Residency and Provigil

[grigory76]

I was wondering if anyone has experience of using Provigil during long calls/ ICU months and if there was any degree of addiction to it and/or any side effects.
Thanks

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[penguins]

Not to sound like a mother, but I wouldn't go down that path. Physicians have one of the highest rates of addiction and such that I would be worried that if you start with something (no matter how innocent it might sound) now it would be easier to graduate to other stuff later. It is kinda shady so just stay on the white side where it is safe.
Besides, isn't it illegal if you don't have a legitimate script for it? If you got caught it could haunt you forever and colleuges that knew might not have the same respect for you.
Good luck with the long nights...

 

[Koko]

I second that. A strong cuppa java should help and is pretty safe.

 

[grigory76]

I second that. A strong cuppa java should help and is pretty safe.

Provigil is FDA approved for use in shift work sleep disorder. It’s considered safe and has very low addiction potential. I just wanted to hear some real life experiences.
Coffee is nice, but it doesn’t come even close to Provigil as far as poor tolerance to sleep deprivation and decline in cognitive abilities go, especially the latter.

 

[Magnus67]

Yeah, supposedly Lunesta has "Low addictive potential" and when you wont fill a script for a patient that has been on it for month, they get pissed, raise hell, and claim they will never be able to sleep without it. There are many kinds of addiction besides "physiological".

Best to stay away from "performance enhancing" drugs, yes even the tripple mocha latte. 🙂

 

[southerndoc]

OK, maybe I'm misinformed.

I thought Provigil was for narcolepsy and OSA and was NOT a sleep aid.

Am I mistaken? If it's not a sleep aid, then it shouldn't be addictive.

 

[tigershark]

OK, maybe I'm misinformed.

I thought Provigil was for narcolepsy and OSA and was NOT a sleep aid.

Am I mistaken? If it's not a sleep aid, then it shouldn't be addictive.

Huh? Only drugs that are sleep aids are addictive?

 

[southerndoc]

Huh? Only drugs that are sleep aids are addictive?

No, apparently it's a class IV drug. I didn't realize that.

That's what I get for skimming the messages. I thought someone was comparing it to Lunesta by mechanism of action, when in fact that person was comparing it to Lunesta's abuse potential.

Sorry for the sidebar discussion. Carry on.

 

[Magnus67]

My example may have been confusing. sorry I was making a point that drugs can be "addictive" for different reasons. I think the OP was asking about residents using Provigl to stay awake on long shifts. I was trying to illustrate that I thought this was a bad idea. Uppers then Downers...and all the other problems that could cause for a stressed out resident.

OR.....maybe its late and Im completely ******ed... 😀

 

[sdn1977]

grigory - I don't have personal experience with your circumstance & I've never taken it, but I'll tell you of my experiences of my patients who have used it (I'm a pharmacist). For those few who have used it for shift work sleep disorders, the awake/alert part of their day is not the real issue - it is the lack of correct cycles of sleep. Using the Provigil aggravates this cycle and it doesn't ultimately help. My patients who respond the best are those who are using a drug that causes them to have daytime sleepiness (some antidepressants).

A common side effect & one which causes some to discontinue it is the incidence of headache. The dependency (hence the CIV designation) is the physiological dependency which can develop. Provigil, Lunesta, Ambien, etc...all change the normal cycles the brain has to go through to provide restful sleep & alert wakefulness....but...so does shift work (or long hours in your case).

Whatever you decide....do NOT try to prescribe it for yourself!!!! Talk to psychiatrists or physicians who specialize in sleep disorders (they are the most common prescribers) for better information than I can give. Then..pursue it with your own physician - don't risk breaking the law!

 

[grigory76]

grigory - I don't have personal experience with your circumstance & I've never taken it, but I'll tell you of my experiences of my patients who have used it (I'm a pharmacist). For those few who have used it for shift work sleep disorders, the awake/alert part of their day is not the real issue - it is the lack of correct cycles of sleep. Using the Provigil aggravates this cycle and it doesn't ultimately help. My patients who respond the best are those who are using a drug that causes them to have daytime sleepiness (some antidepressants).

