Brief Answer: Following steps will be helpful. Detailed Answer: Hello, Thanks for your query. I appreciate your efforts for medical consultation in so much distress. Important aspects of your query are: • 31 year old female • Known case of PTSD, anxiety, panic attacks, panic disorder, narcolepsy, night tremors and adhd • Currently on Klonopin, Provigil, Dexedrine and Prazosin • Concern related to exhaustion after 5pm, sleep problem with Provigil and panic attacks. Considering your treatment it is fine to take Provigil and Dexedrine for Narcolepsy and ADHD. PTSD, anxiety, panic attacks and panic disorder are all grouped in ANXIETY DISORDER. Klonopin contain clonazepam. It is used only for short term control of anxiety symptoms. In long term patient develops tolerance and dependance on it with exacerbation of anxiety like you are having breakthrough panic attacks in-spite being on klonopin regularly. In long term and better control of anxiety SSRIs medicines (Like sertraline, fluoxetine, paroxetine, escitalopram and fluvoxamine) are better. For which you can request your psychiatrist to start. In anxiety patient used to have muscle spams and tremors, which lead to lethargy, tiredness and exhaustion. With better control of anxiety these issues will get solve. Apart from above advice following simple measures will help you to some extent: -Decrease worrying by keeping yourself busy and distracted from worrisome thoughts by talking to family members or watching T.V. or counting back (100 to 0). -Healthy diet: Milk and fruits in diet. -Daily morning brisk walk for 30 minutes. -Breathing exercise, yoga and meditation (which you can learn from some nearby expert) -Screening of thyroid dysfunction: You can get serum T3/T4 and TSH level done, as thyroid problem also lead to anxiety and it is common in middle aged female. -Stop substance use like excessive caffeine (tea/coffee/cold-drinks) and alcohol (If present in your case) -Addition of non drug treatment like cognitive behaviour therapy (CBT: form of psychotherapy) with medical treatment. At the start of treatment provigil can cause anxiety and sleep problem in clinical population for short duration. You can request your psychiatrist to reduce its doses or withhold till better control of anxiety symptoms. I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups. Wish you good health. Regards, http://bit.ly/Dr-Ashish-Mittal

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