In How to Manage MS-Related Fatigue, pharmacological and non-pharmacological strategies to combat fatigue were discussed.  MS fatigue is not the same as simply being tired, or muscles which are fatigued after a good work-out, or the desire to sleep in on a Saturday morning.  MS fatigue can be debilitating and interfere with daily functioning.

Even before I was diagnosed with multiple sclerosis, I was T.I.R.E.D.!!!! 

After diagnosis it got worse, to the point where I needed to take 2-3 naps daily just to make it through.  So I mentioned this to my neurologist who gave me some samples of a medication to try.  Those samples were for Provigil, a prescription medication used to improve wakefulness in adults who experience excessive sleepiness due to one of the following diagnosed sleep disorders: obstructive sleep apnea, shift work sleep disorder, or narcolepsy.

Modafinil (Provigil® / Cephalon, Inc.) is not approved for MS-fatigue but is commonly used off-label for that purpose.  When I first tried it, the effect was not immediate.  It’s not the type of medicine which guarantees that you are peppy in 30 minutes.  However, I did start very conservatively by trying just half a 200mg tablet.  After a few days I tried a full tablet and finally had a day where my brain felt “normal.”  I could think clearly and only needed one nap.  What a blessing!

As I experimented with finding an optimal schedule to take the medication, my neurologist suggested that I take one pill upon waking and an additional half tablet before noon.  That finally provided me with the ability to function through my evening teaching schedule.  I teach music lessons to children and adults on most weekday afternoons and evening.  Before trying Provigil, my fatigue level had reached the point where I was literally falling asleep while teaching piano lessons.  A bit embarrassing and nonproductive.

A challenge with Provigil, however, can be insomnia.  The medication needs to be taken in the AM, because if it is taken too late in the day, you may have difficulty going to sleep at night.  If you can’t go to sleep and end up getting too little sleep, you will certainly be more fatigued and sleepy the next day.  It can be a vicious cycle.

Now, I don’t use Provigil daily like I needed to for a while.  If I’m having several days in a row where the fatigue is becoming oppressive, I will take half a tablet in the morning and maybe the other half tablet at noon.  I find that this gives me just enough assistance to be able to function.

Some people have described feeling jittery or ‘wired’ on Provigil.  I have not felt either.  But my good friend Joan shared with me that it made her suicidal and in fact this is a side-effect discovered during postmarketing reports.  Drugs provide benefits but also carry risks.