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Provigil Not Working


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#1 chavo2177

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Posted 31 May 2013 - 10:25 AM

I am wondering if anyone else has has this problem, i start with 2 in the morning and 1 at noon and i am still tired. I can take this dose and still fall asleep at any time. I am lost on what to do next and the Docs dont seem to know what to do either.



#2 DeathRabbit

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Posted 31 May 2013 - 10:55 AM

The vigils don't work for everybody. I guess old fashioned Adderall is your next course of acton.



#3 chavo2177

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Posted 31 May 2013 - 03:16 PM

i tried rittalin is that about the same cause that didnt work either!



#4 h.wynn

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Posted 31 May 2013 - 09:58 PM

The only one that ever worked for me was disoxyn and that onlt lasted a few months.

#5 doinmdarndest

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Posted 01 June 2013 - 03:29 AM

for wakefulness/normalcy from amphetamines adequate mg/d amts. are essential.   on the other hand, simply going w/bigger and bigger daily doses of amphetamines until eds/fatigue are absent does not always have happy results.

 

i'm fortunate in terms of what my mind and body can sustain in terms of weathering the negative side effects of the amphetamines, and my tx options are miraculously strong.  massive doses (aderrall regimen=270mg/d at present) are rx'ed to me, I used to sort of 'coach' others here how to negotiate successfully for higher doses.  you'll have to do a search on my posting replies to gain my perspective the fight has sort of gone out of me in my efforts here. 

 

i am alone in the belief that the sleep specialty is rx'ing these meds under guidelines based upon erroneous conclusions regarding them.  conclusions arrived at from looking too hard at the patients for whom high dose amphetamines was a disaster, ignoring success stories entirely (like my own, the amphetamines for me are a true miracle) leaving for new arrivals like yourself not much in the way of hope, if you wish to be robust and hard working.  I've been hard at it trying to find a way to reach others who benefit from high dose amphetamines-or who might-to the end of our exploiting our constitutional right to petition for redress and get the appropriate authorites to reconvene somehow so as to adjust upwards guidelines such as manufacturers recommended maximums for the prescribing of stimulants for the simple reason that they reflect puny amounts, almost laughable ones.  for Adderall this = 60 mg/d.  it should be 120-200.

 

but it never will. i wish i had a more hopeful perspective to offer.  i have effective wakefulness. i take on work that is physically demanding.  i repair my own vehicles (unless i can afford a pro-working on a car is just horrible!) and as of yesterday i completed the repair of our washing machine.  it was excruciatingly difficult and i hacked it not only because i'm tough but also because i'm adequately medicated.  were i not, we would just have to deal w/ no washing machine at home.

 

i wish you could turn out to be the first one i find willing to go the distance and fight the dominant paradigm, but i know this will not be the case.  nobody believes me.

 

i will give you one piece of advice for your treatment journey:  expect Stanford sleep in redwood city, ca to be as resistant to amphetamine rx and most especialy high doses as anyplace anywhere treating narcolepsy/hypersomnia.  i'm sure if my case(i was sent to Stanford for evaluation procedures and they turned out not to be open minded at all about high dose amphetamines, which are well tolerated in me, and to which i respond)) were brought up to the brass there they'd say something like "this man obviously is experiencing feelings of persecution as the result of high dose amphetamines" but in reality telling me my treatment is bad medicine makes a working boy downright irate, particularly if his treatment has ben going on for 8 yrs, and w/o it he'd lose his job and his family would starve.  avoiding Stanford may be your safest bet, if this option exists for you.

 

i wish you the best.  as you go forward w/the docs, i offer a quote from david bowie to remember in case it helps (if i'm not mistaken, it could be another frontiersman) "be sure you are right, then go ahead"

 

best wishes,

 

doinmdarndest.



#6 Hank

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Posted 01 June 2013 - 06:42 AM

I am wondering if anyone else has has this problem, i start with 2 in the morning and 1 at noon and i am still tired. I can take this dose and still fall asleep at any time. I am lost on what to do next and the Docs dont seem to know what to do either.

