Provigil vs Ritalin...Cost vs Results

[Big Daddy RRT,RPSGT]

I sleep very well on my auto but still feel very sleepy, and even fall asleep inappropriately 2-3 times a day despite 7 hours of APAP a night, more sleep I feel worse, less sleep no better or worse. I have been on CPAP for almost 2 years and really like it, I don't leave home without it. I was titrated to 17 cmH2O in the Sleep lab with lot's of supine REM. I was on 17 cmH2O for many months and feeling much better and yet still falling asleep inappropriately.

I have now been on an auto for 6 months. It is much more comfortable as I don't always need 17cmH2O sometimes I sleep good on 14 or 15. My 95th is about 14cmH2O when using 8-20cmH2O for a week or more. My AHI on my S9 set 14-20cmH2O is <1 almost everyday. Although some nights I end up on 16 or 17 as my 95th. I have tried it set at 14cmH2o for a weeks, no difference in how I feel but lots of crazy dreams. I have tried 15, 16 and even 17 each for weeks at a time no difference except on 17cmH2O my AHI is 0.0 most nights, I don't move a muscle all night, no dreams, just solid sleep but I feel no different and I have to wear my mask so tight it is uncomfortable at times. I feel gasps on anything less than about 12cmH2O. Without CPAP I sleep like crap and feel like crap and have a hard time staying awake all day so I am much better on than off especially if I have a few drinks.

My sleep doctor wants to start me on Provigil but it is brand name and will cost me a $30 co-pay. Ritalin is only $5. I have tried my son's Ritalin and it really helps. Two 10 mg tabs a day and I feel great. I have also tried a sustained release 20mg of Ritalin and this works well also. Is provigil that much better? What about Nuvigil? Is it worth the extra $300 dollar per year? What is your experience with these drugs?

[M.D.Hosehead]

It's my understanding--but you should check this out for yourself--that:

Provigil has about the same effect as dexedrine or ritalin, but is considered safer and has less potential for abuse and addiction.

Nuvigil is chemically similar, comes from the same company, and was brought out because the patent on Provigil is due to expire in 2012 and several generic manufacturers plan to make it.

[-SWS]

bump... And following this thread with personal interest. Good luck, Big Daddy RRT,RPSGT. And thanks for your contributions.

Thanks for your great contributions as well, M.D. Hosehead!

[TheDreamer]

I don't know about Ritalin, it requires special authorization ... so my insurance company won't tell me how much it would cost me. But, they had no problem in telling me how much Provigil was going to set me back....$383/month.

It was good at first..though it doesn't seem to be effective for me anymore.... Maybe the upcoming sleep study (PSG/MSLT) will tell me what else is wrong with me....

So far the only prescription where I had trouble getting filled was Lunesta. The insurance company said I need to try Ambien first....but you're a computer, you already that I was on Ambien before (also tried Mirtazapine too).

The Dreamer.

[Laurie1041]

Methyphenidate (Ritalin) is a very inexpensive stimulant that can cause dependence when taken regularly. Dependence means that if you stop taking it, you will have symptoms of withdrawal (fatigue, depression, flu-like symptoms) which may last for one to two weeks. It is prescribed for ADHD and is often prescribed "off-label" for chronic daytime sleepiness, chronic fatigue. Benefits: inexpensive, works well in some patients. Cons: Dependency and a tendency to "poop out" (tolerance) requiring dosage increase, some patients complain that the onset is "harsh", can cause anxiety and irritability, once daily dosing frequently may not provide all day alertness.

Modafinil (Provigil): It is prescribed for narcolepsy and shift work sleep disorder and is often prescribed "off label" for chronic daytime sleepiness. Benefits: Less potential for dependence, can be helpful in some patients to provide daytime alertness. Cons: Expensive depending on insurance. Notorious for not working after taking it consecutively for a few weeks. This problem can be alleviated by stopping Provigil for a week and resuming. May cause anxiety or irritability, Modafinil may not provide adequate daytime alertness in some patients.

* New version is marketed under the name of Nuvigil. Essentially the same as Modafinil.

Other stimulants:

Vyvanse (Lisdexamphetamine) - Prescribed for ADHD and "off label" for chronic fatigue, escessive daytime sleepiness.. Benefits: "Smoother" onset, timed release formulation may provide all day alertness, works very well in some patients. Cons - dependency, withdrawal symptoms, may require higher dosage due to "poop out" (tolerance), no generic available yet, expensive depending on insurance, may cause anxiety or irritability.

