ADDition

Blog about personal experience with ADHD by Robert Dawson

My sleep patterns

I've started using the Zeo Sleep Manager, which uses an EEG machine to record and analyze sleep patterns and wake you up at an optimum time. I love it! Before this, I used WakeMate and liked it a lot, too, for the same reasons. It's a little weird waking up with red square spots on my forehead, but I'll tolerate the fading tattoo for the ability to wake up refreshed on as little as 5 hours of sleep.

Speaking of that, in December, I averaged:

Total sleep: 6:41
Deep sleep: 1:24
REM sleep: 2:08
Time awake: 0:03
Times woken: 1

In January:

Total sleep: 6:33
Deep sleep: 1:19
REM sleep: 2:05
Time awake: 0:03
Times woken: 1

Also, the week of 1/8-14, I slept at 11:45 PM on average, while the week of 1/1-7, I slept at 1:05 AM! I think I usually sleep around 11:30 PM these days. Also, the average guy between 30 and 39 years old sleeps at exactly midnight on average. Oh, and I appear to get more deep and less light sleep than average for some reason. Of course, I've been lifting weights lately, so I would expect a lot of sleep time to be allocated towards physical recovery and rebuilding.

Lastly, here is what my sleep looked like last night. Light green is REM, dark is deep, grey is light, and red is awake.

One Busy Break

I haven't posted anything to this blog lately because I've actually been productive for a change and have been flooded with so many ideas that, between work, school, and personal projects, I'm amazed I'm still sleeping at night.

What's happened since my last update on October 27?

  1. Started working on a decade-old idea to convert between music and art
  2. Started a project management class for work
  3. Resumed making iPad art
  4. Resumed making iPhone art, mostly iPhone photo art and iPhoneography
  5. Started making music on the iPad and iPhone!
  6. Started this new website with Squarespace, to improve maintenance and centralize creative activities

I think that qualifies as busy. I know it qualifies as the happiest, most focused, and frustrated about lack of time I've been in a long while. But, overall, it feels good to be productive.

I'm not sure if I can blame Concerta for the ideas. It may be that, and hopefully is part of it or I'm just wasting money, but I think it also coincided with being busy at work and realizing that I could make progress on my conversion idea. Because of my work on this conversion, I've learned and experimented with a ton, and I will be updating that blog soon to reflect that.

The only problem I've found, which I do associate with Concerta, is another way of talking about what my prescribing doctor warned me about, which is that increased focus doesn't imply better decision making. I've found that I can focus for a long time, really in the "zone," but the downside is not having enough time to finish and not making enough time for other things. Fortunately, I haven't shriveled to a stick for lack of eating. I'm actually working out harder than ever right now with the help of a coworker.

The only frustrating thing about being on a medication getting to the end of a prescription. My doctor went on vacation or leave for a whole month in November and I'm almost out of those ingenious little time-released capsules. And I have to call tomorrow to make sure I can pick up a new prescription before I leave for holiday vacation next week. Not fun.

Quick update

I've decided to stay at 36mg because I felt more nausea on 54mg. This is unfortunate because I felt more productive on 54mg. Although, that could be coincidence. And the difference wasn't drastic.

But even on 36mg, I feel nausea sometimes. I feel slightly nauseous now. I need to figure out what contributes to it or why it happens at all. Google hasn't helped me so far, but I'll look again.

Overall, though, this week at work I was very productive, so I'm glad Concerta seems to be working.

Oh, and I didn't drink as much caffeine this week, which is good for my heart! And no noticeable withdrawal.

Finally, I should note that I slept a fair amount this week, more on average than last week and more consistent.

Trying 54mg of Concerta

This morning, I tried 54mg of Concerta, 18+36mg. I felt slightly nauseous on the way to work and breathing seems slightly labored. And when you hear "breathing" in the context of a side effect of medication, you immediately think "not worth it." But it was not enough to make me feel that bad. It was just enough to annoy me. So, unless today is incredibly productive, I'm going back to 36mg tomorrow. Eating helped some, and I actually ate a little before I took Concerta, but, so far at least, it's not worth it.

And I slept 7.5 hours last night, so I should feel okay. Or, at least, I shouldn't feel nauseous this afternoon, if my theory holds.

I noticed this morning that I haven't been playing my usual iPhone games as much lately. I noticed because I received my second notification that a game would be forfeited if I didn't play. That's never happened. More focus? I guess so, although it could just an adjustment phase.

