One month and a bit later...

Same med (Concerta), same dose (54mg). Things have been going pretty well. Sleep is reliable with melatonin. Recently it seems that taking it a little earlier in the evening helps; say, 9pm instead of 10pm when I'm going to go to sleep around 10:30-11pm.

Concentration/focus is a little more difficult to assess (as always). I think I am building better habits every day, which helps. There is no doubt that my overall ability to focus, concentrate, and/or sustain effort has improved greatly. A consistent level of strong focus is still elusive, though; I still  have days when I have a lot of trouble getting settled down to work.

On the other hand, I am always aware of the dangers of expecting meds to remove any and all difficulties. Normal people struggle with their work sometimes. Normal people have days when they just don't feel like they're able to get much done. If the population of sites like Reddit is anything to go by, a great many normal people have days when they spend large chunks of their time browsing addictive websites (here I am assuming that these popluations may be accurately characterized as "normal"). Meds simply cannot make everything perfect, at least not for long. The dosages required to do so imply other risks and side-effects that will simply shift the problem elsewhere. We all know where this goes: a chain of meds, each of which was started to alleviate the side-effects of the one before.

Normalizing persistent, pervasive use of medications just won't lead to happiness. So I reject that route. I want just enough meds to let me make some consistent forward progress on my work habits. I think I'm getting that now. I have to figure out how to evaluate where my weaknesses are and craft routines to build strength in those areas.

One thing I noticed a couple of weeks ago was that I'd gotten back in the habit of drinking a fair amount of caffeine. When I was on the Dexedrine variants, this was never necessary since they always made me feel very awake. Methyphenidate doesn't have the same effect. I think it improves my focus more, but it does not wake me up. After a few late nights I started drinking coffee & tea to help me get through the following days, like anyone would, and I didn't really get myself pulled back to minimal consumption.

This is something that I now think I have to be very careful of on methylphenidate. It seems like the relative effects of sleep loss on my concentration are greater now than they were before medication. Before meds I guess I was always kind of half-asleep, so being a little more tired didn't really matter that much. Now it matters much more. I should consider getting good sleep to be a fundamental part of my ADHD treatment, and I should expect that if I am not getting good sleep that I will have more trouble focussing during the day.

I am also wondering whether physiological caffeine dependency can change how the methylphenidate effects my concentration. Habitual caffeine use modifies the balance in the dopamine pathways in the brain in a way that counteracts the stimulant effects of caffeine. Methylphenidate modifies some of the same pathways. It is entirely possible that caffeine dependency reduces the effectiveness of my medication.

So, it's good sleep and much less caffeine for me. I've tried it that way for the past week and I think it's working well.

Focus questionable, sleep occasionally disrupted

Sleep has been pretty reliable for a while. Last couple of nights my sleep haven't been great, but there could be other reasons for that. I have to get back to practicing really good sleep habits to make sure I'm not having to cope with an irregular sleep schedule and the side-effects of meds.

I think the degree of focus during the day has gone down a bit. I will have to consider whether I want to up the dose soon or not.

Still 56mg Concerta, sleep almost normal

About a week ago I finally noticed that my melatonin tablets were "sublingual", meaning I was supposed to be putting them under my tongue this whole time. Once I started doing that at bedtime as directed, sleep improved considerably. I'd say it is close to normal at this point.

Focus during the day continues to be good. I think the peak level of focus has decreased somewhat, but at the same time the feelings of tension/irritability/anxiety have gone away. I'll have to keep track of the focus and decide whether I need to up the dose.

Other than the insomnia, there have been no noticeable side effects. No mood problems in the evenings, no stomach issues (I have read they are common with Concerta).

In general, I'd say Concerta is working well for me. I have an actual physical appointment with my doctor in about a month, we'll see how things go until then.

Sleep improving, maybe?

The Good: 54mg Concerta is working for me during the day, for sure. It will be a week tomorrow that I started on that dose, and the positive effects are still with me. I'm much more focussed, and I don't feel jittery.

The Bad: sleep is still disrupted. I think it is getting to be less so, though. The last couple of nights I seem to have woken up less often during the night, and I've gotten back to sleep faster. I haven't been feeling too overheated, either, which is also a good sign.

The Meh: Irritability and tension. Not sure this is really a side effect, though. When I went to 40mg Vyvanse I experienced something similar, though I remember it being much more acute. As I mused at the time, it could just be that I am unused to remaining focussed on my problems. Being unable to distract oneself from them, after many years of doing so, is bound to be a stressful experience.

54mg Concerta, disrupted sleep

Wednesday and Thursday were very productive, very focused. Friday a little less so. I am somewhat concerned that the positive effects are going to diminish over time after the dose increase, as they did in the past with Vyvanse, but the negative effects are going to accumulate.

For example, sleep wasn't too bad on Wednesday and Thursday nights. I woke up, but I was able to get back to sleep relatively easily. I didn't feel hot, and I didn't toss and turn. The last couple of nights have been worse. The waking up hot is a particularly bad sign, because it tells me that my body is not shutting itself down for the night. Besides making me mentally tired, this also means that physically, I am not getting that time to repair and rejuvenate.

The worst thing about the sleep problems is that they interfere with my assessment of whether or not the medication is helping. It could be helping quite a bit, but if I am exhausted all the time I might not notice. In fact, I might feel worse.

I know my doctor is going to suggest some sort of sleep remedy. I am already taking melatonin. I do not want to take anything that might be habit-forming, or might have side-effects of its own. I am very concerned about jumping on a medication merry-go-round that leaves me without the ability to determine what is normal and reasonable any more.

I completely understand how the doctors feel about this. I am an engineer by training, a software developer by profession. I solve problems using the tools at my disposal. When I have a system in front of me that is not working, and I can't nail down exactly why, I may introduce speculative fixes and see what happens. If I am told I can't try certain kinds of fixes, I respond that that may prevent me from solving the problem.

I guess I'm OK with that. I'll talk about options with my doctor, but there are some roads I'm just not willing to start down. Multiple potentially (or even certainly) addictive, side-effect-laden medicines is one of those roads.

In any case, I'm going to give the Concerta some time to settle down before I decide it's too much. I have read some information that suggested it might take a couple of weeks for the long-term side-effects to really become clear.

54mg Concerta

Started 54mg yesterday, and I felt pretty focused all day. I also felt a little tense, but I'm starting to think that there may be a necessary relationship between the two. Either the tenseness is indicative of a state that is required for focus, or the tenseness results from being consistently connected with my work rather than distracting myself as soon as any frustration starts.

Feeling good so far today. I know it will take a while to settle down after the dose change, so I'm giving it time. Sleep was a little disrupted last night. I think I woke up once in the early hours, and then I woke up again around 5:30am. Got back to sleep each time, though, without too much trouble. The dose change can always disrupt sleep.

Good Start to Monday

Hey, I just resisted at least 2 major temptations at the start of my day. That's hopeful!