My first round with provigil lasted a year or so. It’s not that the Doctor took me off it or anything, just that I switched insurance companies and had multiple headaches trying to refill my prescription and eventually gave up messing with it because it had mostly done the job and I was regularly waking up at reasonable times.

That lasted… a while. A few months. Maybe a year. Then I started drifting again. The doctor had me try out Ambien with the provigil — Ambien did nothing for me. I was terribly disappointed. I even tried it at double the dose and I was still up most of the night. It did make me extra groggy the next day though. He gave me some samples of Lunesta and those worked, but we’d just switched insurance companies again and more headaches with the mail-order prescriptions ensued, so I gave up on messing with it. I had saved a few pills and the doctor gave me some samples when I was in for the flu (“You’re my only patient that uses this stuff, and it’s expiring soon, so you might as well take it”), so I started just taking them when I knew I was going to be dead to the world without it. But those ran out months ago.

Now my sleep schedule is royally messed up again, my friend who was regularly dragging me out of bed to go to breakfast (and coincidentally make it in to work on time) has moved back to Kansas City, and work is getting a bit impatient with my irregular hours, so I got off my arse, got all my ducks in a row with the mail order pharmacy bits of my insurance plan, and asked the doc for a renewed prescription. I received the provigil Friday.  I’m still waiting on the Lunesta (I think I messed it up when I hung up on the automated phone call when I realized it wanted my credit card number and I’d left my wallet sitting on my desk).

I took the first pill of my new prescription today. And… it’s much like the first time I took it, probably because i haven’t had one in months. Bouncing knee, too much energy, but not quite as irritatingly chipper. The fact that I actually slept quite a lot last night probably adds to it.

Oh — and current price through my insurance: $150 for a 90 day supply. They claim the price without the insurance is something like $1600. I think Cephalon hiked the price so they could encourage people to migrate to their new “Nuvigil” pill, which is basically identical to provigil but won’t be available as a generic for a very long time.

None of it seemed to work well. The adjusted sleep schedule fell apart within a couple of days, bright light seems to help me wake up faster when I DO wake up but doesn’t change when that happens, and the alarm clocks I sleep through or turn off without waking up enough to realize I’ve done so.

 In researching, I ran across a few references to people using Provigil to treat, or at least mitigate, DSPS. It’s a medication I’d heard of before… I’ll talk about it more in another post. Basically it’s marketed as a “wakefullness promoting agent” which has almost no side effects and is non-addictive (well, everything’s addictive but it’s not addictive like, say, methamphetamines).  This seemed appealing to me, as I’ve always hated the idea of sleeping pills (the primary alternative seemed to be taking ambien to force myself to sleep early), and I worry about becoming addicted. One addiction is far more than enough, thank you very much.

So… I went to my doctor to talk about it. He was quite familiar with the topic, which surprised me a bit for some reason. He was open to the idea of Provigil but seemed to favor the Ambien slightly more. When I explained to him how I feel about sleeping pills, he agreed to try the provigil first and see if it did the job. He was concerned, though, about other possible sleep problems, so he sent me for a sleep study. I’ll write about that later, it was interesting.

Took a couple of months between my first appointment and my followup to go over the test results, and another 3 weeks after that for my insurance company to process my prescription and send me my first 30 day supply. This stuff is *expensive* — about $9.50 per 200mg pill. Through my insurance, it’s only $60 for a 30/60/90 day supply (same price for whichever). Since we’re just trying it out, the doctor had the prescription at 30 days. Not too bad I suppose, but still expensive. There’s no generic version available in the US yet.

So… we’ll see how this goes. Wish me luck.

The “normal” internal clock makes people fall asleep somewhere around 9 to 11PM and wake up somewhere around 5 to 7. That’s their “sleep phase.”

Someone with a delayed sleep phase might not be able to sleep until 2 or even 4 in the morning. For them to go to bed and fall asleep at 9pm is as realistic as an average person doing so at 5pm.

The thumbnail explanation I’ve found works for most people is this: Delayed Sleep Phase Syndrome is sort of like permanent jet lag. Pretty much everyone knows what jet lag is and can sort of extrapolate what it’d be like if it didn’t go away.

It’s worth noting that there’s also an Advanced Sleep Phase Disorder, where people fall asleep earlier and wake up earlier (say 6 pm til 4 am). From what I’ve seen in admittedly spotty research, it’s less common than the delayed version, and seems to have a less severe impact on the lives of people who have it (people who go in to work early are viewed as productive, after all. )

Key characteristics of DSPS

1. Sleep-onset and wake times that are intractably later than desired
2. Actual sleep-onset times at nearly the same daily clock hour
3. Little or no reported difficulty in maintaining sleep once sleep has begun
4. Extreme difficulty awakening at the desired time in the morning
5. A relatively severe to absolute inability to advance the sleep phase to earlier hours by enforcing conventional sleep and wake times.

–International Classification of Sleep Disorders

You can read more about Delayed Sleep Phase Disorder and other sleep disorders here:

• http://www.sleepdisorderchannel.com/dsps/
• http://en.wikipedia.org/wiki/Delayed_sleep_phase_syndrome
• http://en.wikipedia.org/wiki/Circadian_rhythm_sleep_disorder

After consulting with my doctor, we’re going to try and treat the disorder with a drug called “Provigil,” (“Modafanil” is the drug, Provigil is its brand name) by attempting to reset my natural internal clock.

The doctor asked me to keep a sleep journal, and for a couple weeks before the medication arrived from my insurance company’s pharmacy, I was jotting down notes on what time I went to bed, fell asleep, and woke up. The medication arrived today, and I took it for the first time. I decided to take notes on the effects as well, because it seemed fairly significant, much moreso than I anticipated. And on the way home, I decided to make a blog for the process instead of just notes. I’m sure there are other people out there like me, who have to work banker’s hours on new york time, when their body thinks they’re in japan. Maybe this will help someone. At any rate, it’s more fun than just jotting crap down on paper.

It’s 2AM. I’ll post my original log notes tomorrow.