 

Don't be discouraged- you may have to try a few on for size before you know what you like. Nuvigil or Provigil are "wake promoting". They will allow you to nap without keeping you awake. You did not mention the dose you are on. If you are on a lower dose, you could consider a higher dose. Do you have cataplexy?

 

There are traditional stimulants, like Ritalin or Adderall. I was on Adderall with good results. High doses, however, can cause racing thoughts and anxiety.

 

Any of these will just be keeping your drowsy brain awake. Make sure you are making the lifestyle adjustments needed to get adequate sleep (considering), avoiding heavy meals during the day, exercise.

 

I hope you get some relief soon.



#7 doinmdarndest

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Posted 01 June 2013 - 01:59 PM

hank is absolutely right about anxiety/racing thoughts from high dose amphetamines.  if/when experiencing this w/amphetamine regimen I offer a simple 3 word approach:  suck it up.  Darwin's law = another useful insight. 

 

be strong and force yourself to function correctly regardless of how peaceless you happen to be internally from these and other such effects. 

 

we are way ahead of ourselves.  but in the future this is the way to handle these imperfections of the drug apmphetamine and its salts.  I did it, some, but not all, other pwn/hypersomniacs can do it too.  there are those in whom this drug is harmful even is small doses.  others respond but high bp cannot be corrected (as lisinopril 10mg/d worked like a charm in my case.  3 other meds did not)  and there are others who know robust living and zeal despite a 2 min. onset latency as amounts to my example, thanks to a 3 digit mg/d Adderall regimen.

 

rare indeed must be this tx statistic.  don't envy me folks, obtaining my rx'er was the ultim ate pain in the you know where. and nevertheless rare are others w/ regimens far exceeding normal guidelines md's follow rx'ing this med.

 

less rare are  patients in whom such an rx would be a wonderful miracle for them and the people they love who will not ever get the rx.  how sad I find it to consider they will have not the least awareness right to the grave of what might have been.

 

pick up the pen;10-30 seconds jotting manuscript on a small form.  and that is the balance of effort required of another human to make it so.  I am aware of the liability/risks, folks. no need to sound me on posting ignorant s.

 

it just makes for me a sad picture.  old school America is fading away; taking chances and toughing it out are less of or are not a factor in narcolepsy treatment and most anything else anymore it seems these days.  to me at least. 

 

in favor of 100% safety in a mamby-pambyville society,  and amphetamine rx'ing as a whole is highly consistent w/this.  is 100% safety always best?  no I'd say; nobody asked me so apologies if I discourteously key in my 2 cents here.

 

I sit down to this device my intent to put 2 or 3 lines;  again it's of considerable length.  I have no clue this and all times I contribute how the post is received.  I might have enough interest in one or two not agreeing w/me; what a good sense of correctness for them if so.  in a simple thought:  'how verbose.  obvoisly an overstimulated patient.'

 

think again.  it's a complex issue, one I feel strongly about.  my apologies if I cast a grim shadow on your outlook, i'm just prepping you for the resistance you might encounter w/ md's.  a simple, possibly useful tip:  'firing' your prescriber is always an option.  don't mention it/'burn your bridge', though.  good luck/god bless.



#8 chavo2177

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Posted 03 June 2013 - 08:47 AM

at this point i just feel defeated.. i am taking provigil and i have tried rittalin and some dextro stuff and nothing seems to work as i am still tired through the day! from my last sleep study my sleep is good..   Just Defeated!!!!!



#9 doinmdarndest

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Posted 03 June 2013 - 10:03 AM

hang tough.  things will get better.  i'm no doctor but I know enough about wakefulness promoting medication to recommend an amphetamine regimen.  most importantly, i'll give you a couple of articles that you'll find helpful.  by bringing a hard copy of them to your next visit w/your rx'er, you'll have tangible evidence from prominent sleep specialists giving your md relief from the trepid sense of putting his or her license on the line most md's inevitably experience when writing a c2 rx that is certain to be effective.  by giving the copy you bring to your prescriber it then is in your file after you leave.  this = useful, tangible tool to justify his/her medical decision w/you should the medical examiners ever require this.

