Holding burnout at bay

October 21, 2012 11:58 PM

Considering asking my doctor for modafinil; concerns and questions.

Maybe this seems like a completely ridiculous question. In recent months (and for the next ~six months) I have been/will be by necessity on a sleep schedule that involves sleeping about 5 hours a night or less every night except Friday/Saturday - and even that is likely to be reduced come the spring semester. It really isn't an option. I get home from my school activities at 9:30-10pm and eat dinner (sometimes my only meal of the day). I know I should be going to bed about 11, since I have to get up at 7:15 to get to work, but I've never been able to fall asleep before 1-2am unless I'm already exhausted from pulling a previous all-nighter. I also end up staying up that late because I need time to do homework/projects/study/housework/pet care... And that's not including just taking time to relax a little. So I'm usually in bed by 2am, in the end, often with things left undone.

I need to be awake and alert for work in the morning, throughout the day, etc. Caffeine does little to nothing for me; I've tried and appear to be mysteriously immune to its effects. Not to mention that I find the taste of coffee repulsive.

I've discovered a medication called Modafinil (the generic form), which is approved for treating narcolepsy and sleep-apnea, but is apparently prescribed frequently for other things as well, notably daytime fatigue. As far as I've seen it's not a medication with a history of being abused, has few side effects, etc. I'm considering asking my doctor about it - but I'm concerned he'll assume I want it for less responsible purposes and just brush me off and tell me to get more sleep. My choices really are "get more sleep" or "get things done." I can't have both right now. This coming summer, when I can quit my job (and I will, believe me; as well-paying as it is it's not worth the stress), I'd stop using any medication and go right back to sleeping the hours I need. Is asking for something like this absurd/unreasonable? Is my concern about my doctor brushing me off legitimate? How do I go about asking him for this?

Pre-empting questions: I'm currently on a vitamin D regimen that will last another 6 weeks; topping up the tank, as it were. Never prescribed other pills for any purpose, and never asked for them. Relatively new to this doctor, but plan on staying with him for as long as I live in the area. I am young and in excellent health.

I also want to reiterate: This is not an attempt to avoid a problem. I will be solving it more long term, but cannot do so until the summer, and I need a stopgap in the meantime to avoid mental and physical burnout. Yes, I've looked at other options regarding moving my schedule around. No, they're not possible for now. Please trust me on this.

Thanks for your attention/advice.

posted by Urban Winter to health & fitness (17 answers total)

For what it's worth: like other nootropics and stimulants, modafinil is heavily abused in academic circles, and your doctor is probably aware of this. Whether or not she actually cares is a different story.

It's also not the miracle drug that a lot of journalistic coverage makes it out to be. It does have side effects, it is habit forming, and it's definitely not a panacea for a lack of sleep.
posted by BrandonW at 12:05 AM on October 22, 2012

I've never been able to fall asleep before 1-2am unless I'm already exhausted from pulling a previous all-nighter.

Right there with you.

Are you aware that Delayed Sleep Phase Syndrome is (a) a thing (b) at least somewhat treatable?

If your schedule really can't be shifted off those brutal morning starts, it seems to me that your health would be better served by approaching your problem from the other side: try looking for something that will help you start sleeping earlier rather than waking earlier. Do some research on and ask your doctor about melatonin, which your body is supposed to make by itself in sufficient quantity to make you sleepy when you're supposed to be. Bright light will suppress melatonin production, so you might get value out of replacing your home lighting with lower-wattage bulbs and avoiding computer screen use after dinner. Melatonin is also available as a supplement and you can ask your doctor about that.

Bright light early in the morning will also start to push your circadian rhythm in a more convenient direction. Perhaps you could look into fitting one of those bathroom fan/light/heater fixtures that uses four hideously bright incandescent floodlamps as radiant heaters.
posted by flabdablet at 1:22 AM on October 22, 2012 [1 favorite]

By the way: in my experience as a fifty-year-old male who has experienced delayed sleep phase pretty much since puberty, stimulants do nothing at all to prevent burnout; all they ever do is turn off the red lights that warn you that you're heading that way, so that when you do hit the wall it comes as a horrible, traumatic and massively inconvenient surprise. The only burnout prevention technique I've ever seen work involves actually gettting enough sleep and learning to pace yourself.

If you snore, go and get a sleep study done. Because if it turns out you have apnea that's treatable with a CPAP machine, the increased sleep quality made possible by that could easily cut two hours off the minimum sleeping time you need to get by.
posted by flabdablet at 1:32 AM on October 22, 2012 [3 favorites]

You can avoid mental fatigue with modafinil, but not the physical. It is a very creepy sensation to be mentally alert while your body feels like it's about to fall apart.

