In a previous post, I talked about my fatigue and my diagnosis of sleep apnea. I mentioned that I’ve been prescribed modafinil, a wakefulness promoter that’s not really a stimulant, because using the CPAP machine every night did not restore my energy right away.

I’ve been taking my modafinil faithfully, and it helps a lot, but not enough to wean me off pretty high-dose caffeine—not yet. I seem to be slowly gaining energy, so I might be able to stop using this stuff eventually. In the meantime, though, it’s very helpful.

2017 Update: This blog post was first published in 2015. I’ve added my 2017 updates here and there throughout the post.

The big news for 2017 is that I’ve recovered enough to stop taking modafinil every day! Woo-hoo! I used to take 400 mg every day: 200 mg when I got up, and 200 mg at 11 AM. I cut this down to 100 mg (half a pill) twice a day, then 100 mg once a day. Now I take 50 mg (a quarter of a pill) if I feel like I need it, averaging 50 mg once every week or two.

What Remedies Help with Fatigue and Brain Fog?

Never satisfied by half-measures, I investigated the possibility of other energizing compounds. (Not amphetamines, though. They’re fairly standard for post-apnea fatigue like mine, but … no.)

It turns out that pharmaceutical companies around the world have been working like crazy on this problem for decades, and there are a lot of things to try. Some are prescription drugs, but many are herbs, nutrients, or other compounds that are available over the counter. Many have been in use for 30-40 years already and have established track records (though sometimes mostly for other complaints than mine).

I’ve tried all the remedies listed below: D-ribose, adrafinil, rhodiola rosea, caffeine, extended-release caffeine, sulbutiamine, and L-theanine.

D-Ribose

My new favorite supplement is D-Ribose, which seems to give me a significant physical boost. Unlike most supplements in powder form, D-Ribose dissolves in water and tastes fine.

Ribose is part of the mitochondrial powerhouse cycle, which I will not even pretend to explain, but it certainly bumped up my physical activity level, in spite of not being a stimulant.

I’ve tried both the powder from Bulk Supplements and the chewable tablets from Now Foods. The powder is much ore affordable, and since (unlike most other supplements I mention) the powder is pleasant-tasting rather than disgusting, you might as well try the powder first.

Read more about Ribose.

2017 Update: I’m still taking D-Ribose powder daily. I stir it into my morning coffee, where it dissolves easily and tastes just like sugar.

Adrafinil (Olmifon)

Adrafinil is similar to modafinil, and in fact was developed by the same company. Adrafinil is now available over the counter, while Modafinil is a prescription drug that costs an arm and a leg (hundreds of dollars a month!). I’ve purchased 300 mg adrafinil capsules from Absorb Health, directly from their Web site.

A lot of people who can’t afford modafinil use the more affordable adrafinil instead. It’s less concentrated than modafinil (for me, 300 mg of adrafinil is equivalent to 100 mg of modafinil and it doesn’t last quite as long). If you buy adrafinil in capsule form, it costs about $1 per pill, and a standard dose of 2-4 pills per day works out to $60-$120 per month. Buying it in powder form cuts the price in half, or more.

See this translation of the original manufacturer’s (Cepalon’s) package insert for Olmifon, or read the Wikipedia page on adrafinil.

2017 Update: I haven’t taken adrafinil for a long time. When I run out of modafinil, I’ll probably use adrafinil instead, since it’s cheaper and I don’t need the extra kick modafinil gives anymore.

Rhodiola Rosea

This is an herb that has, maybe, some stimulating properties in addition to aiding recovery. But if it’s stimulating, I can’t feel it. Rhodiola rosea is affordable and readily available at places like GNC. I use the Now Foods 500 mg Rhodiola rosea product, taking one on arising and one before lunch.

Read more about rhodiola rosea on examine.com.

2017 update: I put rhodiola rosea into a rotation along with echinacea and ginseng. On a month where I take rhodiola rosea, I don’t feel any different than on the others.

