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.
Sunday, April 10, 2011
Sunday, February 27, 2011
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.
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.
Sunday, February 13, 2011
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.
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.
Tuesday, January 25, 2011
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.
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.
Sunday, January 23, 2011
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.
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.
Thursday, January 20, 2011
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.
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.
Monday, January 17, 2011
Good Start to Monday
Hey, I just resisted at least 2 major temptations at the start of my day. That's hopeful!
Sunday, January 16, 2011
36mg Concerta
Last Monday, I called my doctor and we discussed the med-free insomnia. He was a little perplexed. We agreed that I shouldn't start anything else until the problem resolved itself. He suggested I take 3mg of melatonin around 8pm, and I was to call him if it hadn't gotten better by the end of the week.
I don't know whether it was the melatonin or not, but on Monday night it improved considerably, and on Tuesday night I slept like the proverbial log. It must have taken less than 5 minutes to fall asleep, and I remember nothing else before waking up in the morning. So, good news.
It turns out that neither the kind of insomnia I was experiencing nor the improvement after a week should be that much of a surprise. I looked up some research on amphetamine withdrawal, and very light, disrupted sleep is a nearly universal withdrawal symptom. One of the papers also found that most of their subjects recovered from the worst acute withdrawal symptoms after about one week.
Of course, the real question is: why would those symptoms start when I was still taking my meds? I see two possibilities:
There are many outstanding questions here. One of the most central for me is: Why am I so sensitive to amphetamines to experience withdrawal on such a low dose? My effective daily dose was only ~20mg Dexedrine. The subjects studied in the papers were taking 5-10 times that much. It is unlikely that I'll every really know the answer.
The question now is: Will I experience fewer problems on methylphenidate? The experiment we're running to find out is the only one possible: Try methylphenidate and see what happens. On Wednesday, sleep problems resolved, I started 18mg Concerta. Didn't really notice any effects, positive or negative. Maybe a little more awake without any need for caffeine, but that's it. No insomnia.
Today I went up to 36mg as instructed by my doctor when he gave me the prescription. Still not noticing much of anything, but I am feeling nicely awake and alert. So, that's good.
We'll see how work goes tomorrow. I'll call my doctor to consult. I imagine if I have no negative side effects he will put me up to 54mg on Wednesday. I'm fine with moving that quickly now; I think I'm better at assessing positive work effects now that I have more experience with the ups and downs of the meds. It may depend on how I feel today and tomorrow, though. Maybe if I feel like I'm getting some good help on 36mg I'll wait a little longer.
I looked up rough equivalences between Concerta and Ritalin, and Ritalin and Dexedrine. Concerta is equivalent to approximaetly 2/3 of the same daily dose of Ritalin (not all of the medication is released from the Concerta delivery vehicle). Ritalin, in turn, is equivalent to about 1/2 of the same daily dose of Dexedrine. Put that all together, and Concerta is approximately equivalent to 1/3 of the same daily dose of Dexedrine. So 36mg Concerta ~= 12mg Dexedrine.
Now, a given mass of Vyvanse is equivalent to a little over 1/3 of the same daily dose of Dexedrine: 30mg Vyvanse ~= 12mg Dexedrine. So it turns out that today's Concerta dose is about the same as my previous usual Vyvanse dose. Not surprising, then, if it is mostly making me feel more awake.
In any case, it is useful that Concerta turns out to be only a little less potent than Vyvanse mass-for-mass. It will make it easier to compare results vs. my Vyvanse experience.
Going up to 54mg Concerta will be the real test. That will be nearly exactly the Vyvanse dose at which I started to feel more jittery than focused, and at which I started to have sleep problems.
I don't know whether it was the melatonin or not, but on Monday night it improved considerably, and on Tuesday night I slept like the proverbial log. It must have taken less than 5 minutes to fall asleep, and I remember nothing else before waking up in the morning. So, good news.
It turns out that neither the kind of insomnia I was experiencing nor the improvement after a week should be that much of a surprise. I looked up some research on amphetamine withdrawal, and very light, disrupted sleep is a nearly universal withdrawal symptom. One of the papers also found that most of their subjects recovered from the worst acute withdrawal symptoms after about one week.
Of course, the real question is: why would those symptoms start when I was still taking my meds? I see two possibilities:
- I was going through withdrawal at night after my daily dose wore off. This might make more sense for my experience on 50mg Vyvanse than it does for 30mg Vyvanse.
- When it started on the weekend it was withdrawal from the higher doses I was taking during the week when I supplemented during work hours with dexedrine.
There are many outstanding questions here. One of the most central for me is: Why am I so sensitive to amphetamines to experience withdrawal on such a low dose? My effective daily dose was only ~20mg Dexedrine. The subjects studied in the papers were taking 5-10 times that much. It is unlikely that I'll every really know the answer.
The question now is: Will I experience fewer problems on methylphenidate? The experiment we're running to find out is the only one possible: Try methylphenidate and see what happens. On Wednesday, sleep problems resolved, I started 18mg Concerta. Didn't really notice any effects, positive or negative. Maybe a little more awake without any need for caffeine, but that's it. No insomnia.
Today I went up to 36mg as instructed by my doctor when he gave me the prescription. Still not noticing much of anything, but I am feeling nicely awake and alert. So, that's good.
We'll see how work goes tomorrow. I'll call my doctor to consult. I imagine if I have no negative side effects he will put me up to 54mg on Wednesday. I'm fine with moving that quickly now; I think I'm better at assessing positive work effects now that I have more experience with the ups and downs of the meds. It may depend on how I feel today and tomorrow, though. Maybe if I feel like I'm getting some good help on 36mg I'll wait a little longer.
