How to sleep after modafinil
MushroomMan 13 Sep 2013
That night though, I couldn't sleep at all. I decided. I decided I was only going to take OTC sleep aids (because I used the powerful non OTC ones too much in the past) I first tried taking 10mg of melotonin and drank a pot of chamomile tea. Nothing. I had no passionflower or valerian like I usually use. Then I tried 15mg of doxylamine. Then another 15mg. Then I tried rhodiola rosea. I then tried something that many people at addforums swear by. A combination of taurine, magnesium and inositol. I think I got about 20 minutes in total. It felt just like the dexedrine insomnia, my mind was calm but I had this restlessness in my body than made me need to keep rolling over. I think the problem is lack of dopamine, dopamine deficiency causes akathisia (medical term for this inner restlessness).
I'm thinking there must be healthy ways to counteract modafinil insomnia by understanding modafinils unique pharmacology. I was surprised that doxylamine (thats not a healthy sleep aid, I was just experimenting with it) didn't work, because from what I read modafinil promotes wakefulness by releasing histamine in the CNS. A few things I want to try now are kava (only problem is its really expensive), regular meditation (just need to discipline myself to do it daily) and corydalis (I heard of this one, sounds like it has a novel mechanism of action). I have a lot of experience with sleep aids from my past dexedrine use, but I wanna dedicate this thread to modafinil so I'll make a seperate thread for general sleep aids.
Do any of you know any good, healthy and more importantly, sustainable ways to put yourself to sleep after being on modafinil during the day? Can you share your experience with this, as well as your knowledge on the pharmacology of modafinil and possible ways to use that knowledge to counteract the insomnia problem.
lammas2 13 Sep 2013
Q did it! 13 Sep 2013
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Supplier (script?)
Time of ingestion
You may want to lower the time spent sleeping to a average max of 6.5h and not to mention, as stated above, only take Moda in the morning. See http://www.bulletproofexec.com/category/sleephacks/ you may already be aware of the site but it may give you a good idea of how to structure "stims" into your day and I would recommend you try the coffee, highly recommend (no affiliation) also there is plenty of other helpful information there too. And if you are really interested in optimizing your mind and body I would suggest you visit the TULIP thread as well and CILTEP among much more including finding a good diet. I have a resource section with links on my profile page (still in very early development).
Back to topic. Modafinil is awesome but its really only a window to what your mind can do, why stop there? Optimize tell you reach advancement and hit a wall then repeat infinitely.
Tom_ 13 Sep 2013
Modafinil should be trialed at doses of 200mg in the morning at 3 or 400mg this dose can be split with one taken in the mid day or all at the same time.
My advice is spend a week at 100mg in the morning, if you feel the need to increase the dose go to 200 in the morning and then feel free at higher doses to add another one NO LATER than 1pm due to a fairly long half life. So yes, you are right, understanding the pharmacodynamics will help improve the insomnia.
No disorder in the human body is related to a single neurotransmitter. Akathisia has multiple interelated causes, one of which MAY be decreased dopamine firing, although the evidence for that is minimal.
If you have a depressive disorder why are you covering it up with stimulants (and likely worseing it) rather than treating it?
MushroomMan 14 Sep 2013
Tom_: If I had known it was depression 5 years ago, I would have focussed on curing it from the start. I only figured out that this kinda drowsiness and emotional and physical numbness is a tell tale sign of depression a few months ago. I'm thinking now, maybe if I cure the depression, these withdrawal symptoms will be much more maneable so I can get my life back together. As for why I'm covering the symptoms up. for the simple reason that I cannot function well enough to survive at the moment. On top of that, I am in agony with this akathisia. Its severe enough that the thought of killing myself to end it pops into my head from time to time. I will find a solution, but until then I need a way to alleviate these problems.
When you say "treat depression", what do you have in mind? Psychotherapy? I believe my depression is caused by a traumatic event that my mind has blocked out from my memory. Whatever it was, it happened when I was around 20 and I remember the point at which the memory of what happened faded. I think psychedelic or MDMA therapy might be a good approach, but first things first, I need to find a psychotherapist. The only reason I have the energy and motivation to write this thread is because I temporarily relapsed and got back on stimulants for the past couple of days.
