?ubb=get_topic&f=2&t=000948&p=
Quite a few angry people there.Thanks for posting the link.
- Scott
Posted by zeugma on August 26, 2004, at 19:41:44
In reply to um.....interesting dialog on PROVIGIL.......oh my, posted by alesta on August 26, 2004, at 11:47:50
thanks amy for posting the link, i read all the invectives. I am planning on taking 100 mg Provigil tomorrow, no Ritalin, to see what happens. here are some observations over the past few months:
Provigil does cause a lot of side effects, mostly gastrointestinal, a feeling of being slightly queasy. It can cause insomnia (which I can't tolerate for long). It is known to be ineffective against cataplexy, that is why TCA's or SSRI's are typically coprescribed for narcoleptics (the same is true for those taking Adderall or Ritalin).
Cognitively: it does cause a slowdown. This may actually be how it works for ADHD, when it does work for that condition. For me it is a possibly therapeutic effect, where I can't resist the impulse to 'zone out'; there's a kind of pause in that process that it causes that leads me to pull myself out of the fog. I don't know if Ritalin does this because I have only taken 10 mg/day of Ritalin and while that has an effect it is not an optimal dose. I won't be able to up the dose of Ritalin until next time I see my pdoc and it seems he prefers that I see what Provigil does. In any case I have enough Provigil to get me through to next appt. but I need to be sparing of the Ritalin. I think he considers provigil safer to combine with nortriptyline. I'll post results of my experiment in the next day or two.
-z
Posted by zeugma on August 26, 2004, at 19:47:29
In reply to um.....interesting dialog on PROVIGIL.......oh my, posted by alesta on August 26, 2004, at 11:47:50
oh... and if my posts in the next day or two become notably stupid, please let me know. i read those horror stories of people thinking they were brilliant on Provigil only to be told they were actually complete idiots. Reminds me of my old college roommates who had these brilliant 'insights' on coke...
z
Posted by alesta on August 27, 2004, at 7:05:14
In reply to Re: um.....interesting dialog on PROVIGIL.......oh my, posted by SLS on August 26, 2004, at 12:16:50
> Quite a few angry people there.
they sure are. this mild-mannered "mother" writes in for advice, and they just pounce on her! it's hard to know if you can take what they say seriously. our board seems so calm and rational compared to theirs. :)
amy :)
Posted by alesta on August 27, 2004, at 7:18:29
In reply to Re: um.....interesting dialog on PROVIGIL.......oh my, posted by zeugma on August 26, 2004, at 19:47:29
hi, zeugma :),
thank you for the info. yes, please let us know how you are doing on the provigil. and i'm almost positive that ritalin doesn't have that effect.
> oh... and if my posts in the next day or two become notably stupid, please let me know. i read those horror stories of people thinking they were brilliant on Provigil only to be told they were actually complete idiots. Reminds me of my old college roommates who had these brilliant 'insights' on coke...
will do, zeugma, will do. (lol:))
amy :)
Posted by Dr. Bob on August 27, 2004, at 9:03:52
In reply to Re: um.....interesting dialog on PROVIGIL--sls, posted by alesta on August 27, 2004, at 7:05:14
Posted by SLS on August 27, 2004, at 9:27:36
In reply to Re: :-) (nm), posted by Dr. Bob on August 27, 2004, at 9:03:52
Posted by zeugma on August 27, 2004, at 19:26:19
In reply to Re: um.....interesting dialog on PROVIGIL--sls, posted by alesta on August 27, 2004, at 7:05:14
Well, I made it through a full day with this dreaded drug. I skipped the Ritalin and took 100 mg Provigil at 5:15 a.m., on an empty stomach. About 45 minutes later I had breakfast, and in preparation for this great experiment, I had made a small pot of half-caffeinated coffee. The level of stimulation from Provigil was perceptible, and I actually didn't waste the entire morning; I performed such minor but commendable actions as opening the week's mail and paying a bill that was about to go past due. (You can't believe how hard it is for me to get myself to do these things under ordinary circumstances.) And I took my run in the morning, about 9 a.m., instead of waiting till dusk to leave my apartment.
