Would love to hear your general thoughts on Modafinil. One of the things they say is that it has minor side-effects and that tolerance builds up really slow, if at all, in comparison. What's your take on it, empirically?

First a warning, because I've seen many misconceptions: Modafinil is not a sleep replacement. Especially not long-term. Do not use it that way. Its anti-sleep property is that it suppresses many parts of the urge to sleep. It does not provide any of the effects sleep provides.

--

Well, I've always had issues with sleep: I have an 25 hour circadian rythm, so before modafinil I often just let it run and wake up an hour later every day. I thought modafinil might be something useful to help me experiment with my sleep. Note that I did not get a doctor's receipt, so I imported the drug myself. (I'm not in the US; it's not a felony where I am.)

You say "in comparison"-- I must say that I do not have much to compare it to. The only other substance of this kind that I feel an effect of is caffeine, and it's on a completely different level, in all ways.

Side-effects I noticed were mostly dry/chapped lips, reduced appetite and diarrhea-- the last of which seems not to be very common.

In terms of its nootropic effects, I'm normally very bad at focusing on stuff for long periods of time, and for some periods it helped me focus for long times on tedious things. Or it helped me focus on cleaning the house really well, reading the internet thoroughly and avoiding what I had to get done. But if I used it and spent a night studying, I would remember the material studied very well. This concentration effect was also the quickest to fade after longer use.

The main effect is its anti-sleep property is that it suppresses many parts of the urge to sleep. It does not provide any of the effects sleep provides.

Right now I don't use it, because I am not working on anything that would benefit from it, and the side effects are not worth it to me right now. Also, melatonin has helped me with my sleep rythm issues for some time, so I don't need it for that.

I did not notice any addictive effects whatsoever. There's no high you get from it, nor a low after you stop, perhaps besides sleeping a bit longer for a few days.

I recall reading that unusually-timed melatonin supplementation worked for at least one person.

From HPMOR notes:

>Around a year ago, some friends of mine cofounded MetaMed, intended to provide high-grade analysis of the medical literature for people with solution-resistant medical problems. (I.e. their people know Bayesian statistics and don’t automatically believe every paper that claims to be ‘statistically significant’ – in a world where only 20-30% of studies replicate, they not only search the literature, but try to figure out what’s actually true.) MetaMed offered to demonstrate by tackling the problem of my ever-advancing sleep cycle.

Here’s some of the things I’ve previously tried:

    Taking low-dose melatonin 1-2 hours before bedtime
    Using timed-release melatonin
    Installing red lights (blue light tells your brain not to start making melatonin)
    Using blue-blocking sunglasses after sunset
    Wearing earplugs
    Using a sleep mask
    Watching the sunrise
    Watching the sunset
    Blocking out all light from the windows in my bedroom using aluminum foil, then lining the door-edges with foam to prevent light from slipping in the cracks, so I wouldn’t have to use a sleep mask
    Spending a total of ~$2200 on three different mattresses (I cannot afford the high-end stuff, so I tried several mid-end ones)
    Trying 4 different pillows, including memory foam, and finally settling on a folded picnic blanket stuffed into a pillowcase (everything else was too thick)
    Putting 2 humidifiers in my room, a warm humidifier and a cold humidifier, in case dryness was causing my nose to stuff up and thereby diminish sleep quality
    Buying an auto-adjusting CPAP machine for $650 off Craigslist in case I had sleep apnea.  ($650 is half the price of the sleep study required to determine if you need a CPAP machine.)
    Taking modafinil and R-modafinil.
    Buying a gradual-light-intensity-increasing, sun alarm clock for ~$150

Not all of this was futile – I kept the darkened room, the humidifiers, the red lights, the earplugs, and one of the mattresses; and continued taking the low-dose and time-release melatonin. But that didn’t prevent my sleep cycle from advancing 3 hours per week (until my bedtime was after sunrise, whereupon I would lose several days to staying awake until sunset, after which my sleep cycle began slowly advancing again).

MetaMed produced a long summary of extant research on non-24 sleep disorder, which I skimmed, and concluded by saying that – based on how the nadir of body temperature varies for people with non-24 sleep disorder and what this implied about my circadian rhythm – their best suggestion, although it had little or no clinical backing, was that I should take my low-dose melatonin 5-7 hours before bedtime, instead of 1-2 hours, a recommendation which I’d never heard anywhere before.

And it worked.

I can’t #&$ing believe that #$%ing worked.

(EDIT in response to reader questions: ”Low-dose” melatonin is 200microgram (mcg) = 0.2 mg. Currently I’m taking 0.2mg 5.5hr in advance, and taking 1mg timed-release just before closing my eyes to sleep. However, I worked up to that over time – I started out just taking 0.3mg total, and I would recommend to anyone else that they start at 0.2mg.)

It's a very subjective question. Modafinil makes me feel Not Tired. That's pretty much it. Not amped up, not hyper focused, just very awake. If you're having trouble focusing because your tired then this is a huge improvement. But I don't think it's much better than just being actually well rested.

Tolerance didn't seem like a huge issue, but I also wasn't taking it every day.

Tolerance does happen with modafinil, but sensitivity increases again very rapidly for most people, so if you don't take it every day you might never start noticing it.

How do you get that doctor's prescription in the US?

FYI: I would strongly suggest getting a RX for Modafinil (Provigil) and not Nuvigil (Amodifinil). Nuvigil is very expensive and my insurance company required a whole battery of additional tests before they paid for it. I believe Modafinil is now generic so I imagine they care much less.

Last time I checked, cephalon had some sort shady deal to keep generic modafinil off the market for a few more years (paying generic manufacturers to not bring it to market). If modafinil goes generic, it will be really good news.

It's generic, but it's still expensive. My insurance still required prior auth, but it was doable.

From what I've heard before, it was almost impossible for people to get approved by insurance for modafinil, maybe times have changed and I need to pay the doctor a visit in the future.

For now though, nicotine hits the spot.

No it is still friggin impossible...

I have an actual sleep disorder and I am currently going through hell trying to get my insurance to pay for modafinil, and I've been through the whole battery of tests. :( I don't want to be "smarter" I want to be awake.

It is generic but still stupid expensive.

You need to be diagnosed with narcolepsy or shift-work syndrome to get prescribed modafinil in the US.

You don't need to be diagnosed with anything; those are just the approved uses. It can be prescribed off-label for nearly anything your doctor wants.

At one point they pitched it to the FDA as a cure for jet lag (which it arguably is) but the FDA didn't buy "jet lag" as a legitimate medical problem.

Some psychs will prescribe it for ADD/ADHD (mine did).