A common side effect & one which causes some to discontinue it is the incidence of headache. The dependency (hence the CIV designation) is the physiological dependency which can develop. Provigil, Lunesta, Ambien, etc...all change the normal cycles the brain has to go through to provide restful sleep & alert wakefulness....but...so does shift work (or long hours in your case).

Whatever you decide....do NOT try to prescribe it for yourself!!!! Talk to psychiatrists or physicians who specialize in sleep disorders (they are the most common prescribers) for better information than I can give. Then..pursue it with your own physician - don't risk breaking the law!

sdn1977, thank you for sharing this info.

 

[ThinkFast007]

...Then..pursue it with your own physician - don't risk breaking the law!

am i missing something here (only a MSIV)....but prescribing stuff for yourself (upon legitimate reason) is illegal???

granted i know that self prescribing a narc to yourself is OBVIOUSLY abuse (unless you have some condition perhaps that necessitate it 😕 )

just not sure of the 'law' in this respect. i realize that you dont want to get caught up in abusing meds/stealing...etc....but i figured as long as you have a valid rx...and you arent just 'stealing' the meds...it was ok???

 

[sdn1977]

am i missing something here (only a MSIV)....but prescribing stuff for yourself (upon legitimate reason) is illegal???

granted i know that self prescribing a narc to yourself is OBVIOUSLY abuse (unless you have some condition perhaps that necessitate it 😕 )

just not sure of the 'law' in this respect. i realize that you dont want to get caught up in abusing meds/stealing...etc....but i figured as long as you have a valid rx...and you arent just 'stealing' the meds...it was ok???

hmmm...there was a really long thread not too long ago that went into lots and lots of detail on sef prescribing. To make it short...each state has its own set of laws. However, controlled drugs include narcotics (Vicodin) & non-narcotics (Provigil) and are governed by federal law. It is against federal law to prescribe any controlled drug for yourself.

Your comment of having a valid rx is the pertinent one - it must be "valid". Writing the rx for yourself, in and of itself, makes it invalid. Abusing can be with or without a legal rx (abuse of prescribed Vicodin or abuse of otc ibuprofen). Stealing is taking something that is not yours. Once you pay (or have your insurance company pay) for your rx, it is now yours. If you took it from a hospital or dr's office...someone else paid & it is not yours. Don't want to belabor the point since it is off topic, so if you have more questions...pm me.

 

[mms437]

I am an MSIV and used provigil to study for my step 1. I always have to take naps if im reading or right after i eat. It worked well for me and also aided with some concentration issues. I stopped right after i finished my test with no withdrawal or addiction issues. I dont think addiction is a big issue with this drug anyways. I also think that it is decently efficacious.
I dont see harm in writing your own script like others have said. If you see a psych he will just give you the Rx and get you out the door in 5 minutes. I think we are all smart enough to treat ourselves (to a certain extent).
And i was able to sleep at night s problems. Didnt keep me up longer than i wanted.
If you dont like coffee, i would give it a shot. And there are tons of reasons to argue against a bolus of caffeine to keep you awake.
Take it easy.

 

[sdn1977]

I am an MSIV and used provigil to study for my step 1. I always have to take naps if im reading or right after i eat. It worked well for me and also aided with some concentration issues. I stopped right after i finished my test with no withdrawal or addiction issues. I dont think addiction is a big issue with this drug anyways. I also think that it is decently efficacious.
I dont see harm in writing your own script like others have said. If you see a psych he will just give you the Rx and get you out the door in 5 minutes. I think we are all smart enough to treat ourselves (to a certain extent).
And i was able to sleep at night s problems. Didnt keep me up longer than i wanted.
If you dont like coffee, i would give it a shot. And there are tons of reasons to argue against a bolus of caffeine to keep you awake.
Take it easy.