Adderall (Dexamphetamine Salts) - available in a immediate release or extended release version. Benefits: "Smoother" onset with the extended release version and may provide all day alertness. Both immediate release and extended release may be taken twice daily (last dose no later than 3PM to avoid insomnia). Benefits: Both immediate and extended release are available as a generic, very inexpensive, works very well in some patients. Cons - immediate release may not provide all day alertness, dependency, withdrawal symptoms, may require higher dosage due to "poop out" (tolerance).

I have used Provigil but had problems with it completely pooping out on me after taking it for one month. I had to continually stop and restart Provigil to get the same effects.

I have had to experiment with several stimulants to find out which ones worked for me. I have found that Adderall XR (I get the generic) has been the most effective and lasts all day. I take 30 mg. once in the morning and another 30 mg. at 1:00 PM. It has been extremely helpful for my chronic fatigue/excessive daytime sleepiness. I hope that this helps. Laurie

[Junebug999]

I've taken both. I was prescribed Ritalin back in the days my OSA was mis-diagnosed, un-diagnosed....and just finished a trial of Nuvigil.

My belief is.....for the money, and for the side effectgs, etc.....my vote is on the Ritalin. Ritalin in the smaller dosage just gave me a boost to not be as sleepy in the daytime -- I was prescribed 3 a day and only took one in the morning. I rarely -- maybe over the 2 years I took it maybe two or three times took another dose in the afternoon....NEVER took it 3 a day. Never got hooked, was careful with it, kept the extras locked up in the safe. No problem.

The Nuvigil -- made me feel a little more wired than Ritalin. I object to how stinking much it costs. The sleep doc wants me to take Nuvigil, but my primary care doc told me before my first sleep study that when I was down the road a bit and on CPAP that he would be prescribing Provigil for me IF I needed it.

I still think the Ritalin made me less wired and also I liked that it wore off fast in the afternoon. So if say now I took one in the morning, one at noon, and then let it wear off....hell I'd have a normal life!

Well that's my $.02.

[-SWS]

My understanding is that Provigil can be taken on a PRN (as-needed) basis to address EDS. Does anyone know if the same is true for Ritalin or the other stimulants?

[Big Daddy RRT,RPSGT]

Thanks for information, very helpful so far, Dr gave me a coupon that's holds my co-pay at $10 a month for one year, so I gonna fill it this week.150 mg qday. Seems like a lot since i was taking 20mg of Ritalin generic. Tell me more.

[Big Daddy RRT,RPSGT]

I would like to hear more testimonies. I'll let you know how I do.

[jonquiljo]

I have taken Ritalin, Provigil, etc. but settled on Adderall. As it turns out, I have ADHD and it works well for me. But I think my chemistry is different because I could sleep after taking Adderall or Ritalin. Yes, these drugs produce dependence, but you can slowly taper off and avoid most problems IMO. They do tend to raise BP, however. Now that I am on CPAP, my BP is not a problem.

Provigil was not as good for me. It made me jumpy. My sister has taken it (probably for undiagnosed OSA) and found that it loses effectiveness over time. I have heard that from others too. Then again Adderall and Ritalin lose effectiveness. The trick to these drugs is to force yourself not to go beyond a normal therapeutic dose for you. The drug only poops out just a bit at that point. Initially they make you feel like you can do almost anything - its very euphoric for lots of people. That euphoria does not last long and goes away after a few weeks.

So personally I prefer Adderall (or Ritalin in a pinch). Provigil really seems to lose effectiveness if taken regularly. Since Adderall and Ritalin can be abused, many Dr.s are against Rx'ing this drug. It is also more highly controlled and hence the Dr gets more scrutiny. I would go with Adderall or Ritalin, but make sure you can find a Dr. willing to Rx it in the long haul (requires a Dr visit each month as they can only write an Rx for 1 month at a time), but it works much better. Just make sure your body can handle the stress or side effect - not that Provigil is side effect free anyway. Good luck.

[M.D.Hosehead]

My understanding is that Provigil can be taken on a PRN (as-needed) basis to address EDS. Does anyone know if the same is true for Ritalin or the other stimulants?