Good Ol’ Caffeine

Caffeine pills restored a great deal of my functionality. It took me a while to realize that high doses of caffeine are essential to my energy and alertness. I don’t know about you, but it works for me.

For the last couple of years, I’ve taken a 200 mg immediate-acting caffeine tablet first thing in the morning, at 11 AM, and at 3 PM). Caffeine tables give a reliable increase in my energy level and alertness 20-30 minutes after I take them.

Some people point that this is a lot of caffeine, and it is! That’s 600 mg/day, but in fact I also drink coffee and caffeinated diet sodas, so my total intake is probably more like 800 mg/day. That’s twice as much daily intake as is usually recommended.

When traveling, I prefer the old standby, Vivarin, since its waxy coating lets me swallow a pill dry. At other times, I prefer inexpensive caffeine tables that I can wash down with water. Of the low-cost caffeine tablets, I’ve found the Prolab brand to be completely reliable. Others can be oddly variable in effect, even from pill to pill in the same bottle!

Bonus early-morning caffeine tip: Before bed, I set two wake-up alarms, half an hour apart. I keep caffeine pills and a bottle of water next to my bed. When the first alarm goes off, I take a caffeine pill and go back to sleep. When the second alarm goes off, I’m ready to get up. This gets me up far more reliably than expecting myself to find the energy to get up before I take caffeine.

Extended-Release Caffeine

The idea behind extended-release caffeine is to avoid that jangly caffeine jolt shortly after taking it. Instead, it’s supposed to give a smooth alertness. I liked the  Met-Rx 200 mg capsules, which were very affordable. Sadly, they seem to have been discontinued. They claimed an eight-hour extended release. For me, they lasted 3-4 hours.

I’ve tried a couple of other brands, including Sundown Naturals sustained release caffeine, but they didn’t have any effect on me. Other people give this brand very high marks, though, so maybe it’ll work for you.

Sulbutiamine (Arcalion)

Sulbutiamine is a synthetic form of vitamin B1 that’s also helps keep you going. This is more exotic than Rhodiola rosea but is still available over the counter. I’ve purchased 200 mg sulbutiamine capsules from Amazon.com and from Absorb Health. I used to take four capsules per day. I tapered off after they seemed to lose their punch, and now only take sulbutiamine occasionally. I’ve started buying it in powder form, which is much cheaper.

Read the Wikipedia article on sulbutiamine, or the original manufacturer’s instructions for Arcalion, which is just another name for sulbutiamine.

2017 update: It’s been a long time since sulbutiamine had any obvious effect on me, and I no longer use it.

L-theanine

This is an amino acid found in green tea, and it counteracts the over-stimulation that you get from caffeine alone, so you get a calmer pick-me-up. I’ve used 200 mg L-theanine capsules from Now Foods. Frankly, I don’t notice much effect from this and stopped using it some time ago.

Read the Wikipedia page on L-theanine.

Buying Supplements in Powder Form

This is something of a nuisance, since you have to measure your doses, and many supplements taste awful, but it reduces the price by a lot: 50% for adrafinil and 80% for sulbutiamine. That’s a pretty good incentive.

I may write about this in more detail later, but basically you want an inexpensive but accurate electronic scale and probably a simple kit for filling your own capsules.

Sunrise Simulators

I use two different Lighten-Up sunrise simulators to ramp the lighting in my bedroom from pitch black to very bright over the course of half an hour. The idea is that your body wakes up more easily if you give it firm “it’s morning!” cues, and more comfortably if the light level rises slowly.

These devices are just programmable lamp dimmers that you use with the lamps of your choice. I have one on my headboard and one at the other end of the room. They work best with incandescent bulbs, but I think I have one of them using a dimmable LED lamp.