Check the Uniform Health and Safety Act section 11170:
"No person shall prescribe, administer or furnish controlled substances for himself".

A violation of this section will result in a felony arrest, notification to the Dept of Justice & surrender of all controlled rx forms, prohibition for ordering, writing or using additional forms (essentially you will not be allowed to prescribe controlled drugs) and notification to the corresponding State Board authority which will suspend your license while you are being investigated by the Dept of Justice. My advice is to keep it honest, no matter how smart you think you are. Every CII & CIII are automatically transmitted to the DEA in real time & they follow prescriber practices & patient names. As a prescriber...you can get a printout for yourself or a patient of yours.

I've seen 2 physicians & 1 DDS locally who have been caught by this. They did receive a felony conviction, had their license suspended, had their C prescribing privleges suspended & when they were reinstated, they were not what they received before (CII, CIIN, etc..)

As a pharmacist, I am required to report it otherwise I'm complicit. Please don't put me in this position because I won't share your desire to break the law - I hate it & you know better! Use your own physician!

 

[f_w]

I dont see harm in writing your own script like others have said. If you see a psych he will just give you the Rx and get you out the door in 5 minutes. I think we are all smart enough to treat ourselves (to a certain extent).

Dangerous path. Read the law, otherwise your medical career will be a short one.

(no state medical board will pull your license for self-prescribing that bottle of Lac-hydrin skin lotion that the derm wrote for you years ago. the moment stuff is on any of the narc schedules or just a common drug of abuse like benzos, you are on very very thin ice if you self prescribe)

 

[kbrown]

One of my classmates was constantly falling asleep in class, at morning report, etc...basically anywhere that she stood still for more than 5 minutes. She went to the doc, he gave her provigil and she never fell asleep during the aforementioned things again. I don't know if she is still on it, I would suspect yes b/c she is an OB/GYN intern, but I know that it helped her immensely. I have no clue about addictive potential, side effects or anything else that she has experienced. All I know was that she had a serious issue with sleeping at inappropriate times and this corrected it. Take it for what it's worth.

Note: I am NOT condoning the use of Rx drugs to help you get through your job. You asked for an experience with it and that's what I gave. That being said, I have made it through two years of clinical rotations, with crappy call, residents that call you at 2,3, 4 ,5 in the morning and had class until 5 the next day in a dark room with comfy chairs. I was dog-ass tired, but never took pills, just doubled up on caffeine and kept a full bladder to keep myself awake. So it can be done without 'assistance'.

 

[KidDr]

To answer the OP's question:
Yes, and it worked well, and I know several others who take it and it's made a huge difference in their lives. No major issues w/addiction that I've heard of.

Note: I am NOT condoning the use of Rx drugs to help you get through your job. You asked for an experience with it and that's what I gave. That being said, I have made it through two years of clinical rotations, with crappy call, residents that call you at 2,3, 4 ,5 in the morning and had class until 5 the next day in a dark room with comfy chairs. I was dog-ass tired, but never took pills, just doubled up on caffeine and kept a full bladder to keep myself awake. So it can be done without 'assistance'.

Cut the judgmental $hit & get real. Many people have legitimate sleep disorders that are treated, with the help of board-certified sleep doctors, with meds like provigil. And it sounds like your friend had some real issues and was really helped by Provigil, to the point where she can now function normally at work. Sounds like a positive thing to me. But your post seems to imply that those who take Provigil (even for legitimate reasons) are weak, while those like you, who somehow find a way to make it through long periods of time w/o "assistance" are somehow more legit? Please. What is Provigil anyways? A substance that acts on a specific area of the brain to increase alertness. How is that different from caffeine? Maybe your friend's not the only one getting through the work day with some "assistance."

 

[Anasazi23]

You might want to float this question in the psychiatry forum. The folks there have a lot of experience with that med.

Provigil is prescribed legitimately for both on and off label use, particularly by psychiatrists, for a number of reason, including shift work, studying, etc. If you're having trouble adjusting to long shift hours, you may be better served by a stimulant than hurting a patient with your fatigue.