Other minor but commendable actions performed: getting my refill of Provigil (ha), depositing my paycheck, reading part of a magazine I've been asked to review. And I got to work on time. (You see? Provigil isn't that bad.)
Now for the downsides: I felt a crash about 4 p.m., cognitively and physically. So the duration of action is about 10 hours. The crash is very unpleasant. It is worse than I experienced on Ritalin LA, but I wonder if that is due to the fact that the dosage of Ritalin was too low to get me too far above baseline- my Provigil crash returned me to baseline, which means that it must have had a powerful energizing effect to produce such a contrast. Some gastrointestinal distress, which seems to come with the territory.
I think I may need more than 100 mg, if I were going to use this med as stimulant monotherapy. The crash is bad, and the peak, while definitely better than I was getting from the 10 mg Ritalin formulation, is still too modest. Its effect is different from ritalin. I would describe it as a very 'self-conscious' kind of effect, in which I'm strongly aware of where my attention is at any given moment. And when the crash comes, it's like things start getting blurry again. And the fatigue is awful.
I dealt with the crash (luckily only had to work a couple of hours) by eating chocolate and some decaf iced coffee. As the crash was coming on I was getting cravings for caffeine but from my previous experience with this dosage of Provigil I know that's a surefire recipe for insomnia. The good thing was that I was highly aware that I was only feeling that way because of the crash, and I was able to resist the urge to compensate with caffeine. That's better than I did my last go-around with Provigil.
OK, that seems like enough civilized discourse for one day ;) Tomorrow I'll repeat this experiment then try adding the Ritalin LA on Sunday.
-z
Posted by BJM on August 27, 2004, at 21:52:01
In reply to civilized discourse on PROVIGIL, posted by zeugma on August 27, 2004, at 19:26:19
It took a little getting used to in the beginning but the "stupids" went away. And to keep the crash from coming on too early in the day I take half my dose in the morning and half between 1 and 3 pm. I've done that since I was only on 100mgs and am doing that now on 200mg. It was some trial and error but it was worth it. And I don't get the speeding feeling like Ritalin or the depressed feeling when it wears off. It is so wonderful to not feel groggy all the time and to still be able to sleep at night.
Posted by alesta on August 28, 2004, at 9:29:20
In reply to civilized discourse on PROVIGIL, posted by zeugma on August 27, 2004, at 19:26:19
hi, zeug,
loved your post; it kind of had the feel of an exerpt from a novel. :) I think if anyone is capable of having a “civilized discourse”, it’s us :) (I love those words!). so I thought I’d give you a little support on your first day with prov. (I’ll try not to comment on every provigil entry--sometimes I think I give too much feedback :).) it sounds like you’re doing great so far! The people at that uncivilized forum seemed to be saying that the “stupefying” effect from provigil is possibly due to an accumulated sleep deficit. I guess we’ll find out. especially if you can keep up that awesome willpower and stay away from the caffeine during your afternoon slump. :) perhaps if the “comedown” is too difficult you could start provigil a little later in the day, so that the crash hits you at a better time? Maybe you could take the non-extended release Ritalin (the effects last around 2 hours, right?) when you get up so that you can wait a couple hours before starting provigil so you don’t crash at work. I don’t know....just a thought...there’s got to be some way around the crash (aside from starting the day with tons of caffeine, as it is long-lasting, and then you’d be way overwired when you added the provigil). All right, well anyways, I’m here if you need any support....and I’ll check in with you periodically....or vice versa....
Take care :),
amy
Posted by alesta on August 28, 2004, at 9:34:25
In reply to Re: civilized discourse on PROVIGIL » zeugma, posted by alesta on August 28, 2004, at 9:29:20
just read BJM's post...well, there you go!!! a solution for < THE CRASH >.......
thank you, BJM, for that valuable info!
amy :)
Posted by zeugma on August 28, 2004, at 17:01:42
In reply to Re: civilized discourse on PROVIGIL, posted by alesta on August 28, 2004, at 9:34:25
thanks, amy (and BJM),
amy, your suggestion about taking the Ritalin IR was a good one. I was thinking maybe taking the IR at wakeup like you suggested, then the Provigil on the way to work. Or maybe taking the LA or IR with the Provigil might work, since I read somewhere that Ritalin delays the absorption of Provigil by a couple of hours. That would be convenient! It did seem, when I took the Ritalin with the Provigil, that the crash was less harsh.