Bedtime

To help get to sleep, and for the general benefit they provide, I take 3 mg of melatonin and 600 mg of Valerian extract about 90 minutes before bedtime. These aren’t particularly powerful sleep aids, but all they’re supposed to be doing is to point my body in the right direction.

So I’m recovering from that nasty cold that’s going around. It hit me pretty hard, so I’m taking prescription medications, and over-the-counter remedies, and herbs, and rest, and plenty of fluids. And that’s just fine: I’m getting better.

But a friend of mine, who had the exact same thing, was spending the weekend with some very nice people who told her that her prescription meds were nasty, and the Gatorade she was drinking because it was the only think she could keep down was nasty. It took her a while to shake off their influence and go back to doing things that actually worked. I’m not saying that she’d have avoided that trip the the ER if she hadn’t listened to them, but she might have.

So I have a few suggestions for all you readers out there…

What to Do When a Friend is Really Sick

• Get them to a doctor. Just do it. Do it now. Expect that both you and your friend are in denial. Push right past it.
• Learn the difference between prevention and cure. Prevention is important. Exercise is good for your heart. But only an idiot would get up and run around the block during a heart attack!
• Learn the difference between emergency care and palliative care. Palliative care is there to speed up a normal recovery that’s already under way, or to make the recovery more comfortable. Deterioration below what you’d get with an ordinary cold calls for a doctor. It’s fine to play doctor for your own palliative care and for prevention: we all do it. Just don’t play ER.
• ABC’s. Airway, breathing, circulation. That’s the order in which an EMT checks to see what needs to be done to keep you alive. To a layman, this boils down to “are they breathing okay?” Note that “breathing” is on this list and “healthy eating” isn’t.
• If someone is deteriorating and has trouble breathing, it’s an emergency. Don’t fart around. Call an ambulance or go straight to the ER. Immediate Care centers aren’t good enough — they’re for ditsy stuff like colds and sprained wrists. Grandma’s home remedies and denial aren’t even in the running.
• Don’t encourage people who are obviously sick to throw their meds away. The world has enough maniacs already. If you think they’re sick because of the meds, you can ask them to call their doctor to compare symptoms and side effects. But if you just don’t like meds, knock off the deathbed conversion thing.
• If they’re getting doctoring, what they need is nursing. There’s a whole industry devoted to second-guessing doctors, because there’s a huge pile of money in it. There isn’t any money in helping a friend out, doing their chores, being encouraging and companionable, and checking in on them frequently. But that’s what they’ll need most, once they’ve seen the doctor.

 

When to Use Alternative Methods

Alternative methods are usually milder and are often slower-acting than conventional methods, with effects that build over time. So taking an alternative remedy whose results have a slow onset, like Omega-3 fish oil, isn’t going to do much for a problem that’s only going to last a short time. Some work well in the short term — I especially like Valerian for back pain and insomnia — but most healthy alternatives are long-haul things.

The same goes for diet. If you’re not allergic, diabetic, or suffering from celiac disease, falling off the wagon for a day or a week or a month is no big deal. You just climb back on again when you can. So if your tummy can’t handle whole grains or raw milk, there’s nothing wrong with sustaining yourself on whatever works until the trouble passes, which for me is ginger ale and saltine crackers.

I live in the country, which is a good healthy lifestyle choice, and we raise a lot of our own food, which is another. And I routinely take many of the usual herbs. And when I get sick anyway, I go to my doctor.

My dad was a champion snorer, could fall asleep anywhere in a minute or two, and had enormous difficulty getting up in the morning. He almost certainly had a severe case of sleep apnea, but he passed away before sleep apnea was widely understood.

You can see where this is going. I snore. I have trouble getting up in the morning, and, worse, my level of energy during the day has been plummeting. This has been going on for some time now. Sorta hard, when I have a full-time job and three businesses!

So I went to my doctor, and, after a certain amount of folderol that I’ll describe later, I have a shiny new diagnosis of sleep apnea and a fancy new machine to keep it from killing me.