This will come down to how liberal your doctor is in prescribing a schedule IV drug for non-medical reasons.

What would you do if this were all happening before 2004 (when modafinil was approved)?
posted by the jam at 1:34 AM on October 22, 2012 [3 favorites]

my experience: I have a legit prescription for modafinil thanks to my crazy-ass work schedule and you know what? I never take the shit except in the direst circumstances, like I just got off a flight and need to work another ten hours. And even then I schedule it relative to when I need to be sleeping as much as possible because it will keep me up for days and make me moody. I hate it. If you're looking for something to keep you motoring and not get burnt out, I would enthusiastically recommend you look elsewhere - it is absolutely not the miracle drug you might be hoping for.

I also have to be alert as quickly as possible after waking up and have found that half and hour to forty five minutes of intense exercise (I tumble out of bed and into the rowing machine) works vastly better.
posted by par court at 5:44 AM on October 22, 2012

By the way: in my experience as a fifty-year-old male who has experienced delayed sleep phase pretty much since puberty, stimulants do nothing at all to prevent burnout; all they ever do is turn off the red lights that warn you that you're heading that way, so that when you do hit the wall it comes as a horrible, traumatic and massively inconvenient surprise. The only burnout prevention technique I've ever seen work involves actually gettting enough sleep and learning to pace yourself.

This is likely the reason a doctor won't prescribe it.

Here is the thing: with a schedule like that, you should be absolutely exhausted by 11pm. Dog tired, walking dead. If you aren't, you've got something else going on: too much caffeine, and/or you are stressing yourself out and you are running on your natural stimulant, adrenalin. Meaning that likely, more stimulation isn't what you need. You also have to eat properly. Partially because it's the right thing to do for your energy levels, and partially because your doctor is going to tell you the same thing.

Regardless, the best way to treat whatever is going on is to be absolutely straight with your doctor.
posted by gjc at 6:21 AM on October 22, 2012 [1 favorite]

The only time I've heard of Modafinil being prescribed for daytime sleepiness in non-narcolepsy situations, it was to counteract the sedating effects of another, life-saving drug.
posted by lunalaguna at 6:28 AM on October 22, 2012

As unfortuneate as it is, you need to sleep. I'd focus on learning to fall asleep at an appropriate time, rather than trying to stay up longer.

Whether it's speed or some other pharmaceutical, depriving your body of sleep is a horrible, horrible thing. It will eventually screw with your brain and frankly, you don't want that.

Have you thought of taking dipenhydramine (Benedryl, Zzzquil) as a way to force drowsiness? I think that might work better for you.

Certainly, speak with a doctor about your schedule, about physical and mental exhaustion and of methods for getting the amount of sleep you actually need.
posted by Ruthless Bunny at 6:33 AM on October 22, 2012

Melatonin is also available as a supplement and you can ask your doctor about that.

Melatonin works pretty well for me when am trying to change my sleep schedule (jet lag, shift work, etc). It's available OTC (but yes, you should ask your doctor about it). You could also talk to your doctor about how to get to sleep more quickly and have better sleep (with medication or other methods).
posted by bluefly at 7:48 AM on October 22, 2012

Thanks for the answers so far!

For the record, I don't have insomnia of any form, nor do I snore/have any sleep issues (after my initial failed experiment where I tried coffee/tea, I've had no caffeine at all in the last few weeks). I can force myself to go to bed at 11pm, and though it might take twenty minutes to a half hour, if I lie down in the dark I will eventually fall asleep. I wait until I'm tired to go to bed for three reasons: 1) It's nicer to fall asleep immediately instead of spending that 30-45 minutes thinking about how much I still need to get done and how going to sleep is essentially just fast-forwarding to the next miserable work day. 2) I need time at home to de-stress. At the beginning of the semester I did force myself to go to bed around 11-12, and my stress levels skyrocketed due to not having that "chill out" time in my day. 3) I have work to do. I can't just come home, eat dinner, and go to bed. I have homework, housework, pet care, etc to take care of.