How Concerta works genetically

If you're interested in genetics and you take medication, you have to check out PharmGKB. I looked up the pharmacogenetics (new word for me, too) of methylphenidate (i.e., Ritalin, Concerta) and found that it is thought to be associated with several genes and to target several others.

Genes associated with methylphenidate

  • ADRA2A - regulates "neurotransmitter release from sympathetic nerves and from adrenergic neurons in the central nervous system"
  • CES1 - "responsible for the hydrolysis or transesterification of various xenobiotics, such as cocaine and heroin, and endogenous substrates with ester, thioester, or amide bonds"
  • COMT - "catalyzes the transfer of a methyl group from S-adenosylmethionine to catecholamines, including the neurotransmitters dopamine, epinephrine, and norepinephrine"
  • DRD4 - "encodes the D4 subtype of the dopamine receptor"
  • SLC6A3 - "encodes a dopamine transporter which is a member of the sodium- and chloride-dependent neurotransmitter transporter family"
  • SNAP25 - "presynaptic plasma membrane protein involved in the regulation of neurotransmitter release"

Genes targeted by methylphenidate

  • SLC6A2 - "responsible for reuptake of norepinephrine into presynaptic nerve terminals and is a regulator of norepinephrine homeostasis"
  • SLC6A3 - "encodes a dopamine transporter which is a member of the sodium- and chloride-dependent neurotransmitter transporter family"
  • SLC6A4 - "encodes an integral membrane protein that transports the neurotransmitter serotonin from synaptic spaces into presynaptic neurons"
As an aside, I'm starting to think that lack of sleep contributes most to afternoon nausea.

Extreme focus with sufficient sleep

Last night, with the help of a sleep aid, I managed to stay unconscious for almost 10 hours. Guess how I felt today. Extremely focused. I felt so focused that I worried I might never stop paying attention.

This reconfirmed the value of sleep while taking Concerta. It makes so much difference. Sleep deprivation basically negates the benefit. Plus, I feel incredibly, inexplicably tired. Side note to self: Find out why Concerta does that.

Today, I read a small library's worth of ADD/ADHD information. And I found an excellent website that gives an excellent overview of symptoms. Check out adultaddfacts.com. I also bought the author's book entitled Adult ADD Factbook - The Truth About Adult Attention Deficit Disorder. I've only read a few pages, but I've already found a part discussing DAT1, the dopamine transport gene, and its possible relationship to ADHD/ADD. Highly recommended.

I also drew today in preparation for a still-life painting. The idea is to include enough detail and take enough notes to rely only on those things and memory while painting. I mention this because I felt very focused as well while drawing for accuracy. Its become harder as I've gotten older to focus on visual details when drawing or painting. I tend to want to draw expressively and improvise. That said, generally speaking, art has always been the one area where I hyperfocus and forget to eat.

36mg

I slept 5 hours last night. I stayed up to update my iPhone operating system to iOS 5. I love it! But I didn't sleep enough. And I feel horrible, worse than I would have expected given this relatively small amount of sleep deprivation. It feels like I've been awake for days. My body aches for sleep. This is a pattern.

Anyway, this morning, I went to my doctor for my first checkup. It helped that I prepared my observed changes and concerns. She listened, wrote almost everything I said down, and prescribed a one-month supply of 36mg, the dose I'm taking now in two capsules. And she told me that I could try 54mg if I'd like to see the effect. I'm basically experimenting on myself with professional supervision. But that's how it goes short of an MRI or other such direct brain-based observation. So, since I have only 6 18mg capsules left and already have my new prescription, I'll try 54mg one day this weekend.

She says that 36mg and 54mg are the most common doses and that I might see improvement with another increase. My two worries, I told her, are that I will have less appetite, which is now easily manageable, and that I will focus more, which, while being the point of taking the medication, can be a real problem if I focus on the wrong things. Wrong = want. Right = should.

And I asked about discontinuing Concerta on weekends. She said that some people do that, but that I might feel moody and tired. So, I'm not sure about that. My goal is to do more with less and, over time, to do more with nothing, on my own.

Blah Friday

I slept 6.5 hours last night, but I feel exhausted. I'm not sure why.

I haven't eaten much and I'm not hungry, but my stomach seems to be telling me to eat, so I need to decide what to eat. I think I need carbs.

As for productivity today, I've been a little productive, but I need to pick up the pace this afternoon. Specifically, I need to make a list of next actions and self-imposed due dates. Otherwise, I have no direction and won't make much progress.