I looked up rough equivalences between Concerta and Ritalin, and Ritalin and Dexedrine. Concerta is equivalent to approximaetly 2/3 of the same daily dose of Ritalin (not all of the medication is released from the Concerta delivery vehicle). Ritalin, in turn, is equivalent to about 1/2 of the same daily dose of Dexedrine. Put that all together, and Concerta is approximately equivalent to 1/3 of the same daily dose of Dexedrine. So 36mg Concerta ~= 12mg Dexedrine.
Now, a given mass of Vyvanse is equivalent to a little over 1/3 of the same daily dose of Dexedrine: 30mg Vyvanse ~= 12mg Dexedrine. So it turns out that today's Concerta dose is about the same as my previous usual Vyvanse dose. Not surprising, then, if it is mostly making me feel more awake.
In any case, it is useful that Concerta turns out to be only a little less potent than Vyvanse mass-for-mass. It will make it easier to compare results vs. my Vyvanse experience.
Going up to 54mg Concerta will be the real test. That will be nearly exactly the Vyvanse dose at which I started to feel more jittery than focused, and at which I started to have sleep problems.
Sunday, January 9, 2011
"...maybe amphetamine is just not your drug."
Prophetic words. Last weekend, just after posting about feeling like the Dexedrine wasn't working out very well, I started to have sleep problems. Same problem I had on 50mg Vyvanse: not too difficult to get to sleep initially, but then I wake up around 1:30am and barely get back to sleep at all after that. Really, really light, fitful sleep.
This actually started on the Sunday, when I was only taking Vyvanse. Didn't think too much of it, though. Only one night, right? I start off on only 2.5 Dexedrine on Monday, though.
On Monday night, same thing. Hmmm...now I notice the trend. So on Tuesday I take just the Vyvanse. At this point I'm completely sure that the problem will go away. After all, I've never had a single issue on 30mg Vyvanse.
Same problem Tuesday night.
Now I'm worried. On Wednesday, I don't take anything, not even any caffeine. I expect to feel completely bagged, but I'm oddly OK. Call my doctor, tell him what's going on. We agree I should stop the amphetamine-based meds and try Concerta. "At least," I think, "I'll get a good night's sleep tonight."
Nope. Wednesday night is the same as the others.
On Thursday I again take nothing, though I have some tea to get me through the day since I'm now really tired. Can't tell if this is some amphetamine withdrawal or just the effects of not sleeping well for several nights in a row. Despite having picked up my new prescription, I decide to stay off all meds until I've had a good night's sleep. Concerta has a 12% reported occurrence of insomnia; how am I going to know if I'm affected if I have sleep issues before I take the first pill?
Thursday night I take 6mg melatonin. Never had to take it before since my previous sleep problems have gone away as soon as I reduced the meds. Friday I try 3 mg, and last night I tried 6 again.
I think last night I finally saw some improvement. I still woke up around 1:30am, but I had to pee and unlike the previous nights I felt pretty sleepy. Don't remember having a ton of trouble getting back to sleep. I did wake up a couple more times, but my memories of the night are of brief periods of wakefulness. I'll take 6mg melatonin again tonight and we'll see how things go.
One very interesting part of this experience has been doing my job through it. I have definitely had more trouble with alertness (not shocking given the lack of sleep), but I haven't had a ton of trouble getting things done. I feel much more relaxed. I don't know why, but it seems like over the last month the amphetamines stopped making me feel motivated and energetic, and started just making me jittery.
Hopefully my sleep will settle down and I can try the Concerta. Will post when I do.
This actually started on the Sunday, when I was only taking Vyvanse. Didn't think too much of it, though. Only one night, right? I start off on only 2.5 Dexedrine on Monday, though.
On Monday night, same thing. Hmmm...now I notice the trend. So on Tuesday I take just the Vyvanse. At this point I'm completely sure that the problem will go away. After all, I've never had a single issue on 30mg Vyvanse.
Same problem Tuesday night.
Now I'm worried. On Wednesday, I don't take anything, not even any caffeine. I expect to feel completely bagged, but I'm oddly OK. Call my doctor, tell him what's going on. We agree I should stop the amphetamine-based meds and try Concerta. "At least," I think, "I'll get a good night's sleep tonight."
Nope. Wednesday night is the same as the others.
On Thursday I again take nothing, though I have some tea to get me through the day since I'm now really tired. Can't tell if this is some amphetamine withdrawal or just the effects of not sleeping well for several nights in a row. Despite having picked up my new prescription, I decide to stay off all meds until I've had a good night's sleep. Concerta has a 12% reported occurrence of insomnia; how am I going to know if I'm affected if I have sleep issues before I take the first pill?
Thursday night I take 6mg melatonin. Never had to take it before since my previous sleep problems have gone away as soon as I reduced the meds. Friday I try 3 mg, and last night I tried 6 again.
I think last night I finally saw some improvement. I still woke up around 1:30am, but I had to pee and unlike the previous nights I felt pretty sleepy. Don't remember having a ton of trouble getting back to sleep. I did wake up a couple more times, but my memories of the night are of brief periods of wakefulness. I'll take 6mg melatonin again tonight and we'll see how things go.
One very interesting part of this experience has been doing my job through it. I have definitely had more trouble with alertness (not shocking given the lack of sleep), but I haven't had a ton of trouble getting things done. I feel much more relaxed. I don't know why, but it seems like over the last month the amphetamines stopped making me feel motivated and energetic, and started just making me jittery.
Hopefully my sleep will settle down and I can try the Concerta. Will post when I do.
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