Don't prescribe it to yourself, since it's class IV.

 

[penguins]

If it is so legit and innocent than go to your doc and get a script. Then you get the help you need and you haven't risked anything.

 

[skypilot]

If it is so legit and innocent than go to your doc and get a script. Then you get the help you need and you haven't risked anything.

You know the old saying: "A doctor who tries to treat himself has a fool for a patient and a charlatan for a physician"

Objectivity is a cornerstone of medical practice and you won't get it by treating yourself.

 

[Koko]

Provigil is FDA approved for use in shift work sleep disorder. It’s considered safe and has very low addiction potential. I just wanted to hear some real life experiences.
Coffee is nice, but it doesn’t come even close to Provigil as far as poor tolerance to sleep deprivation and decline in cognitive abilities go, especially the latter.

Why are you considering using this drug in the first place? Is it because you anticipate having difficulty or because you have a history of difficulty with taking call and/or ICU months?

Regardless of what a few people may have to share here as far as "real life experiences", people respond differently to medication and have differing propensities for substance abuse, so I don't understand the value in soliciting anonymous opinions. I suggest that you seek an objective, professional opinion (i.e. your pcp/psychiatrist) from someone who knows you and the drug, and can offer alternatives to help you.

I say this out of concern for you and your patients, and not to pass judgment. Good luck.

 

[grigory76]

I am an MSIV and used provigil to study for my step 1. I always have to take naps if im reading or right after i eat. It worked well for me and also aided with some concentration issues. I stopped right after i finished my test with no withdrawal or addiction issues. I dont think addiction is a big issue with this drug anyways. I also think that it is decently efficacious.
I dont see harm in writing your own script like others have said. If you see a psych he will just give you the Rx and get you out the door in 5 minutes. I think we are all smart enough to treat ourselves (to a certain extent).
And i was able to sleep at night s problems. Didnt keep me up longer than i wanted.
If you dont like coffee, i would give it a shot. And there are tons of reasons to argue against a bolus of caffeine to keep you awake.
Take it easy.

mms437, KidDr, kbrown,
Thank you very much for sharing your experiences.

If you read my original post, I didn’t ask if I can prescribe to myself- that is a totally different issue, and for the especially conscientious ones (i.e. sdn1977)- no, I am not planning to break the law by self prescribing Provigil, Lunesta or Morphine. It wasn’t my question and please refrain from educating us on the issues not relevant to the original subject.

Koko,
I have a similar lifelong situation as mms437 described in his post (#14). I had many close calls falling asleep on the major conferences, presentations, almost falling asleep holding retractors during surgeries and waking up on my way to the surgical wound, etc. I have extremely poor tolerance to sleep deprivation and I am dreading about it as my residency start approaches. My physical endurance and cognitive function go way down at the end of 24h shifts. The last thing I want to happen is to make mistakes that would affect my patients. I am not even talking about humiliation, others’ opinion, reputation going down, unwillingness of the staff to write decent recommendation letters for the fellowship (I myself would not recommend someone like me- it’s a dangerous person), etc.
When it comes to my survival during the residency and quality of care I will provide, I will be willing to examine any possible options I might have to deal with the above problem. It’s too much at stake to be a Spartan warrior sipping another cup of coffee trying to prove to yourself you can make it till the next morning. Without any self- and collateral damage.

 

[Wednesday]

mms437, KidDr, kbrown,
Thank you very much for sharing your experiences.

If you read my original post, I didn’t ask if I can prescribe to myself- that is a totally different issue, and for the especially conscientious ones (i.e. sdn1977)- no, I am not planning to break the law by self prescribing Provigil, Lunesta or Morphine. It wasn’t my question and please refrain from educating us on the issues not relevant to the original subject.