I wonder if Concerta is taking a toll on my body. How do human bodies typically react to the introduction of amphetamines? Although, this can probably simply be explained by basic lack of sleep. But, it feels like I'm tired, yet Concerta is keeping me going. Feels a bit strange. Could just be low energy.

Oh, and I see my ADD/ADHD doctor next Thursday, so I need to make a list beforehand of post-Concerta changes and concerns.

Concerta x 2 – Day 3

I slept very well last night, just not long enough at only 6 hours. The worst part of staying up late is not knowing why. I bet a lot of people with ADD/ADHD say this. What do I recall? Well, I know I read about Steve Jobs and pre-ordered his upcoming biography. And I'm pretty sure that I read some posts in Google+. But that can't take hours, can it? Unless time is more relative than we thought, yes, it can! I slept around 12:30am.

But I feel good now. Maybe the medicine is kicking in. Because I slept so well last night, Concerta wasn't likely to blame for poor sleep the night before. I'm not sure what to blame.

And yesterday went well. I had no stomach ache in the afternoon like I did on the first day of a double dose. And, as I said, I slept well, which was the other potential problem. As for focus yesterday, while I can't prove that yesterday was an improvement over the average, it felt like it was slightly more productive.

Oh, and, because I felt so tired and irritable this morning on my way to work (irritable because of rushing, not that it's rare), I took piracetam and Alpha GPC again. I want to test the interaction and I feel confident, despite my lack of degree and debt from that degree, that it's safe to try. If it wasn't, I would have felt horrible the first time as Concerta works immediately.

Concerta x 2 - Day 2

I didn't sleep well last night, although I slept about 7 hours, which is usually enough to feel fine. So, I'm guessing that the double dose is to blame. But, to be sure, I have to take another dose again to compare. So, I took 36mg again today. If I have another stomach ache this afternoon and I don't sleep well again tonight, then I'll revert to 18mg until I see my doctor.

I should note, however, that I felt alert as late as 11pm last night and, before bed, played what I hadn't finished earlier in the day of a MindSparke session, doing very well compared to how I've done recently. So, if I can sleep but I also stay alert, even after the medication has supposedly worn off, then I'm happy! That is, assuming that I'm not burning the candle of my life at both ends.

I should also note that I worked out last night for about 20 minutes, doing mostly weights. So, however unlikely given the short length of time, it is possible, that this contributed to poor sleep.

This morning, I took Concerta with food and I can't tell any difference so far. I feel good, although a little less vivacious than yesterday morning, a difference that I, again, attribute to poor sleep.

Concerta x 2 - Day 1

Today, I took two 18mg capsules of Concerta. Surprisingly, I feel calmer than yesterday. I got close to 8 hours of sleep last night, so I expected to feel wired or jittery. But, no. I feel calm. And focused. Good. But, it is a bit scary to take double the first dose and see a better result. But, if, at the end of the day, my day has been productive, then this is the dose for me. At least until I talk to my doctor.

Update at 4:12pm
At around 1:45pm this afternoon, my stomach started feeling a bit uneasy. I wanted to describe it as jittery before I started this update, but it's really a slight stomach ache. I'm guessing that Concerta is the culprit and that I didn't feel this way this morning because my body was fresh and energetic. When energy slumps, maybe the stomach can't deal with the drug as well? I'm clearly not sure, so I plan to try again tomorrow. I really enjoyed feeling calm and I have felt more focused than usual today, even more focused than any day since Friday when I started taking one 18mg capsule.

Update at 4:45pm
It can't be this simple, and I should write a separate post to focus on the matter, but it seems from reading articles like this that ADD/ADHD boils down to low dopamine. And dopamine is what medications like Concerta increase.

Concerta - Day 4

Yesterday was great. Sure, I wasted time on something unimportant, but I was completely focused on that task, which is a start. And, generally speaking, I felt a lot of energy and focus throughout the day.

Today feels okay. I have been productive so far. But I haven't planned my day, which I need to do to make sure I don't spend too long on any given task. As the psychiatrist who prescribed Concerta said, medication can't make decisions for me. That's my job.

But I can confirm that sleep helps a lot. I'm pretty sure that more sleep (slept 7 hours) would have given me even more energy and focus. Although, this is true regardless of Concerta's influence.

Concerta - Day 3

Sleep helps tremendously. Last night, I slept over 9 hours and, today, I felt very focused. In fact, I still do, I assume because I took Concerta later than usual, around 10am.