As I said, my options are either sleep more or stay on top of things that need to get done. Please don't assume that forcing myself to sleep more will solve my problems. At best all I'll do is fail one of my classes due to not getting the homework done.
posted by Urban Winter at 7:54 AM on October 22, 2012

Apologies for the double-post here. Just wanted to add that I realize in my initial question I said I could "never" fall asleep before 1-2am. What I meant there was that I don't get tired/am not inclined to do so/have to force myself to go to sleep any earlier than 1-2am. I should have been more specific rather than inviting all the insomnia speculation.
posted by Urban Winter at 8:05 AM on October 22, 2012

I've taken something similar to modafinil for jet lag/shift work. It really does help with alertness (I had to halve the dose), but you will continue to build up a sleep deficit. You have to pay the piper eventually. So, say I started working on Monday while taking the modafinil, I would crash and burn by Thursday and need 12 hours of sleep to catch up on the deficit.
posted by kamikazegopher at 8:40 AM on October 22, 2012

Modafinil is FDA approved for shift work sleep disorder. By all means, go to your doctor and get evaluated for it; it sounds like it might fit (and allay your fears about misuse).
posted by Wordwoman at 10:29 AM on October 22, 2012

I don't have experience with modafinil directly, but I do have a fair amount of experience with numerous nootropics, among them adrafinil. (Adrafinil is metabolized in vivo to modafinil.) I took it for much the same reasons that you did: I was under some severe academic and professional stress, and I was looking for a fix.

I don't do that anymore, nor will I ever. There're a couple good reasons why.

1) It is habit forming. AFAIK you don't develop physical dependency on it, but I can definitely say that you run the risk of developing a psychological dependence on it. It makes sense: it's something that improves memory, concentration, and mitigates the effects of mental fatigue. To somebody who's mentally active, that's a damn appealing set of effects. I too told myself it was "just for a short time", but I'll be damned if I didn't feel so very much more effective with it that I was pretty tempted to take it even when I didn't "need" it just so I could get more done. This is not a good cycle.

2) Resist the urge to use it to skimp on sleep. Sleep when you can. Yes, you'll feel more productive if you short yourself and try to make up for it with drugs. This kinda comes back to point #1, but self discipline is key here.

3) It is not without risk of adverse effects. I believe that people should avoid medication that's not medically-necessary. (This belief stems from a couple years of not heeding this advice.) Adrafinil has some nastier side effects than modafinil (there's some indication that adrafinil is hepatotoxic although IIRC neither mechanism nor risk were well-established), but neither is risk-free. Modafinil seems to be well-tolerated, but it still has a long list of reported adverse events, some potentially lethal. If you're not OK with the possibility of any of these side effects happening to you, you should not take it.

4) It is expensive and (if you're in the US) scheduled (albeit Schedule IV). If you plan on getting it from... shall we say a "discount" source online you are, frankly, acting foolishly. In addition to being in what is at best a legal gray area, online pharmacies have an "interesting" history when it comes to purity and consistency. (I'm not saying you are planning on doing so -- just that you shouldn't even consider it.) So in addition to having to get a prescription, modafinil will be an expensive short-term fix.

Lifestyle modification is a hell of a lot safer and cheaper, and I'd recommend you try that before you even consider turning to ampakines. I know I should have.
posted by -1 at 11:06 AM on October 22, 2012

After reading your post, I've been trying to find a convincing article that I read not so long ago arguing that modafinil is emerging as not as harmless or non-habit-forming as it originally appeared.

I haven't be able to find the exact one, but still I'd say make sure to do lots of research before jumping into taking it.
posted by umbú at 11:38 AM on October 22, 2012

"Hey Doc, I need a medicine to help me live on five hours of sleep a night for the foreseeable future. I have a crazy schedule and there is nothing I can do to change it. I'm so exhausted during the day that my performance and school and work is impaired. I think modafinil might be helpful. What do you think?"

Stay honest with your doctor so you can stay healthy.
posted by pupus at 5:35 PM on October 22, 2012

Another thing, specifically about school and Modafinil. Are you familiar with state-dependent learning? I've never experienced this so strongly as I did on Modafinil. Furthermore, it's not great for taking tests. I always missed trick questions because my brain wouldn't "slow down" or "pause" long enough to consider all the possibilities. Furthermore, I'd always run out of time because my brain was FOCUSED SO HARD ON TEST that I no longer had a sense of time passing. I remember specifically a calculus test where the first half I got most all the questions correct and the second half was just blank.

I only took it because I have some neurological problems that prevent me from sleeping well and my excessive daytime sleepiness had gotten completely out of control--and even then it wasn't worth it to me. I switched to a Ritalin type drug and I've been pretty happy with it. Maybe there is a similar solution for you. Good luck.
posted by sunnichka at 12:20 PM on October 25, 2012