What is the point?
I have been dealing with exhaustion and sleep issues for years. I’ve always been told things like “you’re a new mom, of course you are tired!” Or “You have multiple kids, that’s exhausting” or “Your husband has a demanding job and that puts a lot of pressure on you!” Now that I’m 45, I’ve heard, “it’s hormones!” Of course those are contributors, but I felt like no one was really understanding of how bad this felt. I get scared to drive. I constantly look for opportunities for my next nap. Mornings feel so depressing.
I do have weird sleep, so I assumed I was tired from the weird sleep. I’d wake up in the middle of the night with restless legs or just unable to sleep. I’d get in a vicious cycle of up a night, nap after work, lather, rinse, repeat. My doctor prescribed Ambien. That was a no-go for me. Too much sleepwalking. After I was done having kids, I went on Trazadone, which I was on for years. This last year, I switched to Lunesta after complaining to my psychiatrist about this on going exhaustion. Don’t worry, I’ll circle back to him in a second.
Since I’ve been dealing with this exhaustion, I’ve also been diagnosed with depression, anxiety and OCD. Last year, I had a bit of a mental break when my OCD got a bit out of control. The medication I was on to control it wasn’t working. For the last year, my psychiatrist has adjusted my medication and with a lot of therapy, the OCD is under control. However, my depression wasn’t. In May 2026, my doctor and I decided to add in Abilify to help with the depression symptoms. Within days, I was a different person. I had energy and motivation that I’ve never felt. I had no idea my brain could work that well. I had no idea I could feel like such a participant in life. It was a case of “I didn’t know what I didn’t know.” But, and there is always a but, I started having some muscle problems that were attributed to the Abilify. I had to wean off.
No big deal. My psyc said he’d add in another, similar med. But then there were issues with my insurance. I was delayed getting a new medication by two months. In those two months, I grew even more depressed knowing that life could be so much better. I started on Rexulti. While my depression symptoms have cleared up, I was still exhausted, sleeping all the time, no motivation, scared to drive, etc. I Googled. I read Reddit. I asked a bunch of people around me about their sleep. Why did I feel so good on Abilify? Was that feeling real? Would I ever feel like that again? I found there was an off label use for Abilify in idiopathic hypersomnia. Maybe?
I went to my PCP and we ruled out everything else. Ferretin. Thyroid. I even had a fecal study to ensure I didn’t have internal bleeding. She sent me to a sleep specialist who has a three month waiting list. My appointment is still scheduled for November.
In the meantime, I had an appointment with my psychiatrist again. I told him everything. He said this:
“Sometimes we don’t know what comes first, the sleep issues or the depression and anxiety.”
This changed everything for me. I had to know if the sleep issues I have been complaining about to my doctor since 2011 (and it’s documented) are the contributor of so many of my mental health challenges. I told him about the wait for the sleep medicine doctor. He told me to call a few others in the hospital system and see if I could get in sooner, but in the meantime, he prescribed modafinil. 200 mg per day.
It has made a huge difference in my life. I still feel exhausted after work and want to sleep. I usually take a nap but it’s not as long and not as hard to wake up.
I did meet with a sleep doctor. I know many will blame my meds for the sleep issues, but he wasn’t overly concerned about that part because the issues have been mentioned to the doctor and documented for such a long time. Due to insurance, he had to order a sleep apnea at home test. I haven’t gotten the results.
He said if the at-home test shows apnea, I need to at least try the cpap. Fine. I’d be hard pressed to think this level of exhaustion is from sleep apnea, but I’ll concede if that’s what it shows.
He said if it doesn’t show apnea, he plans to order the in-lab testing and the MSLT. He won’t rule out narcolepsy or IH without that.
But my question is, what’s the point? If my psychiatrist is willing and able to prescribe the modafinil, is it worth even going through the testing for treatment that would likely be the same? I’m going to have to pay a lot of money. I’ve reached my insurance deductible, but it only covers so much. Is it worth the money to know? And if it doesn’t show narcolepsy (which I doubt) or IH (which I’m leaning toward) as so many have said has happened to them, would I have to give up the modafinil?