My brain seems to be on fire today. I had a few good ideas and made several interesting connections, which is unusual, although perhaps usual on 9 hours of sleep. The only downside I noticed is that I spent a long time working on something unimportant. I got so absorbed. And I was fascinated with myself for being so focused and able to solve problems.

So, the lesson is to focus on what's important. And, first, to set a daily agenda!

Tonight, I will try to sleep at least 7.5 hours so that I have enough energy tomorrow and can see if sleep helps as much as it seems. If tomorrow isn't productive, then Tuesday I will try another 18mg.

Concerta - Day 1

This morning, I started Concerta, 18mg, at 7am. It takes around an hour to kick in. I found this fascinating explanation of how this complicated, extended-release pill works. You might need to read it a few times. Brilliant!

I haven't felt much of anything yet. I might be feeling more focused; I'm not sure. Of course, last night was one of the worst nights of sleep I've had in a while. Before bed, I drank more than 8oz of water mixed with casein protein to help rebuild muscle after last night's workout. Bad idea. I woke up three times to pee, from 2-4am. I tend not to sleep well, anyway, when I'm nervous about something, as I was last night about starting Concerta, so I don't expect to see much benefit from Concerta today.

Oh, I decided to take a low 1g dose of piracetam around 8:30am, as a precautionary measure. I've read that suddenly stopping piracetam can lead to headaches. And, as a rule, I think it's best to stop anything gradually but also as quickly as possible. Also, again, Medscape shows no adverse effects of combining piracetam with Concerta. Yes, I realize that I have not attended med school and that self-treatment can be harmful, but I have also taken a lot of time to educate myself about both substances and I am doing what I think and feel is best for my body and brain and emotional stability on a Friday with poor sleep.

I will continue to post any observations I have about the effects of Concerta today. My guess is that I won't feel much, but who knows? It might just work!

Update at 11:17am
So far, I've noticed:

  • More attention to background noise
  • Slightly less focus
  • More sensitivity to sound

My guess is that the first two are symptoms of poor sleep. I could use a nap. But I suspect that I might feel even more tired without Concerta. I feel somewhat more alert than I would expect to be.

Sensitivity to sound is unexpected, although this could also be an effect of poor sleep that I've never noticed before.

Concerta

This morning, I went to see a psychiatrist about ADD. She told me that I definitely have ADHD (I distinguish between ADD and ADHD because, by her facial expressions, she seemed to clearly suspect hyperactivity, along with impulsiveness and risk-taking) and prescribed Concerta, 18mg to start. Unfortunately, at the CVS pharmacy, I was told that Medco, which handles my prescription insurance, requires the doctor to fax back written authorization specifying that Concerta has been prescribed for ADD.

She said I can take another 18mg pill after 2-3 days if I don't see improvement. I asked about side effects and how I would know if it's working as well as when I've taken too much. She said side effects include loss of appetite and sleeplessness, I will know it's working if I can focus for extended periods (although, she pointed out, deciding what to focus on is my call), and I will know it's too much if I feel jittery and/or a racing heart, conditions that shouldn't last more than about half an hour.

I told her that I am taking piracetam, which I gather from her expression she had never heard of, and 5-HTP, which she clearly had. After prescribing Concerta, she told me to stop taking everything else. I assume vitamins are okay.

I also asked about caffeine and she said that it's okay but I might not want as much of it, since the attention-enhancing effects of caffeine will hopefully be replaced by Concerta's. I will take her advice. But I feel compelled to mention that WebMD's Medscape website indicates that I should expect no adverse reactions when combining Concerta with piracetam. So, it might be okay to take both, but I will play it safe and maybe try a lose dose of piracetam with Concerta later if Concerta helps. I think each works on a different pathway or mechanism in the brain.

Piracetam - Day 2

This morning before work, I took the same dosage of piracetam, roughly 4,200 mg, with Alpha-GPC. Here is what I felt throughout the day.

9:10 am
My MindSparke score is somewhat lower than yesterday, down to 3.7 from 3.9. I felt distracted throughout, but I did manage to finish all 20 blocks without interruption. And, although I felt distracted while trying to complete each block, it was in the sense that I felt more aware of other thoughts, if that makes sense, and not in the sense that I wanted to do something else, as is usually the case. So, I think my mind is more aware of itself but my impulsivity seems lower than usual.

