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.