The side effects seem to be under control. Still some stomach upset. The sleep debt discussed on all the narcolepsy forums shows that it's not just a problem with Provigil, it's the fact that missing sleep has even more dire consequences for narcoleptics than for anyone else. And narcolepsy does have a strongly 'emotional' side. Check out this abstract:
Sleep. 2002 Nov 1;25(7):724-32. Related Articles, Links
Emotional experience during rapid-eye-movement sleep in narcolepsy.Fosse R, Stickgold R, Hobson JA.
Institute of Psychology, University in Oslo. rfosse@hms.harvard.edu
STUDY OBJECTIVES: To describe emotional experience during sleep-onset rapid-eye-movement [(REM) SOREM] sleep and nighttime REM in narcoleptic patients and to relate any differences in REM emotion to the more general abnormalities of this disorder. DESIGN: Awakenings were performed from SOREM (REM at the onset of daytime naps and nighttime sleep) and nighttime emergent (ascending) REM in 15 patients with narcolepsy and from nighttime REM in 9 normal healthy participants. Subjects rated the occurrence and intensity of discrete emotion types for each line in their REM-mentation reports. Fragmentation of REM was measured and related to emoton. SETTING: Subjects were studied in their own homes over 2 consecutive days and nights (3 nights for normals) and were monitored by ambulatory polysomnography. PARTICIPANTS: Fifteen patients with narcolepsy, aged 17 to 70 years (mean = 45.3) and 9 normal healthy subjects, aged 31 to 60 years (mean = 43.0). Results: Emotions were found more often and were more intense in narcoleptic SOREM than in nighttime REM of either narcoleptic or normal subjects, with anxiety/fear exhibiting the strongest increase, followed by joy/elation. Comparing nighttime REM in narcoleptic and normal subjects, narcoleptics were found to have more intense feelings of anxiety/fear and of joy/elation but to have a less frequent experience of surprise and anger. Positive and negative emotions occurred in a balanced fashion in SOREM and nighttime REM in narcoleptic subjects. In the SOREM of narcoleptic patients, high levels of positive emotions, in particular of joy/elation, were associated with a less fragmented (more stable) REM sleep. CONCLUSION: The REM sleep of patients with narcolepsy affords a unique opportunity to study emotion and to analyze its psychophysiology. Narcolepsy intensifies REM-dream emotion, especially anxiety/fear and joy/elation, and this is most clearly seen during SOREM sleep. The changes in REM emotion of narcoleptic patients could reflect the effect of the fundamental pathology of this disorder upon neurobiologic systems that support cognitive-emotional functions.
One other solution that I'm going to try for the crash is to exercise in the evening. The crash depresses me but exercise finally seems to be helping my mood (it's taken months) and also makes me feel less drained. Thanks again for the feedback, it's always appreciated!
-z
Posted by Dinah on August 29, 2004, at 9:56:24
In reply to um.....interesting dialog on PROVIGIL.......oh my, posted by alesta on August 26, 2004, at 11:47:50
Thanks for the link.
I've been a bit concerned myself with my Provigil use. I feel like I'm abusing it, even though I'm taking only half the prescribed dose. It does decrease my daytime naps, and I'm more productive. But I'm starting to feel the accumulated sleep loss. Maybe I *need* to sleep ten hours a day rather than seven.
It doesn't feel right somehow to trade increased productivity for what feels like some sleep deprivation damage being done to my body. All my puritan instincts are sending up red flags.
I don't *feel* the stupids yet, but from what they said, I'd be the last to know? I haven't noticed an increased error rate in my work.