No but knocking one neurotransmitter out of the equation, can cause all kinds of conditions. The evidence that akathisia is caused by dopamine deficiency is astronomical. Selective dopamine antagonists induce it. Atypical antipsychotics induce it. Parkinsons disease get it. Bromocriptine alleviates it. There are more neurotransmitter systems involved, like acetylcholine which causes over activation of muscarinic receptors when there is a deficiency of dopamine.
Tom_ 14 Sep 2013
I'll highlight quickly that the evidence for psychedelic and MDMA therapy is almost non existant (not to mention hard to get hold of it). I really advise again trying psychedelic/MDMA psychotherapy (be aware both can cause worsening suicidal ideation and movement disorders). After you have tried every antidepressant and adjunct known to man (within reason) they are possibilities but there are safer more effective options.
While memory loss is a clinical phenomena it almost unheard of in a psychiatric context (at least for more than a few days) and while 50-60+ years ago in the age of psychoanalytic therapy almost everyone in therapy was suspected of similar problems research and clinical experience has shown a very different reality.
The management of depression should follow a fairly solidly evidence based algorithm. I understand your urge not to be on medication but treating depression is easier and more effective with antidepressants. This doesn't mean AT ALL that psychotherapy should be avoided, in your case due to a chronic or at best relapsing and remitting episode, its going to be very important.
If you are interested in my suggestions for depression diagnosis and management, tell me on here/pm me and I'll give you the full shebang.
Treatment of the akathisia should be with beta blockers as a first line along side withdrawal of the causative agent of course. You could add to this treatment with a SHORT (2-3/4 weeks) course of Clonazepam at 0.5-1mg or Pregabalin/GABApentin. You could choose to start an antidepressant with reasonably potent anticholinergic effects along side Pregabalin or Propanolol.
Q did it! 14 Sep 2013
MushroomMan 14 Sep 2013
Tom_: I have extensive experience and knowledge with various classes of psychiatric drugs and their use in treating depression and other ailments. You recommend trying every class of antidepressant before trying psychedelic therapy. You pointed out the problem with this in your previous post. MAOIs, SSRIs, SNRIs, SARIs, TCAs etc., they all just cover up the symptoms, rather than cure the root cause of the problem. If that was the only problem though, I'd personally have no problem with staying on a drug that worked my whole life. In reality, these drugs often abruptly stop working, and I'm not talking about the gradual development of tolerance via up/downregulation of receptors or whatever, I'm talking about long term neurophysiological changes that occur. The medical term is tachyphylaxis, the laymans term is "pooping out" and its quite common with SSRIs and SNRIs. I experienced this with trazodone (a SARI), one day it just abruptly stopped working as a sleep aid. If one has been on the drug for years, they will be in for a nightmarish withdrawal that can last years. SNRI withdrawals are exceptionally horrific. If I were to go to a doc for an antidepressant, I'd try selegiline (a reversible MAOI) first since my depression manifests as drowsiness, and it works instantly but this is no different to taking modafinil, it is just covering up the symptoms. SSRIs cause long term neurophysiological changes by promoting plasticity via upregulating BDNF, but they do so at a terrible cost (all the other brain changes they cause).
As for akathisia, I steer clear of benzos as they temporarily remedy the problem, but make it much worse as they wear off. Gabapentin and propranolol don't help. I know of all kinds of drugs which do remedy it (opiates, scopolamine, bromocriptine, doxylamine etc.) but I'm looking for substances which won't make the problem worse in the long run. The reason I started this thread on a nootropics/longecity forum is because I'm looking for healthy solutions to my problems. The unhealthy ones are what got me into this mess.
Edited by MushroomMan, 14 September 2013 - 04:14 PM.
Tom_ 14 Sep 2013
They do make semi-permanent changes to brain micro-structure and to a lesser extent the macroscopic level. These changes are 'good' changes, they reverse the damage done to the hippocampus, nucleus accumbens etc..of course there are some unwanted side effects but they certainly don't outweigh the benefits. There is good research showing no long term reduction in cognitive abilities.
The risk of poop-out (which you will find in the academic discussion of Neuropsychopharmacology is now the clinical term) and if it poops out a swap is a perfectly reasonable move. You also will find the risk of poop-out to be low. Poop-out will not lead to withdrawal syndrome (I'm sure if you look hard enough you will find a case study) but its not the rule. Typically withdrawal lasts less than a month.
There is a VAST difference between taking Sertraline (for example) and d-Amphetamine. Modafinil appears to have some mild antidepressive properties.
