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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
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?
Posted by cybercafe on February 20, 2003, at 23:45:13
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?i take ritalin sr, and i sleep way too much
Posted by Hattree on February 21, 2003, at 9:59:43
In reply to ADD medications sleep, posted by toodlebug on February 20, 2003, at 18:26:55
I've taken almost every stimulant in the book, and I found Adderall XR took the longest for the side effects to completely subside after I stopped it. That may account for your extended sleep disturbance.
Two thougts: try Adderall without the XR. Also, I have always had a problem with late night waking, and sleeping pills (have you tried Ambien?) all make me hung over, but I started Neurontin about a year ago and though I sometimes have trouble falling asleep, I almost always sleep through the night.
Posted by toodlebug on February 21, 2003, at 10:03:40
In reply to Re: ADD medications sleep, posted by Hattree on February 21, 2003, at 9:59:43
> Two thougts: try Adderall without the XR. Also, I have always had a problem with late night waking, and sleeping pills (have you tried Ambien?) all make me hung over, but I started Neurontin about a year ago and though I sometimes have trouble falling asleep, I almost always sleep through the night.
Thank you for the suggestions. I have tried Ambien, and I love it, but my body builds up a tolerance to it very quickly. If I take it every night, by the end of the week I will need 3x the dose I needed at the beginning. I don't think I have tried Neurontin, though, which surprises me because I thought I have tried every sleep aid there is! Elavil also works pretty well, but after about a week I get lethargic (although awake) and don't feel like doing anything.
Posted by Hattree on February 21, 2003, at 14:35:13
In reply to Re: ADD medications sleep, posted by toodlebug on February 21, 2003, at 10:03:40
Neurontin isn't necessarily a sleep aid, though some people use it that way. It helps me to be more relaxed and even, but doesn't actually put me to sleep or make me sleepy during the day--I don't know why it lets me stay asleep.
Posted by jodie on February 22, 2003, at 1:46:50
In reply to Re: ADD medications sleep, posted by Hattree on February 21, 2003, at 14:35:13
Just wondering, have you tried clonidine ( Catapres) to help you sleep? It is commonly prescribed to patients with ADD/HD. My son takes it, it helps a lot. He has tried the stimulants Dexedrine, Adderall, Adderall XR, and now on Ritalin. Insomnia was a big problem for him due to the meds. The clonidine works wonders for my son.
Jodie
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.
-----------------------------------------------
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Posted by jodie on February 22, 2003, at 1:52:17
In reply to Re: ADD medications sleep » Hattree, posted by jodie on February 22, 2003, at 1:46:50
Posted by Hattree on February 22, 2003, at 16:23:22
In reply to Re: ADD medications sleep » Hattree, posted by jodie on February 22, 2003, at 1:46:50
I've only heard of clonodine as a sleep med in connection with stimulant/ADD treatment. Anyone know why?
Posted by jodie on February 23, 2003, at 12:44:45
In reply to Re: clonodine, posted by Hattree on February 22, 2003, at 16:23:22
For my son it is used to calm him down at night and sedate him. Some Dr.'s also use it for ADHD patients during the day. It has been shown to reduce hyperactivity, that sometimes stims can't do alone. Some parents & Dr's decide to only use it before bedtime. I've read that it is also used for autistic patients as well. My sons pdoc put him on clonidine because he said it is safe for long term use. He said he has better luck with it versus a benzo in children especially. He actually said it is not "addictive" (those were his pdocs words, not mine to all who may be offended by that word). I felt better putting my 8 yr. old son on clonidine instead of a benzo. I am personally taking Klonopin, and I am very greatful to benzos!!!!! I take Klonopin during the day, and I've tried just about every sleep aid that is legal & have no luck.
I am considering asking my pdoc about clonidine for my insomnia. I've never tried it.
Anyway, sorry I have a habit of babbling on & on. I'm not sure if I helped answer your question or not. Hope I did!
Jodie
Posted by Festus on February 23, 2003, at 23:06:21
In reply to Re: clonodine » Hattree, posted by jodie on February 23, 2003, at 12:44:45
Many drugs have multiple uses and Clonidine is one of these.In addition to it being used for blood pressure and ADHD,it is also helpful in aiding folks coming off opiates to ease withdrawal.Toodlebug,it sounds like you may want to try Ritalin.It is not as strong as Adderrall and does not last as long.Ask your doc.Festus
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