Koko,
I have a similar lifelong situation as mms437 described in his post (#14). I had many close calls falling asleep on the major conferences, presentations, almost falling asleep holding retractors during surgeries and waking up on my way to the surgical wound, etc. I have extremely poor tolerance to sleep deprivation and I am dreading about it as my residency start approaches. My physical endurance and cognitive function go way down at the end of 24h shifts. The last thing I want to happen is to make mistakes that would affect my patients. I am not even talking about humiliation, others’ opinion, reputation going down, unwillingness of the staff to write decent recommendation letters for the fellowship (I myself would not recommend someone like me- it’s a dangerous person), etc.
When it comes to my survival during the residency and quality of care I will provide, I will be willing to examine any possible options I might have to deal with the above problem. It’s too much at stake to be a Spartan warrior sipping another cup of coffee trying to prove to yourself you can make it till the next morning. Without any self- and collateral damage.

Hi Grigory,

You should go see a sleep disorders specialist. Get an appointment soon because they are usually pretty booked up. This would be the perfect person to discuss these things with and to get any drug recommendations/prescriptions from. I think that you have generated a lot of lively discussion because provigil is a drug that a lot of med students take without a prescription and then try to justify as no big deal. I would venture to say (and others have also tried to say) that even though lots of people have gotten away with this, it might not be the best avenue for you. You may have a sleep disorder that can be recognized and treated properly with provigil or some other drug or treatment--it sounds like the ob/gyn intern above was in that situation. Good luck.

 

[grigory76]

Hi Grigory,

You should go see a sleep disorders specialist. Get an appointment soon because they are usually pretty booked up. This would be the perfect person to discuss these things with and to get any drug recommendations/prescriptions from. I think that you have generated a lot of lively discussion because provigil is a drug that a lot of med students take without a prescription and then try to justify as no big deal. I would venture to say (and others have also tried to say) that even though lots of people have gotten away with this, it might not be the best avenue for you. You may have a sleep disorder that can be recognized and treated properly with provigil or some other drug or treatment--it sounds like the ob/gyn intern above was in that situation. Good luck.

I don’t think I have a sleep disorder. People have different sleep requirements. My wife can sleep 5-6 hours and she’ll be totally fine. I need my 8 hours to function normally and think sharply. And I need these 8 hours pretty much after every 16 hours of alertness. If I get less sleep prior, or go beyond 16 hours, the things I described in my previous post start to happen. So it doesn’t look like a sleep disorder, it’s just very poor tolerance to sleep deprivation.

 

[kbrown]

To answer the OP's question:
Yes, and it worked well, and I know several others who take it and it's made a huge difference in their lives. No major issues w/addiction that I've heard of.



Cut the judgmental $hit & get real. Many people have legitimate sleep disorders that are treated, with the help of board-certified sleep doctors, with meds like provigil. And it sounds like your friend had some real issues and was really helped by Provigil, to the point where she can now function normally at work. Sounds like a positive thing to me. But your post seems to imply that those who take Provigil (even for legitimate reasons) are weak, while those like you, who somehow find a way to make it through long periods of time w/o "assistance" are somehow more legit? Please. What is Provigil anyways? A substance that acts on a specific area of the brain to increase alertness. How is that different from caffeine? Maybe your friend's not the only one getting through the work day with some "assistance."

hey jackhole,

you can't be serious. i am sorry that you misinterpreted my post. i was saying that i have made it through with caffeine and a full bladder (which has had it's complications i.e., high blood pressure and UTI's). i was in no way saying that i am better than my classmate who took provigil. hell she got more out of class that i did. all i could think about was my raging headache and abd pain. i put assistance in quotes b/c it has been referred to as such previously. sorry that this is a touchy subject for you. i have found that HTN and UTI's keep me awake, some find that meds keep them awake...to each his own. get a grip.