I spoke to my neurologist about this, and he wants me to eliminate caffeine after 3 pm before I do anything about the Provigil and see how that works.
Posted by alesta on August 29, 2004, at 10:09:04
In reply to Re: um.....interesting dialog on PROVIGIL.......oh my » alesta, posted by Dinah on August 29, 2004, at 9:56:24
hi, dinah :),
you're welcome. i don't notice any indication of "the stupids" whatsoever in your post. to the contrary, you sound very intelligent.
yes, it seems like avoiding the afternoon caffeine intake is the answer, if the stupifing effect they talk about truly is just an issue of sleep deprivation. zeugma and i have been working out this issue in another thread (above, i think it's called "a civilized discourse on provigil"), if you'd like to take a look at it. she takes ritalin as well, which only lasts a couple hours, so the solution for her is to take ritalin instead of caffeine...i hope you can figure something out...(i'm not talking about extended release ritalin, but the other. it gives a short, approximately 2-hour boost...would be perfect to take for your crash, possibly...)
take care,
amy
> Thanks for the link.
>
> I've been a bit concerned myself with my Provigil use. I feel like I'm abusing it, even though I'm taking only half the prescribed dose. It does decrease my daytime naps, and I'm more productive. But I'm starting to feel the accumulated sleep loss. Maybe I *need* to sleep ten hours a day rather than seven.
>
> It doesn't feel right somehow to trade increased productivity for what feels like some sleep deprivation damage being done to my body. All my puritan instincts are sending up red flags.
>
> I don't *feel* the stupids yet, but from what they said, I'd be the last to know? I haven't noticed an increased error rate in my work.
>
> I spoke to my neurologist about this, and he wants me to eliminate caffeine after 3 pm before I do anything about the Provigil and see how that works.
Posted by SLS on August 29, 2004, at 10:44:47
In reply to Re: um.....interesting dialog on PROVIGIL.......oh my » alesta, posted by Dinah on August 29, 2004, at 9:56:24
Hi Dinah.
> I spoke to my neurologist about this, and he wants me to eliminate caffeine after 3 pm before I do anything about the Provigil and see how that works.
That is a perfect plan.
You might find that things work out well if you can get that full 8 hours sleep. Some investigative work done recently and reported in the media suggested that getting 9 or more hours of sleep is counterproductive and possibly physically unhealthy.
I would not become fixated on the fear that you might become "addicted" to Provigil. The drug doesn't work like that. It doesn't induce cravings or psychological dependence. It doesn't even seem to promote physiological dependence. You should be able to come off of it relatively easily should you choose to.
Good luck.
Has Rick posted recently regarding his experience with long-term use of Provigil?
- Scott
Posted by zeugma on August 29, 2004, at 12:17:28
In reply to Re: um.....interesting dialog on PROVIGIL....... » Dinah, posted by alesta on August 29, 2004, at 10:09:04
> hi, dinah :),
>
> you're welcome. i don't notice any indication of "the stupids" whatsoever in your post. to the contrary, you sound very intelligent.I guess that on the other message board, that would mean she was a Cephalon plant ;)
>
> yes, it seems like avoiding the afternoon caffeine intake is the answer, if the stupifing effect they talk about truly is just an issue of sleep deprivation. zeugma and i have been working out this issue in another thread (above, i think it's called "a civilized discourse on provigil"), if you'd like to take a look at it. she takes ritalin as well, which only lasts a couple hours, so the solution for her is to take ritalin instead of caffeine...i hope you can figure something out...(i'm not talking about extended release ritalin, but the other. it gives a short, approximately 2-hour boost...would be perfect to take for your crash, possibly...)
>I do agree about the caffeine issue. I have become a true caffeine addict over the years in which I was self-medicating, and I was instructed by the doctor to cut down as much as possible on caffeine, and to avoid it completely after 3 p.m. This has proved hard for me to follow, as that corresponds to the period in which I crash, but the few times I've given in and felt instant relief were paid for with insomnia. And the terrible thing about sleep debt is that it exerts its most detrimental effects not the day after, but later, as many as four or five days where it can lead to a total 'meltdown.' I can well imagine that sleep debt can accumulate and lead to disaster after months.
