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Re: ADD medications sleep -- sleep window » toodlebug

Posted by michael on February 22, 2003, at 1:47:52

In reply to ADD medications sleep, posted by toodlebug on February 20, 2003, at 18:26:55

> I recently started taking Adderall (extended release formula) for ADD. (I'll admit, weight loss was also a reason-- I have gained 40 pounds in the past two years, I think due in part to anti-depressants which I no longer take.) I was taking just 10 mg. in the morning. It really helped me focus and stay on task. I had to quit taking it, though, because it interfered with my sleep too much. I could fall asleep just fine, but woke up after about 3-4 hours' sleep. I already had problems with that as it was, so I had to quit. Before Adderall I was taking 150 mg. Trazodone, then after a week on Adderall needed 600 mg to sleep the night through! (The max dose of trazodone/desyrel is 400 mg. so I had to quit the Adderall.) It has been two weeks since I have taken any Adderall, and I am still needing 400 mg. trazodone to sleep. And even on 400 mg. trazodone, I still frequently wake up in the middle of the night! And 400 mg. trazodone usually leaves me groggy. So I feel pretty bad these days. And I am still fat! (And yes, I do exercise.)
>
> So, how long will it be before my need for trazodone will decrease? Would the regular formula (as opposed to extended release) be better for me? And is there another ADD medication that will interfere with sleep less?

toodlebug -

I don't know if this applies to your case, but thought you (& others) might find it interesting. I found it originally a couple of years ago, and was able to find it again on the web now at (for the full text):

http://www3.sympatico.ca/frankk/medspaul.txt


He talks about what he calls a "sleep window" w/respect to stimulants. I'm only putting part of it here (still pretty long) - you can see the whole thing at the link above, if interested.

Btw - if you find that this does apply to you, I hope you'll relate it to us in this thread. I'd be interested to hear a first hand account (fwiw, I've found some truth in this in my own experience).

Good luck.

michael


"...About 15-20% of patients will not need a second dose of Dexedrine at the end of the 12-hour period. They simply notice that the benefit of the medication fades away, with a gradual return of the ADD symptoms. The remaining 85% of patients, however, will notice a rather abrupt drop-off in the effect of medication, with a rapid return of the ADD symptoms. In fact, patients often experience a rebound of the ADD symptoms, which are actually amplified above the pre-medication level. I refer to this as "filtered rebound." By this, I mean that even though the medication's effectiveness has subsided, there is still a small amount of the medication remaining in the blood stream which can modify the symptoms of ADD as they return. Therefore, the symptoms in this rebound period may be somewhat different from the symptoms in the pre-medication state, and are frequently amplified over the pre-medication state. This "filtered rebound" lasts anywhere from 2-8 hours, but is more likely to be toward the 8-hour end of this range.

Because of the rebound effect, adults and children may have difficulty going to sleep. There are several ways this can be managed, but it frequently does not indicate too much medication, as is often assumed. What it actually represents is too little medication at the wrong time. Most often, by adding some of the 4-hour tablet form of Dexedrine at approximately 11-11 1/2 hours after the morning dose of the spansule or capsule form is given, the patient can go to sleep quite readily at the end of this period.

I refer to this as the "sleep window." The "sleep window" lasts from 30 minutes prior to expected wear-off of the medication to about 60 minutes after the expected wear-off. If the person is able to get to sleep during this period of time, the rebound still occurs, but usually does not waken the patient, nor does it usually prevent a person from getting back to sleep, even if that person must get up during the night. On the other hand, failure to get to sleep within the 90-minute sleep window places the patient into the rebound period. Once this rebound has begun, it frequently keeps the patient awake for several hours. There are several ways this can be managed. One of the best on a short term basis is to use a minidose of the tablet form of Dexedrine (2.5-7.5 mgs.), which is just enough to muffle the rebound effect, but not enough to keep the person awake. If this is needed very often, other medication approaches are usually better.

I normally begin with up to one-tenth of a milligram per pound of bodyweight in the Spansule form, with a maximum starting dose of 10 mgs. That is to say that a person who weighs 50 pounds would be started on 5 mgs. Someone who weighs 100 pounds would be started on 10 mgs. Someone who weighs 200 pounds would still be started on 10 mgs. I suggest the patient increase the dose by the starting amount at 4-7 days, in case side effects, such as headache, nausea, jitteriness, perspiration, or diarrhea, are not too bothersome. I check them again at two weeks to consider an increase.
-----------------------------------------------

This not intended as specific medical advice and is for general informational purposes only. It is not intended to serve as a replacement for consultation or evaluation by an appropriate physician.
-----------------------------------------------
(c) 1995, Paul T. Elliott, M.D., 600 University Village Center, Richardson, TX 75081, 214-234-0352; CompuServe: 71016,676; AOL: PTElliott; Internet: paule@fni.com. All rights reserved. Permission granted for reproduction unchanged and in its entirety for personal use only. All other uses require written permission. Uploaded by author. Ver. 950529"


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poster:michael thread:202241
URL: http://www.dr-bob.org/babble/20030219/msgs/202693.html