They certainly can be taken PRN, in fact, that is exactly how they are used by the Department of Defense, Homeland Security and NASA. DOD's use of amphetamine for fighter pilots goes back at least to the Korean war in the 1950's.

As jonquilo says, the doctor must provide a new written prescription for Ritalin, Adderal, or dexedrine every month. They can't be phoned or faxed to a pharmacy and can't be renewed. A monthly face-to-face meeting with the doctor is not legally required. AFAIK, it is still permissible for the doctor to mail the original prescription to the pharmacy.

Provigil is not as cumbersome.

[howkim]

Modafinil (Provigil): It is prescribed for narcolepsy and shift work sleep disorder and is often prescribed "off label" for chronic daytime sleepiness. Benefits: Less potential for dependence, can be helpful in some patients to provide daytime alertness. Cons: Expensive depending on insurance. Notorious for not working after taking it consecutively for a few weeks. This problem can be alleviated by stopping Provigil for a week and resuming. May cause anxiety or irritability, Modafinil may not provide adequate daytime alertness in some patients.

Just FYI:

PROVIGIL is indicated to improve wakefulness in adult patients with excessive sleepiness associated with narcolepsy, obstructive sleep apnea/hypopnea syndrome, and shift work sleep disorder.

http://dailymed.nlm.nih.gov/dailymed/dr ... nlm34067-9

[SleepingUgly]

Stimulants = Methylphenidate and amphetamine derivatives.
Provigil & Nuvigil are technically not in the class of drugs called "stimulants", but fall under the general umbrella of "wake-promoting agents". Tolerance means needing higher doses to get the same effect. Tolerance can develop to stimulants, so drug holidays are recommended in patients who take it for EDS. Technically, tolerance is not documented to Provigil, but anecdotally some people report experiencing it. There can be rebound sleepiness when discontinuing a course of stimulants. I don't know if that is the case with Provigil. I routinely used to go off Provigil one day a week to decrease the likelihood of tolerance developing. Now I take it PRN. They can all be taken PRN.

As evidenced here, everyone has a different opinion about these medications. Personally I would prefer to be on Provigil than on Ritalin because, as M.D. Hosehead noted, it's less tightly regulated so I have less hassles with refills and such. Sometimes the decision of which to use is a function of timing. For example, a person might take an extended release formulation early in the day, but if it offsets too early, they might take an immediate release, short-acting version later in the day to avoid insomnia that night. Immediate release medications can be a rough ride because the onset and offset are abrupt.

I don't know much about the cardiovascular profiles, but it wouldn't surprise me if Provigil has less of an effect on BP than do traditional stimulants.

[Laurie1041]

Modafinil (Provigil): It is prescribed for narcolepsy and shift work sleep disorder and is often prescribed "off label" for chronic daytime sleepiness. Benefits: Less potential for dependence, can be helpful in some patients to provide daytime alertness. Cons: Expensive depending on insurance. Notorious for not working after taking it consecutively for a few weeks. This problem can be alleviated by stopping Provigil for a week and resuming. May cause anxiety or irritability, Modafinil may not provide adequate daytime alertness in some patients.

Just FYI:

PROVIGIL is indicated to improve wakefulness in adult patients with excessive sleepiness associated with narcolepsy, obstructive sleep apnea/hypopnea syndrome, and shift work sleep disorder.

http://dailymed.nlm.nih.gov/dailymed/dr ... nlm34067-9

Thanks howkim! I was unaware that Modafinil was approved for OSA. I appreciate the info.

[jonquiljo]

I don't know much about the cardiovascular profiles, but it wouldn't surprise me if Provigil has less of an effect on BP than do traditional stimulants.

I would bet they are less harsh - for sure - but remember, none of them are totally easy on you. The biggest problem with the XXXvigil drugs is that they cost a bundle, though it is good to see them approved for OSA. I bet that makes a lot of insurers angry.

Stimulants help me because I have ADD. I could take an Adderall and go to bed right now - not that I'd recommend it. It actually was the reason I figured out I needed to get diagnosed several years ago. Most people say that Ritalin and Adderall make them jumpy - so beware. Plus, if any of your friends find out you are taking the stuff they constantly bother you and try to get some. Yes, even adults and it's really annoying.