 

[surgdia]

thanks, kbrown.
I was getting annoyed just skimming the response you got to your post.
sd

 

[50960]

For what it is worth lunesta, and it's enanomer cousin zopiclone (used in europe alot) have not been shown to interfere with stage 4 sleep. Provigil is proving to be a histamine reuptake inhibitor mainly in the frontal lobes, and although it wakes you up it can make you very agitated. 😉

 

[thewebthsp]

For what it is worth lunesta, and it's enanomer cousin zopiclone (used in europe alot) have not been shown to interfere with stage 4 sleep. Provigil is proving to be a histamine reuptake inhibitor mainly in the frontal lobes, and although it wakes you up it can make you very agitated. 😉

I just did a presentation on provigil for my psych clerkship -- it's a very good drug for both shift work disorder and for narcolepsy. Off label can be used for many many indications including increasing concentration (useful in dementia) and for ADHD.

Provigil is Schedule IV, NOT Schedule III or II unlike the amphetamines. It's 200ish times less potent in terms of addiction as compared to dextroamphetamine and has had less cardiac side effects. This is all because provigil acts in only a few brain areas (anterior hypothalamus, and some others) and not the entire cortex (as the amphetamines do). In short, it's a decent drug. The main things you would be concerned about is not using it in a person with left ventricular dysfunction, valvular disease. This can kill in those situations. Also, the drug has been shown to cause psychosis and seizures ESPECIALLY IN SLEEP DEPRIVATION. So just because you're working nights does not mean you're ok with skipping sleep.

In fact, I think I remember reading that Provigil might become schedule V -- OTC in the near future. It might be appropriate for doctors having trouble adjusting to night call, who get enough sleep and who have been cleared by their own doctors for its use. Much better than say, taking Ritalin to stay awake.

 

[grigory76]

Also, the drug has been shown to cause psychosis and seizures ESPECIALLY IN SLEEP DEPRIVATION. So just because you're working nights does not mean you're ok with skipping sleep.

These are pretty scary side effects. Would you happen to know the incidence of these in otherwise healthy (well, not exactly healthy I guess- with narcolepsy, SWSD, etc) sleep deprived people?

 

[sdn1977]

These are pretty scary side effects. Would you happen to know the incidence of these in otherwise healthy (well, not exactly healthy I guess- with narcolepsy, SWSD, etc) sleep deprived people?

grigory - you can find all the published information on the rates of side effects online. To summarize, in subject studied, incidence of headache - 34%, nervousness - 7%, insomnia - 5%, seizures - 1% (conflicting info here). But...don't let the #'s scare you! You can look up the side effects of aspirin - many folks claim it would never be approved for OTC use today because of the incidence of side effects (just an example). For the people who need Provigil & benefit from it - the side effects can be more tolerable than the illness it is treating. In my very limited opinion reading the literature - we really don't have much published yet with good studies on its use in shift work, but it does have a possible place, as a previous poster explained. But...as a physician...you know you don't just treat a symptom. For example, HBP can be a symptom of a renal disease or cardiovascular disease, so you rule out one or the other or neither one. Your symptom of inability to stay awake my just be you or it may be one of many sleep disorders. (But..I'm singing to the choir here..) Have you ever read any work by William Dement, MD? He was a pioneer in sleep disorders at Stanford years ago. He did interesting work on graduate & medical students and found sleep disorders really can occur during wakeful hours - not just sleeping hours. The brain is really complex & not well understood & we're finding these drugs in the short term are very, very effective; but over long term they disrupt the normal REM/nonREM patterns & lead to more serious complications. I'd second what Southerdoc said & post this on Psych Forum - they treat this stuff a lot - would be interesting to see what they say....I agree with others though...your situation is serious for your health & for the health of those who trust you so worthy of pursuing what you can to improve it. Good luck!

 

[double elle]

Wow...Quite a discussion!

I've taken provigil...got some samples from the psych guy when I was on my rotation. Couldn't believe how it worked. I guess in the past 2.5 years, I've taken it about...oh...6 or 7 times. He only gave me a few samples. I've got 4 pills left and I guard them with my life. (I should look to see if they've expired!)

Anyway....hearing some of the posters recommend sleep consults interests me because I've been wondering if I need to do that.