 

if the md has you on < 60 mg/d, particularly way less, buck for this amt. in Adderall.  the er is like trying to get better mileage out of a car by leaning out the mixture.  you get instead bad performance/a less distinct sense of wakefulness.  get the ir Adderall in the generic form it will be covered.  get it in the 30 mg tablets, supplies/inventories of these are least impacted by recent shortages of this drug(ask your local pharmacist if this is so in your area) and it is also an effective dose.  if you have no stimulant history, you will be peppy.  there are those here that find natural remedies better than Adderall.  others have tried it but didn't like it.  still others, like me, have particularly stubborn, severe eds and this is what makes it go away.   

 

I've already put enough to take in for a sleepy person through a haze of fatigue.  I so know that feeling.  the 2 articles are 'PHARMACOLOGICAL ASPECTS OF HUMAN AND CANINE NARCOLEPSY' by dr. Emmanuel mignot.  on pg. 36 dr. mignot recognizes the need for higher doses in some patients.  you probably won't need them now but as this drug builds tolerance having this brought to your md's attention sets the stage for increasing the dose effectively if/when this takes place.  the other is 'ON THE TREATMENT OF NARCOLEPSY' by dr Robert Yoss.  i'll work on resources to allow ease in availing yourself of a hard copy of both.

 

I have a link to the first, but it stopped working here when entered by me.  just a bug i'm certain, but there's another link i'll put it in a f/u reply for you.  the second is from 1956 so I may have to key in the whole thing but that's ok I've been intending on doing this so everybody here can see dr. yoss' forgotten work. very likely you and most certianly I would be better off if narcolepsy/hypersomnia tx were the same now as it was then.  this seems absurd but it not. 

 

it is but valid.

 

a positively phobic view of the amphetamines pervades these days among both many md's and even some patients.  for some of us this view simply does not apply........and it can be an obstacle to effective tx of eds.

 

the straightforward, easily understood rx'ing criteria offered by dr yoss for determining the dose handily remedies eds when the amphetamines are indicated.

 

lastly, and most importantly, do NOT be all verbose and long-winded like I am here negotiating for your rx.  this blows it.   just hand him the articles opened to the relevant parts have them highlighted.  you should appear tired-even as the adrenaline from knowing how critical your situation is has you otherwise.  use few words as possible.

 

 you can do this.  have faith in yourself, I have done all I can at this point.

 

good luck, best wishes 



#10 chavo2177

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Posted 03 June 2013 - 10:25 AM

in my case the Cost is no concern as it is covered 100%. no matter what i need its $0 out of my pocket!!! i just dont want to keep trying this and trying that.. i am the type of guy that want the right fix the first time!.. i also dont think i am seeing a specialist and i am gettting less than average care when it comes to a sleep disorder!



#11 doinmdarndest

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Posted 03 June 2013 - 12:22 PM

o k here is a link that will let you download and print off the first article.  if you have any trouble and have access to a fax machine send the fax # to my email on my profile page and i'll fax it over.   this link gets you a list of articles.  the one I mentioned is the 8th from the bottom.

 

http://med.stanford....blications/html



#12 doinmdarndest

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Posted 03 June 2013 - 12:28 PM

I just tested the link in my reply.  it did not work, but it does when I click on it in correspondence w/another forum member w/in the nn system's internal email.  this is where I got the link from sk8aplexy.  but now it's not performing. 

 

send me an email w/address from my profile page; i'll reply w/link that will function.  fax option also not too inconvenient @ my end, remit# and we'll go w/fax.

 

it may be some time before I can get the 1956 article keyed in; this one is by far the one of lesser value to bring to your md.  I hope I have the tenacity to follow through on my stated intention to present dr. yoss' work here in the forum. 

 

it will arrive, should I actually hack this, as a new posting in 'treatment' as opposed to a reply.

 

I truly wish other pwn to have an opportunity to check it out.  it is as useful as it is forgotten, but my hunt and peck w/one finger method presents a formidable task to do if I am to avail others of it here. 

