Letters

[Read "Better Waking Through Chemistry" by Larry Smith.]

Dude, Larry, cut the dose in half -- maybe into fourths. Those pills are easy to split. You don't need 200mg. I also found that to be an unnecessarily strong dose with annoying side effects. You should have realized that the second or third day of your experiment.

If you want to keep experimenting with pharmaceuticals then you might also try Xyrem (sodium oxybate), otherwise known as GHB. Yes, it's the infamous date-rape drug. It's available by prescription now by virtue of it being Schedule 3 (some medical use), while at the same time it is still Schedule 1 (no medical use at all -- don't you love government logic?). Xyrem is supposed to be prescribed for narcolepsy, like Provigil, but for the opposite reason -- it helps you get to the deepest stage of sleep so that you awake feeling refreshed.

However, if you want my best advice, what you really need is to learn how to relax. Look into Progressive Relaxation and diaphragmatic breathing. Relaxation is a skill (yes, a skill) that you can acquire and improve upon. You're a funny writer, but you're obviously tense as hell (like the majority of people in our high-strung culture who have never learned how to properly relax). Pharmaceutical treatment for insomnia is ultimately a palliative that postpones a real solution. I only mention the Xyrem because it produces better sleep than the benzodiazepines (and it's quite fun).

Good luck!

-- Thomas James

For those of us who rely on Provigil to get us through the day when our nervous systems can't (narcolepsy), the recent explorations of the drug by so many are sometimes amusing, sometimes irritating.

If we could stay awake through office meetings, or movies, or television shows, or even during sex without medication, we would happily go on infomercials to promote our method.

Provigil helps some of us. Alas, not all.

I've taken it daily for over a year with none of the symptoms reported in this article. But then again, wakefulness has been an undiscovered country from whose bourn no traveler has sent a postcard.

-- Harry Kelley

Thank you, Larry Smith. Great article. The doctor in your family was absolutely spot-on about Provigil. My first husband, an internist and E.R. physician, died at the age of 40. He was addicted to pharmaceutical speed, defined by the medical profession as a "self-medicating physician." I figured out once that he actually lived the waking hours of a 60-year-old. He wore out his body.

Any drug that keeps you on your toes when you should be flat on your back is dangerous. What are we all thinking? Turn off the computer, the TV, the light bulbs, the street overheads and snuggle up with your mate, your dog or cat, and/or yourself.

We all need to work less, and sleep more. If you can't sleep, just stay in bed and think. Create strong, social networks -- the old-fashionED word for this is "family." Somebody has to tell you when to go to bed.

-- Mary McCurnin

As a lupus patient and sufferer of overwhelming, incurable, clinical fatigue that often accompanies the disease, I read Larry Smith's article on his "experiment" of taking Provigil only to find myself feeling like I was a rabbit looking at oncoming headlights.

No wonder my insurance company doesn't want to cover this drug for anyone. It's clearly being widely abused. Hell, it's a popular "upper," from what Smith reports.

Those of us who actually need this drug for clinical reasons have found insurance companies are resisting coverage for Provigil for anything but narcolepsy -- despite the fact it has been proven through clinical trials and medical research to be highly effective in treating the fatigue associated with lupus, Sjogren's Syndrome, fibromyalgia and chronic fatigue syndrome.

Can I live without Provigil? Possibly. But not for long -- without Provigil's benefits, I cannot hold down a job, hold a conversation, or even hold a cup of coffee without suddenly falling asleep. Those of us who actually need the drug don't feel shaky or nervous or receive the least bit of "rush." In fact, it barely makes us "normally awake." Smith's side effects are reported by people who don't need the drug for medically sound reasons.

Smith's little experiment may have grave future costs for those of us who truly need the drug. Shame on you, Larry. You should have done more research into it -- and just said no.

-- Nancy C. Hanger

Like many people with conditions like M.S., ADHD and narcolepsy, I've been prescribed Provigil by specialists in order to combat extreme fatigue (in fact, I doubt I could hold down a job without Provigil and similar medicines).

When my doctors gave me this drug, they gave me very strict and detailed instructions on how to properly use it -- i.e., absolutely no caffeine, alcohol or any other substance that might either enhance Provigil's stimulant effect, or lessen it. They warned me that most people don't think of a glass of wine or a cup of coffee, or even an aspirin, as something that might complicate strong medicines like Provigil, but that I couldn't afford to think that way if I wanted the drug to work effectively. They also told me about the possibility of Provigil making me feel a little "hyper" and "speedy" for a short time immediately after taking it, and gave me instructions as to how to deal with this. The feeling does go away -- unless, like Mr. Smith, you keep ingesting coffee and chocolate and sugar and wine and all the other things that he, like other people I've known, don't seem to understand will interfere with the drug's effectiveness and make you feel sick.

My question to Mr. Smith is, why didn't your doctor explicitly tell you these things? Or, if he did, why didn't you listen? Because now you've gone and written an article that, in my experience, misrepresents this drug and others like it. And, of course, the public will read it and completely miss the point that you swallowed just about everything that interferes with the working of Provigil in one day, and expected to get an optimal result. I think it's very irresponsible.

Not everyone should take Provigil. I personally wish that I didn't have to take anything in order to lead what most people consider a "normal" life. But it's clear to me that most people (including Mr. Smith) seem to expect that they can take these drugs under any conditions and get the result they want. They are careless and unaware of what it's like to have a chronic illness and have to think about everything you put in your mouth, not just a doctor-prescribed "designer" drug.

-- Carolyn W.