I can't sit and read for more than...literally...a couple of minutes without nodding off and....seriously...having an actual dream in the 2-3 seconds I nod off. I can do this over and over while trying to sit and read. It's to the point where I simply do NOT read all that much anymore, which is a problem. I can't stay awake for lectures. I close my eyes for a second and have that "falling" sensation. A couple of times, I've almost fallen out of my chair.

Now, the part that has me wondering if I really need a sleep study is that I KNOW I am sleep-deprived. I go to bed between 10-11 (most nights...some nights I go to bed and cuddle with my 3 year old around 9)...and I get up at 3:45 so I can run before going to the hospital. Oh, and I am an intern.

So, I already know what some of my problem is. However, the other thing is that I wake up...an average of 4-5 times/night...and those are the times I remember doing so. I wake up, look at the clock, then go back to sleep.

I can fall asleep anytime/anywhere. There is not a single second in my day that I don't wish I was sleeping. Climbing into bed is - for real - the highlight of my day.

Physically, I am training for the St.Louis marathon...so I don't lack physical exercise. And I don't overtrain by any means.

So....I am afraid to go to a sleep specialist and have him/her tell me what I already know 1)you are an intern...this is expected 2)you need more sleep

That's a LOT of money for diagnosees (sp?) that I can do myself! I also don't want someone to prescribe antidepressants. Not against them...been on them...just honestly don't think I'm depressed. I have a constant, baseline amount of anxiety and agitation...I'm a sleep-deprived type-A...what can I say! 😀

However, if there is a chance that there may be something I can do about this...then I would be willing to go. I just 1)hate going to the doctor 2)hate seeing docs I work with, but don't want to take vacation/sick time to travel to another town to see someone else 3)don't want them to find "nothing" = wasted money and time and then I look like a frickin psych case.

Oh, I am married with a 3-year old daughter. I love my life...but, man, I'm exhausted.

 

[thewebthsp]

You should see a sleep specialist... they would be the most appropriate place to get the right diagnosis

Wow...Quite a discussion!

I've taken provigil...got some samples from the psych guy when I was on my rotation. Couldn't believe how it worked. I guess in the past 2.5 years, I've taken it about...oh...6 or 7 times. He only gave me a few samples. I've got 4 pills left and I guard them with my life. (I should look to see if they've expired!)

Anyway....hearing some of the posters recommend sleep consults interests me because I've been wondering if I need to do that.

I can't sit and read for more than...literally...a couple of minutes without nodding off and....seriously...having an actual dream in the 2-3 seconds I nod off. I can do this over and over while trying to sit and read. It's to the point where I simply do NOT read all that much anymore, which is a problem. I can't stay awake for lectures. I close my eyes for a second and have that "falling" sensation. A couple of times, I've almost fallen out of my chair.

Now, the part that has me wondering if I really need a sleep study is that I KNOW I am sleep-deprived. I go to bed between 10-11 (most nights...some nights I go to bed and cuddle with my 3 year old around 9)...and I get up at 3:45 so I can run before going to the hospital. Oh, and I am an intern.

So, I already know what some of my problem is. However, the other thing is that I wake up...an average of 4-5 times/night...and those are the times I remember doing so. I wake up, look at the clock, then go back to sleep.

I can fall asleep anytime/anywhere. There is not a single second in my day that I don't wish I was sleeping. Climbing into bed is - for real - the highlight of my day.

Physically, I am training for the St.Louis marathon...so I don't lack physical exercise. And I don't overtrain by any means.

So....I am afraid to go to a sleep specialist and have him/her tell me what I already know 1)you are an intern...this is expected 2)you need more sleep

That's a LOT of money for diagnosees (sp?) that I can do myself! I also don't want someone to prescribe antidepressants. Not against them...been on them...just honestly don't think I'm depressed. I have a constant, baseline amount of anxiety and agitation...I'm a sleep-deprived type-A...what can I say! 😀

However, if there is a chance that there may be something I can do about this...then I would be willing to go. I just 1)hate going to the doctor 2)hate seeing docs I work with, but don't want to take vacation/sick time to travel to another town to see someone else 3)don't want them to find "nothing" = wasted money and time and then I look like a frickin psych case.