It's interesting to think about how I feel right now. I feel in "the zone" or more focused on each activity, but the feeling is mild. Or maybe it's profound and I just don't realize it yet. I'll drink my morning coffee and see how that affects me differently, if at all. The half-life of piracetam is 4-5 hours, so I have until noon to experiment. I guess this also means that, if it does help me focus, I'll need to take an afternoon dose as well.

5:03 pm
Today has been unproductive. I have had a slight headache off and on. I felt better after lunch, although very sleepy before grabbing my afternoon caffeine boost. So, lack of sleep is definitely catching up. Tomorrow morning, I will try half as much piracetam and I will bring another dose for the afternoon.

My sense is that piracetam does not help with motivation but does encourage a "flow" state or sustained focus.

Piracetam - Day 1

Today, piracetam arrived from Amazon. I've tried it before, in 1999, along with Hydergine. I threw up Hydergine and felt nothing from piracetam. I don't recall how big of a dose of piracetam I took, but I do recall wondering if it might be a placebo or, in the best case, provide an undetected long-term cognitive benefit.

I ordered it again to see if it helps with focus and motivation. I've read claims of both benefits. Piracetam is often called the first nootropic and is regarded as extremely safe with little or no side effects. Maybe it's sugar. If so, it's the worst-tasting sugar on the planet.

Tonight, I took my first of two "attack" doses at around 4,200 mg. Tomorrow morning, unless I experience poor sleep, I'll take the same amount. Then, I should be able to take less, maybe half.

I'm taking it with Alpha-GPC. I've seen this advised several times, since piracetam depletes choline and the combined effect is supposedly greater than when taking either alone.

What have I felt so far? I took it around 9 pm and, about an hour later after eating something, I actually felt foggy, mostly in the sense that I felt myself visually zoning out while watching a show. Of course, I tend to do this when I'm tired, so I can't attribute it to piracetam, and the show isn't that interesting.

I do have a slight headache. But, again, this could be from piracetam, Alpha-GPC, both together, dehydration, or a number of factors.

As for cognitive benefit, I'm sitting here wondering if I would normally write this long of a post at 11:49 pm. If I feel tired, it's only slightly. And I slept around 1 am last night, getting a little over 5 hours of sleep, so I would expect to be dozing off right now. So, maybe piracetam, Alpha-GPC, or both together are reducing drowsiness. If so, great! Although, I do love sleep. And I do wonder if choline has a natural cycle in the brain (e.g., less or more at night) and if I shouldn't take it at night.

I also definitely feel calm and focused. I recall reading that piracetam is a derivative of GABA and people take GABA for stress, so maybe piracetam provides a nice calm feeling. If so, I might take it for that reason, alone, given the other potential benefits. It would be like Super GABA.

In any case, I'll sleep now and see how I feel in the morning. Hopefully, bright-eyed!

Introduction

I have 14 books on my desk. I've started 4. Don't get me started on my e-book collection. Is it such a problem that I will never read all the books I own or borrow? It is in that it's annoying and I never seem to make headway before finding a new one.

How does my mind work? The same as yours. I make connections and solve problems. The difference is that I constantly shift from one interest to another. Oh, I often return to earlier interests. But I rarely maintain the same level of interest in any given subject for more than a few days. If I do, there is probably a deadline attached to it.

I'm not spacey. I don't lose keys or forget to zip my pants. I have done both, but it's rare. Although, I do have a problem paying attention to details and I occasionally take a wrong exit, even when going somewhere familiar. I get lost in thought.

I'm not hyper, either. I've always maintained a calm demeanor and, although I welcome adventure and love to experience new places and try new things, I am much more of a homebody than a party animal. I spend most of my free time reading, painting, watching movies, and playing games.

But, inside, I am hyper. My brain is on hyperdrive and, short of sleep or drugs (e.g., alcohol or sleeping pills), doesn't decelerate. It's not that I jump from one inventive project to the next. That takes too much effort. It's that once I figure out a problem or see the big picture, I lose interest and move on to a related interest. I do this all the time. I can't stop!

Well, okay, I could join a monastery. I do love the idea of meditation, even if I rarely ever practice it. But, no, I'm not one who preaches the need for a balance between nature and technology. Technology extends nature and we need to learn to live with it, not vacillate between avoidance and overindulgence. Besides, sleep offers plenty of respite and I get it every day.

Anyway, if I had to sum it up, my ADD-related problems are

  • rapidly changing interests
  • inconsistent productivity
  • winding conversations
  • moodiness

Hopefully, by keeping track of my day-to-day struggle with ADD and my attempts to manage it, I will become more aware of how it affects me and, in turn, better able to manage it.