This is going to be long, but I really appreciate any feedback because I’m getting frustrated and hopeless.
For a long long time I’ve struggled with constantly feeling tired, and it’s gotten worse in recent years. First I got treated for symptoms of depression (the apathy, lethargy, lack of motivation and interest in activities etc) with bupropion and sertraline (Wellbutrin/Zoloft). It kinda helped a bit but in ways made things worse, because I gained quite a bit of weight in the ~2-3 years I was on those meds. I had a pretty good job working from home as a remote employee, but I was having a harder and harder time getting up in the morning for the period from 8AM-5PM I was expected to be online (despite going to bed as early as I could), and eventually lost my job because of it. I stopped taking the antidepressants because I also lost my insurance coverage.
I’ve never really been able to properly adapt to a “normal” schedule, and have suspected I have Delayed Sleep Phase Disorder (or Syndrome), a type of circadian rhythm disorder. It’s apparently common in teens but most adults “grow out of it” and it’s fairly rare for adults. I’ve never grown out of it. If I let my body do what it wants I end up going to bed at 4-5 AM and waking up around 2 PM. I sleep a solid 8-10 hours without interruption. I can feel sort of rested on this schedule, but whenever I try to adapt to “normal” hours I never feel rested regardless of what time I go to bed (and can even have trouble falling asleep at say, 10PM-12AM even if I was dog tired during the day. It’s like I get a sudden second wind in the late hours and my body absolutely resists falling asleep). I’ve tried melatonin for that but it doesn’t seem to do much. Needless to say, keeping those kinds of hours is completely unacceptable for the vast majority of careers.
I had a sleep study done a few months ago where they diagnosed me as having mild sleep apnea (~9.5 AHI). I got the CPAP machine and was really hopeful that it would make a big difference. I use it religiously every night and while it has made some positive difference, I have been disappointed in that the difference is fairly minor and I am still experiencing excessive daytime sleepiness (I also switched from a nasal mask to a full face mask due to waking up with my mouth open and air leaking out of it, but that also did not make a big noticeable difference). When I explained this to the GP I am seeing, she said I should be fine because my blood tests came back “normal” (except for a bit of vitamin D deficiency, for which I’m taking a vitamin D supplement) and was not willing to prescribe any sort of medication. I don’t think she’s even aware of or acknowledges circadian rhythm issues.
I’ve been wanting to see another psychiatrist to see if they will help me with any medication, as now I do have insurance again (state sponsored Medi-Cal, California’s medicare program), but they seem to have almost no coverage of psychiatrists in my area. They have really out-of-date records and every one I’ve called from their directory says they don’t take it anymore. I might be able to get one that’s covered but I’m going to have to travel pretty far.
Anyway, I’ve read good things about modafinil/armodafinil (ProVigil/NuVigil) but have never tried it. I have tried Adderall which I do not have a prescription for (bought under the counter from a friend - I know this is illegal and makes me a horrible person etc. etc.) but I wasn’t doing it to get high, I was doing it because it genuinely helped give me enough energy to get through the day. It helped a lot. But I can’t afford to keep buying it that way and I want to do the legal thing anyway. I know they probably won’t give me a stimulant that strong and I don’t want to come off as a “drug seeker”. But supposedly modafinil is less dependence-forming / has fewer potential side effects than amphetamines like Adderall anyway (if it does indeed work). I’m not sure whether I should try getting back on anti-depressants or not. But I do feel that at least a large part of my depression is directly linked to the fatigue, and the problems that not being able to stay awake and alert during the day has caused for me (personal, social, and financial).
I’m trying to figure out what to do here. I’ve tried everything non-medication related like eating better, exercising, supplements, light therapy etc. and while all these things can help a little, it’s just not enough. Coffee/caffeine helps a little too, but again, not nearly enough. I’m so fucking tired all the time that I can’t even properly take care of myself. I just started a new job that’s only part-time but it’s still incredibly taxing on me and I am worried I am not going to be able to stay awake and focused during the day like I need to. And am really worried for the long-term, but I don’t even want to think about that right now.