Oh, I am married with a 3-year old daughter. I love my life...but, man, I'm exhausted.

 

[njbmd]

Hi folks,
I am a PGY-4 general surgery resident with long hours compared to most residents. I frequently work with less sleep than I would like but it really isn't all that bad. I drink an occasional cup of coffee, a bottle of Mountain Dew but that is about it. Provigil may be a great drug (so is caffeine) but so far, I haven't encountered anything that a deep breath of fresh air and a shower couldn't undo. If you find that you need some kind of a drug on a regular basis to get your work done, then you may need to seek some medical attention for an undiagnosed disorder.

I tend to come down on the side of getting as much rest as you can, eating the best that you can and getting some regular aerobic exercise (even walking a couple of flights of steps during the night).

Before I entered medical school, I really thought I needed at least eight hours of sleep to be rested and refreshed. Now I have learned that anything that interferes with my quality of sleep is not particularly good for me and that things like generally taking care of myself physically and mentally is a good thing. I have found that four or five hours per night is plenty and that when you are tired, your body is trying to tell you something so pay attention. Attempting to wipe out that "tired" feeling is probably not good in the long run.

njbmd 🙂

 

[beriberi]

Love, love, love the provigil.

(I have a legit rx from a PMD who I only know in the context of a pt/dr. relationship
Beriberi: I have a hard time adjusting to night shift schedules. I want to try Provigil. Have you ever written it/used it?
Dr.: No. Why don't I give you a script for a few and see how it goes. Oh yeah, we should check your LFTs before you start.
Beriberi: Thanks).

I think it is far more benign than caffeine--at least in the way it makes me feel and the (lack of) interference with my ability to fall asleep later. No shakiness or buzzes feeling (like I often get with coffee) and no withdrawal (that I have noticed.) I often take it the first few of a series of nights, until I am getting great sleep during the day. Then I stop with no consequences. When I switch back to days, I take it for a few days.

Love, love, love.

However, I think you would be an idiot to prescribe it yourself and a jerk if you asked a colleague to prescribe it for you.

 

[grigory76]

Love, love, love the provigil.

(I have a legit rx from a PMD who I only know in the context of a pt/dr. relationship
Beriberi: I have a hard time adjusting to night shift schedules. I want to try Provigil. Have you ever written it/used it?
Dr.: No. Why don't I give you a script for a few and see how it goes. Oh yeah, we should check your LFTs before you start.
Beriberi: Thanks).

I think it is far more benign than caffeine--at least in the way it makes me feel and the (lack of) interference with my ability to fall asleep later. No shakiness or buzzes feeling (like I often get with coffee) and no withdrawal (that I have noticed.) I often take it the first few of a series of nights, until I am getting great sleep during the day. Then I stop with no consequences. When I switch back to days, I take it for a few days.

Love, love, love.

However, I think you would be an idiot to prescribe it yourself and a jerk if you asked a colleague to prescribe it for you.

Thanks for this info, beriberi.

 

[traveltheworld]

As a personal antecdote, I've been using Provigil since it was prescribed to me almost 2 years ago and it's drastically improved my life. I'd seen a sleep specialist for 6 years because like that OB/Gyn resident, I'd fall asleep as soon as I sat down (or even standing sometimes), whether that was a one-on-one discussion with a resident or friend or whatever. Anyhoo, the provigil has stopped that and while I still get sleepy in class after a big meal or after not getting enough sleep the night before like most everyone, I can stay awake.

I do however work hard at my "sleep hygeine" and sleep around 7-8 hours a night. A couple things to note about it...1) you do build a tolerance for it, and so I don't take it one weekends, which helps make it more efficacious on the weekdays. However, I plan on crashing on weekends too because of it. 2) It only lasts about 12 hours for me and I haven't tried taking it at night when on call yet. Overall, it's a great drug, but like everyone else has said be careful.