the early mornings aren't hard for me in the morning, but when I get home at 4 or 5 i'm usually staggering around like a drunk. I just try to keep myself awake, clean my apartment - anything to put off bedtime til at least 9 or 10. the best i can do is at least keep my bedtimes early so the few early mornings aren't such a shock to the system.
i've known i was narcoleptic since high school but only got official diagnosis/sleep testing/provigil about 3 years ago. going to a neurologist and going through that process was a total lifesaver for me !
I'm surprised to hear about your provigil regimen. From my understanding it's not supposed to be a short-acting drug (like ritalin or caffeine). it definitely gives me a little boost in the morning (at 100mg) . it doesn't feel like a buzz or a high but it does wake me up. after that, i'm up all day without experiencing sleep attacks.
I think the greatest benefit of the provigil has been regulating my night-time sleep - since taking it, i feel much better when i wake up in the morning and have an easier time getting up. i have to take it every single day to get this effect though - if i skip one or two days i'm back to falling asleep without warning and sleeping through alarms.
it definitely makes me metabolize other
things faster. like alcohol. oh boy was that a surprise, the first time i ended up reeling drunk at a work function at 5 pm because i'd had half a bud light.
caffeine has never done anything to fend off my sleep attacks ... i once burned myself cause i fell asleep holding a cup of coffee. lesson learned
i would say from the symptoms in your first post, your current regimen isn't adequate and it might be time to go back to the Dr. and tweak it a bit. obviously i can't give you advice about what to do, other than to say go back to the Dr. If your PCP has been managing this, go to a legitimate sleep doc (usually a neurologist). they are WAY more knowledgeable about narcolepsy management.
Do a bit of googling about sleep hygiene. It really has made a huge difference for me and it requires no drugs and no docs.
As for the school bit - I just don't think telling your school is going to solve the problems, and would probably create more. Right now it's a matter of managing your personal health, which the school can't do for you. All they can do is react when they see a student falling asleep in clinicals.
Good luck !