For the past week, though, I've been able to sleep more or less normally. I attribute this largely to better adherence to my dr.'s insructions about caffeine.
Btw, I realize that my screen name is ambiguous as to gender, but I am male. By coincidence, there is another poster whose screen name is an almost literal translation of mine, 'linkadge,' also male.
-z (enjoying last cup of coffee before ban for the day goes in place. oh yea- need to get some decaffeinated coffee for the delicious placebo effect :))
> take care,
> amy
>
>
>
>
>
>
> > Thanks for the link.
> >
> > I've been a bit concerned myself with my Provigil use. I feel like I'm abusing it, even though I'm taking only half the prescribed dose. It does decrease my daytime naps, and I'm more productive. But I'm starting to feel the accumulated sleep loss. Maybe I *need* to sleep ten hours a day rather than seven.
> >
> > It doesn't feel right somehow to trade increased productivity for what feels like some sleep deprivation damage being done to my body. All my puritan instincts are sending up red flags.
> >
> > I don't *feel* the stupids yet, but from what they said, I'd be the last to know? I haven't noticed an increased error rate in my work.
> >
> > I spoke to my neurologist about this, and he wants me to eliminate caffeine after 3 pm before I do anything about the Provigil and see how that works.
>
>
Posted by Dinah on August 29, 2004, at 13:22:57
In reply to Re: um.....interesting dialog on PROVIGIL......., posted by zeugma on August 29, 2004, at 12:17:28
That's my main indulgence and I drink it till late in the night. It's never been a problem to my sleep till now, and it's going to be hard to break that habit.
And I don't think I worry about addiction so much. There are days I don't take it, and the only thing I notice is that I'm very very tired.
I just worry sometimes that I'm taking Klonopin and Provigil and I wonder if the only difference between me and someone who is in danger of arrest is the insurance coverage to pay for a doctor. :( It just doesn't *feel* right, somehow.
But like I said, I have rather Puritanical views about meds, at least in regards to myself.
Posted by alesta on August 29, 2004, at 13:34:38
In reply to Re: um.....interesting dialog on PROVIGIL......., posted by zeugma on August 29, 2004, at 12:17:28
> Btw, I realize that my screen name is ambiguous as to gender, but I am male.
OMG, zeugma, i am so sorry! i don't know why i assumed you were female! i was wondering for the longest time and then i guess my subconscious just went ahead and picked a gender to think of you as. :) i don't think it's natural to think of a person in a genderless way, you know what i mean? anyways..thanks for telling me!!!forgive me, dear sir...(being dramatic :))
amy :)
Posted by alesta on August 29, 2004, at 13:44:26
In reply to I'll definitely try cutting down on the diet Coke, posted by Dinah on August 29, 2004, at 13:22:57
hi, again, dinah,
i am also conservative with meds, and believe in exhausting more natural options first as well as finding out any health issues that could be causing problems. i also like to know what the true problems are. what is the reason you are taking the provigil? is it to counteract klonopin sleepiness or did you have fatigue before klonopin?amy
> That's my main indulgence and I drink it till late in the night. It's never been a problem to my sleep till now, and it's going to be hard to break that habit.
>
> And I don't think I worry about addiction so much. There are days I don't take it, and the only thing I notice is that I'm very very tired.
>
> I just worry sometimes that I'm taking Klonopin and Provigil and I wonder if the only difference between me and someone who is in danger of arrest is the insurance coverage to pay for a doctor. :( It just doesn't *feel* right, somehow.
>
> But like I said, I have rather Puritanical views about meds, at least in regards to myself.
Posted by Dinah on August 29, 2004, at 14:28:28
In reply to Re: I'll definitely try cutting down on the diet Coke » Dinah, posted by alesta on August 29, 2004, at 13:44:26
My neurologist thinks it's likely I have narcolepsy although the sleep test wasn't conclusive. I'm not nearly as sure as he is, although a good number of my mother's large family has been diagnosed with narcolepsy or idiopathic hypersomnia.