How Sleep Apnea Works

During sleep, people relax, and some people relax so much that their breathing is obstructed as they inhale; their tongue shifts backwards or their windpipe closes, causing you to struggle for air and likely snore in the process. If the loss of air is severe enough, your brain wakes you up to allow you to gasp for air (successfully, this time), then you instantly fall back to sleep, after being awake so briefly that you don’t remember it in the morning.

The upshot: your quality of sleep is terrible, making you tired all the time, and the struggle for breath and low oxygen levels can cause all sorts of trouble.

Remedies That Didn’t Work For Me

Well, I don’t know about you, but I prefer being healthy and energetic. There are various minor things you can do about sleep apnea if you have only a mild case, and I tried some of these while I was waiting for the whole diagnostic process to complete:

• Sleep on your side instead of your back. Didn’t stop my snoring, so it probably didn’t help my apnea.
• Decongestants and nasal saline rinse. Ditto.
• Mouth guard to help reposition your lower jaw slightly forward. The one-size-fits-all one I bought didn’t fit.

What Did Work For Me

The gold standard of sleep apnea treatment is the CPAP (continuous positive airway pressure) mask, which is basically just a very low-pressure air compressor with a hose and a mask that goes over your nose, or in some cases your nose and your mouth. This adds a little extra air pressure to make it easy to inhale in spite of your airway’s pesky tendency to close. There are different kinds of CPAP machines, from very basic models to super fancy ones.

The sleep medicine center at the Corvallis Clinic prescribes only the super-fancy automatic CPAP machines with lots of data-collection capabilities. I guess they figure they might as well, since the automatic features and instrumentation will surely save you at least one overnight stay in the sleep lab, so the extra features will pay for themselves.

From my point of view, the advantage of a fancy machine is that I can use the built-in instrumentation to fine-tune the settings until I have them just right. I’m an engineer, after all. (I respect my doctors and keep them informed of what I’m doing, but if there are knobs and switches to adjust, I’m gonna adjust them myself.)

I selected a ResMed S9 AutoSet unit, which has a good reputation. This unit has every conceivable bell and whistle, including a HEPA filter and a built-in thermostatically controlled humidifier, which is pretty nice for a machine whose main purpose isn’t allergy control!

One of the spiffiest features is the “mask test” feature, which tells you whether your mask is leaking too much or not. They tend to leak a little, and it’s kinda scary to be left without any way of telling whether it’s a problem or not.

There’s a bit of a pretense that patients only have access to a few basic settings, but the keypresses that give you access to the provider menu are not much of a secret, since they’re available online in the ResMed S9 AutoSet Clinical Guide, which only took me about a minute to find.

All the sesssions are recorded on an SD card, which you can download into your PC and examine with the ResMed software or the freeware Sleepyhead software. I like the sleepyhead software best.

Here’s a small part of a Sleepyhead chart showing me having a sleep apnea event. The line on the chart goes up when I inhale and down when I exhale. Everything starts out okay, then gets sorta ragged, and at 1:47:15 I pretty much stop breathing for 15 seconds, then take a few big, gasping breaths.

Of course, I didn’t notice anything, because I was asleep at the time.

During my overnight sleep test, before treatment, I averaged 13.8 such events per hour. The first night on my CPAP machine, I averaged only 3.35. After adjusting the settings, I”m averaging about 0.3 events per hour, with none at all on some nights.

So How’s It Working?

My energy is coming back, but more slowly than I’d like. The thing that surprised me most was how much time I’m spending sleeping! But it makes sense (and it turns out that it isn’t unusual). After a long, long time with very poor quality sleep, I have some catching up to do. But my daytime energy is up, my caffeine intake is down, and once I do get up in the morning, I can get to work sooner than before.

Other CPAP Machines

I’ve also tried an XT Fit travel CPAP machine. No bells and whistles, but it gets the job done. I use it rarely, but it packs a lot smaller than the ResMed unit, and is also much less expensive.

