I too am a nurse and have been on and off patch. Any time I changed the dose I had to get use to the sleepyness. It may take some time, but I sometimes had to drop back to a lower dose due to just being sluggish all day. Give it a few weeks and drop by 12.5 mcgs to see what you can best tolerate. It's a great drug for pain, hang in there. One more suggestion, keep up with your gi motility. As you know, this works on your opiod receptors in bowels as well as your brain. Miralax works very well for me. pam z.