I take timespan when I go to bed - about 10:00 pm. When I was having lots of problems, my neuro recommended adding timespan in the morning also to try and even out the mestinon. I continued to take 60 mg every 4 hours during the day. It helped a little for a while, but I started going downhill again and that is when I started a trial of Cytoxan infusions for a year.

I guess my point is that you can take timespan more than just a bedtime. However, if that doesn't work, there are other options you can try. You do seem to be on a lot of mestinon, but some people have no problem with taking that amount. I can't because it messes up my gi tract and I have a lot of cramping, diarrhea, etc. I also use IVIG bi-weekly and that really helps. Here's hoping you find a combination that works for you.

Juanita