Its been 2 weeks since I started dose ranging for codeine.
After the first week I analyzed the subjective assessment of my alertness against the amount and timing of the doses taken.
Taking a loading dose did not help, there was no evidence that taking a single dose higher than 45mg had any additional benefit over 45mg.
However, doses lower than this had smaller effect on alertness.
If I went for more than 8 hours without taking any dose my alertness would drop significantly.
A dosage of 45mg 4 or 5 times day seemed optimal, for a total daily dose of between 180-225mg. This is roughly equivalent to a morphine dose of 18-22.5mg per day.
From the UCLA article, the sole subject with narcolepsy and used morphine for pain at a dose of 2 x 10mg per day for 9 years, had a much larger number of hypocretin neurons than the control.
Effect on symptoms
Dramatic improvement in daytime alertness
Reduction in sleep paralysis and sleep inertia to almost zero.
No euphoria, or anything that could be considered recreational.
After I started on the higher dose ie 150mg/day or greater I was unable to go to sleep, this coincided with the improvement in alertness during the day.
I thought that this may be related to the alerting effects of codeine, but the sleepless persisted even if I scaled down or stopped codeine administration 8 hours before going to bed.
After 2 weeks the sleeplessness started to abate and I have now had adequate, but not not great, sleep quantity for the past 4 nights. It maybe have been some sort of rebound effect from the brain’s response to the abnormal chemistry caused by the disease.
I’ll persevere with the current dose for the next 4 weeks to see if the effect is sustained and then review with my doctor. Hopefully my sleeping pattern will continue to improve.
I definitely got an acute benefit. And likely a long term benefit as well [from changes in receptors levels etc], but the effects of sleep deprivation make it a little challenging to be certain, and its still a little early.
I should have a better idea in 4 weeks time, but at this stage it looks very promising.