I don't think my daytime sleepiness has increased since starting Klonopin, although some of the sleep problems noted in the study (central apnea and reduced stage 3-4 sleep) can be caused by Klonopin. But since I started the Klonopin because I'd wake up at 3 in the morning with anxiety attacks, I'm not sure doing away with it would help my sleep any. :)
Still, I do wonder if I'd need the Provigil without the Klonopin and Depakote (for mood stabilization and migraine prophylaxis). How much is the medication merry-go-round?
Oh well. First things first, I suppose. See if reducing caffeine stops the Provigil from interfering with my sleep. If it does, it might feel more natural (like the Klonopin and Depakote do) and it won't feel as much like I'm popping pills to meet some external standard of productivity.
Posted by alesta on August 29, 2004, at 14:56:23
In reply to Re: I'll definitely try cutting down on the diet Coke » alesta, posted by Dinah on August 29, 2004, at 14:28:28
dinah :),
no, i don't think you should go off the klonopin...i just wondered b/c some people say they take provigil due to klonopin-induced drowsiness...i was going to suggest if that was the case for you (which it isn't, so never mind) that you reduce your klonopin dose a bit. it seems like you have good reasons for taking everything you're taking right now. please stop thinking about taking meds in such a negative light.:) there is a crucial difference between you and a drug abuser off the street. You’re taking these drugs to become normal. These street addicts are taking them to get high. they are abusing drugs, you are using them properly. and in some cases I’m sure these street addicts are attempting to merely self-medicate, but they are going about it the wrong way. They need to go to a good psychiatrist who can help them restore a more natural balance, rather than throw it off even further..amy :)
Posted by zeugma on August 29, 2004, at 17:30:05
In reply to zeugma...sorry!!:), posted by alesta on August 29, 2004, at 13:34:38
> > Btw, I realize that my screen name is ambiguous as to gender, but I am male.
>
> OMG, zeugma, i am so sorry! i don't know why i assumed you were female! i was wondering for the longest time and then i guess my subconscious just went ahead and picked a gender to think of you as. :) i don't think it's natural to think of a person in a genderless way, you know what i mean? anyways..thanks for telling me!!!
>no forgiveness needed. it's impossible to think of anyone in a genderless way, and in particular the English language forces gendered pronouns on us, so when confronted by an ambiguous name, one must pick. I find gender one of those difficult things to understand, myself. but I'm working on it! :)
> forgive me, dear sir...(being dramatic :))
> amy :)
again no forgiveness necessary...-z
Posted by Rick on August 30, 2004, at 18:48:43
In reply to Re: um.....interesting dialog on PROVIGIL... Rick? » Dinah, posted by SLS on August 29, 2004, at 10:44:47
> Has Rick posted recently regarding his experience with long-term use of Provigil?
Interesting to check out Psycho-Babble for the first time in many moons and see that someone had just asked about me the day before.
So we've discovered an exciting new benefit of long-tern Provigil use, namely development of telepathic powers :)
Eveything's still going fine after four years of a combo of 100 mg Provigil + 1 mg Klonopin for non-depressive Social Phobia. (At various times I've had some other stuff in the mix, but not for quite awhile.)
Provigil has a lot fewer side effects than the great majority of psychotropics I've taken. The main adverse effects over the past year are sometimes-awful dry mouth (my pdoc thinks it's the Klonopin, but I don't) and occasional increased heart rate. Provigil still works great as part of my anxiety treatment (e.g., makes me more outgoing) and doesn't interfere with sleep. Maybe a few times a month I experience some insomnia which might be exacerbated by Provigil (I really can't tell), and also a few times a month I experience the kind of daytime sleepiness that I had frequently pre-Provigil.
I do have some episodes of memory problems and what that gaggle of INTENSE conspiracy-obsessed sleep board folks called the "stoopids", as well as low motivation at times, but who knows what the drivers are? My guess is that the main suspects are Klonopin, increasing age (most recently at a rate of 1 year every 365 days) and/or...well...ME.
Rick
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