How Bad is the Mask?

The masks take some getting used to. Most of them only cover the nose, anyway, so they’re not as claustrophobic as a nose-and-mouth mask, though these don’t bother me, either.

I made the beginner’s mistake of over-tightening the mask, which is very uncomfortable and doesn’t help anything.

I’m using a “nasal pillows” mask at the moment, and there’s some tendency for this to lead to a certain amount of air-puffing out the mouth, and if you breathe through the mouth when you’re asleep, this nullifies the benefit of the CPAP machine. I’m using an elastic chin strap, set without much tightness, to prevent this problem. I noticed that a puff of air tended to escape my mouth just as I fell asleep, and this was keeping me awake!

Conclusions

By the way, CPAP treatment also stops snoring completely. Some people may not think that a mask and a hose and a CPAP machine are very romantic, but a partner who snores is even worse!

The worse part about sleep apnea treatment is that people who need it are completely exhausted, so it seems like a lot of work. It is and it isn’t. Personally, I’m looking forward to having my energy again!

 Update, One Year Later

My return to high energy has not been happening as quickly as I expected, but I noticed something interesting: on days when I do a lot of driving, I take a lot of caffeine to make sure I drive safely, and on those days I feel better (more normal) and get more done. This sent me on a quest for non-scary stimulants:

Caffeine. This implies that I need stimulants to achieve a state of normalcy. I’ve experimented with caffeine pills to keep me going. At first, the right dose was 200mg of caffeine every three hours(!), for a total of four pills per day. It was important to take the first one even before getting out of bed. Now, I’m down to three pills per day.

Modafinil. I emailed my sleep doctor and he said that one of the newer “smart drugs,” Modafinil (Provigil) will give me better results without the caffeine jitters. Modafinil is often prescribed for people with sleep apnea who are using their CPAP masks faithfully but are still fatigued, and has an excellent record for safety and lack of weird properties, even with long-term use. I did not know that!

I started out on quite a high dose of modafinil (400 mg per day, half in the morning, half at at lunchtime), and this helped amazingly. The combination of caffeine and modafinil was a real life saver. As I’ve recovered, I’ve tapered off my modafinil usage to 100 mg per day.

Adrafinil. Modafinil is incredibly, appallingly expensive, but there’s an alternative. An older compound, adrafinil, is quite similar to modafinil and is available over-the-counter in the US. I’ve used adrafinil capsules from Absorb Health and they work great.

 

Other Remedies. See my I’m Tired of Chronic Fatigue post for more details about these and several other effective remedies I’ve used to boost my energy.

Bottom Line

My energy is slowly coming back. Some of this is due to the miracle of being able to breathe all night, thanks to my CPAP machine. Some is due to useful remedies, some of which are stimulants, and some aren’t. See my I’m Tired of Chronic Fatigue post for the full list.

As I recover, I need fewer stimulants, but the stimulants are important! It used to take me a couple of hours in the morning to be ready to do much of anything. Now I being work as I drink my first cup of coffee. That’s a huge difference!

A friend suggested that these issues can be cured without medical treatment, through, for example, hypnosis, but that’s not the way I roll. I love self-hypnosis, and I’m sure it’s helping with my returning energy. But a CPAP machine lets me breathe whether my affirmations have taken hold or not. Safety first!

My 17-year-old autistic son Karl was hospitalized with Type 1 diabetes in July, and I’ve started a blog about what we’re doing about it.

Karen and I are both engineers and are relentless about doing our research, so this ought to be worth following if you or a loved one are diabetic, and especially if it’s a diabetic child or someone in the autistic spectrum.

We’ll be talking about how we adjust Karl’s diet — in spite of his very strong food preferences — and monitor and manage his insulin. We are adjusting his dosage ourselves to keep things under better control than if we waited for a regular doctor’s visit.

So take a look at Karl’s Diabetes Blog.