 

it is not available via internet and was not easy for me to obtain.  I will go fwd now; hope neither time nor volume limits in the nn posting mechanism s.cans my effort.  if so, sira sira and all that s.  life goes on.   I wish there was a 'save as a draft' feature; maybe there is now, there's a new spell check I notice. 

 

thanks, nn! I needed that!



#13 doinmdarndest

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Posted 03 June 2013 - 09:07 PM

well, there it is.  took all afternoon.   the older article now appears in 'treatmenmt'



#14 doinmdarndest

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Posted 04 June 2013 - 10:44 AM

You know you'll end up  w/o medication until your next fill date if you do that.  I can't speak as a high man apart having done the same thing.  had to work.  sleepy construction workers get fired. 

 

do your best to work w/your dr .  if your dr finds out you took more pills than the rx instructions say your rx is gone for sure.   i'll send the other study today.   remember, you got to print off hard copies of these, find and highlight relevant parts for your dr.  

 

IF AND WHEN THE MAXIMUM DOSE (guidelines only. there is no maximum dose = a rule for rx'ers) OF ADDERALL HAS FAILED TO GET A RESPONSE.   TO OBTAIN STIMULANT RX, TACT/TIMING and especially PATIENCE ARE ABSOLUTELY ESSENTIAL.  In other words, you gotta have 'game', dude.   

 

you mentioned about the 'dextro stuff' and Ritalin.  how much?  if it was 60mg/d it's time to show your dr. the articles.  that is the manufacturer's recommended maximum./  he/she probably won't find the old one from 1956 relevant, but it might help.  that's mainly for all here to see that at one time md's had methods to go about finding the right medicine and the right dose and making you wakeful that somehow the medical community today seems to have forgotten altogether.

 

the newer article is from 1996 and is written by dr emannuel mignot of Stanford sleep.  on pg. 36 high doses are acknowledged as needed for some of us.  this is certain to be taken seriously by any md because dr mignot is a giant in his field; w/endless allocades this man has written over 200 articles his fame in medicine is global. 

 

it makes me sad I must advise you to beware of dr mignot and Stanford.  just look at 'poor mali einen of Stanford sleep'  in the 'free writing' part of 'this has nothing to do with narcolepsy and you know it'

 

you will read what happened to me w/this mignot/Stanford.  lost potential is such a sad thing.   what might have been if a patient w/my indications had been worked w/by his office?   could a better understanding of high dose rx'ing been there for Stanford research to learn?  I am afraid so.  my Adderall regimen = 300 mg/d at that time.   

 

BEWARE of Stanford and dr mignot if you need amphetamines in high doses.  but you can use his article to help you get them.  it's just how the chips happen to have fallen in this s., man.  I will log out of nn and email the other article now.  log in to nn use 'edit' and pull your email address out of the open forum the moderators don't want that.



#15 chavo2177

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Posted 04 June 2013 - 12:19 PM

i know that the doc i am dealing with are not specialist at all!!!



#16 chavo2177

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Posted 04 June 2013 - 12:21 PM

i know that the docs i am dealing with are not specialist at all! so i know for a fact that they will follow all guidlines set.. hell i had to take 2 sleep studies to get onto modafinal.. so i know its going to be a long tuff road to really get anything done at all!



#17 doinmdarndest

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Posted 04 June 2013 - 12:38 PM

getting a sleep specialist is probably the best thing you could do.  are you in n. California?  dr Lynda wyrtzes in sacramento is one of them.  one I can recommend.



#18 chavo2177

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Posted 05 June 2013 - 11:25 AM

i am in SD. i really dont think there is a specialist in my area as i am seeing neurologist and psycologist...



#19 chavo2177

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Posted 05 June 2013 - 11:38 AM

what i am really lookinf for is what i can take with Modafinal to help it work better..Can i take rittalin / addero l/ Dextro?? i am wonding if anyone has combined these with Mod????? 



#20 h.wynn

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Posted 16 June 2013 - 09:06 PM

If it is any help I see Dr. Whitney in Plymouth, MN. About a 2 and a half hour drive from MN SD border. Im just over an hour form him and he is worth it. They even give my ride a room for the night when I have sleep studys done.