Selegiline while approved by the FDA is not an effective antidepressant. If you want to try an MAOI without the horrible side effects choose Moclobremide.
The broad sweeping statements you are making are inaccurate. SSRI's do increase BDNF, in select areas, where funnily enough depressed people have a lack of it.
This is the healthy way to deal with depression, along side psychotherapy. The unhealthy way is to try drugs that can cause true dependance syndromes, are legally or should be legally band because they can cause people to act in such a dangerous or reckless manner, have a poorly understood but usually very unpleasant side effect profiles (including chronic neurological impairment) and above all else have no evidence of efficacy in depression.
You can of course do exactly as you choose. However you clearly do not have an extensive knowledge of psychopharmacology and this is my favorite forum so I'm going to keep posting how much I disagree so if any newbies happen to come along and read this they at least get a balanced argument.
If you want more & much better phrased information on clinical psychopharmacology I would recommend "Essential Psychopharmacology of Depression and Bi-Polar disorder - Stephen M. Stahl".
If you are beginning to have suicidal thoughts due to the Akathisia then a short term course of Benzo's may help relieve that severe distress, although I can entirely understand and respect the wish to stay away from Benzo's. I did mention a trial of Pregabalin, which while being a sister drug of GABApentin has a very different mechanism of action and is effective for Akathisia.
Its also worth mentioning Bupropion may be of use. It is an NDRI but not strong enough for abuse and will likely relieve at least to some extent the Akathisia. Its also an effective antidepressant. You can go down the route of dopamine agonists but you already highlighted how that isn't helpful. However starting Pregabalin and Bupropion/amphetamine and then slowly reducing the dose of Bupropion/amphetamine may be effective.
MushroomMan 14 Sep 2013
I should point out though, what you said about withdrawals typically lasting under a month isn't true. I've withdrawn from a few classes of drugs so did a fair bit of reading up on other peoples experiences, and I have heard plenty of horror stories, especially with effexor and other SNRIs. The acute part of it might last under a month, but the post acute withdrawal symptoms can last years. It depends on various factors such as the person, the duration of use, the doses used, the persons diet etc.
Edited by MushroomMan, 14 September 2013 - 07:23 PM.
MushroomMan 14 Sep 2013
I heavily disagree with this paragraph, so have to say something. The vast majority of antidepressants cause physical dependence which can lead to severe withdrawals. Many of these classes of antidepressants have poorly understand and often very unpleasant side effect profiles. Everyone responds differently to drugs, there are people on antidepressants who act in dangerous or reckless manners. Should the antidepressants be banned? Was it the drugs fault that the person acted in this way?This is the healthy way to deal with depression, along side psychotherapy. The unhealthy way is to try drugs that can cause true dependance syndromes, are legally or should be legally band because they can cause people to act in such a dangerous or reckless manner, have a poorly understood but usually very unpleasant side effect profiles (including chronic neurological impairment) and above all else have no evidence of efficacy in depression.
I don't really know what you consider to be effective for treating depression. Amphetamine has been shown to alleviate depression in some people, does that mean its an antidepressant?
Tom_ 14 Sep 2013
No approved AD has a poorly understood side effect profile, due to the testing they go through before approval, although yes some (mostly older class) aren't as tolerable.
They do respond differently to drugs but its very rare for someone on a clinical dose of psychotropics to go off the deep end.
Amphetamine has consistently been shown not to be effective for treating depression. In some people it will mask the symptoms for 4-12 hours but then the depressive symptoms return in some cases briefly worse. Yes AD's can worsen depression although this tends to be a two week period and then an improvement is seen - not always, however evidence supports a swap even into the same class as not causing the same problem.
Nate-2004 18 Apr 2018
The original poster may have tried this but an anti-histamine like diphenhydramine seems to do the trick for me if I couple it with a vape oil blend of equal parts THC and CBD and on top of that, 500mcg melatonin.
The anti-histamine will counter modafinil's pro histamine mechanism of action. It's worked for me on most nights. Chamomile helps too if you lop that on top of all this. I still wake up feeling pretty energized from the remaining modafinil in my system but it works.
I wouldn't worry so much about sleep with modafinil, just ride it to the next evening when you'll sleep like a rock and it'll be fine. I've managed to conquer the insomnia I've had since childhood with proven methods of sleep hygiene so make sure you follow those as well. Just google it.