Dino asked about handling side effects of ADHD stimulant medication, especially sleep. (comment on ADHD Tip O the Day 865)
For insomnia, you would take the medication earlier in the day and possibly lower the dose. Of course, you want to make sure you’re practicing good sleep hygiene. Very few of us do and most people just want a pill to fix their insomnia but sleep hygiene works and is needed even if you do take a pill.
Still, you might also take something to help you sleep; my first choice is always melatonin, which works for 70% of people if you get the dose up high enough. Try 5 mgm, 10, 15. You will know in two nights if that dose will work for you. If 15 doesn’t, forget it. Melatonin has few if any possible side effects and a very low chance of getting any.
This question illustrates some of the points about side effects which I will repeat again:
All medications have possible side effects as do all natural substances and alternatives. The questions are, what are the possible side effects, are any of them serious, and what percentage of people who take this medicine get them?
For example, lithium is a wonderful medication for bipolar, for 50% of patients, whereas 50% get enough side effects that they can’t take it. One possible side effect is upset stomach. If someone gets that, they can switch to the delayed release type of lithium, which usually takes care of that problem, but lithium is unusual in its high rate of side effect problems.
Another example is Zoloft (Sertraline), a good antidepressant as well as helpful with PTSD. 10% of people will gain weight on it, usually in the second or third year. 90% of people will not gain weight on it.
One of the frustrating issues is that all medications list their “side effects” rather than their “possible side effects.” Most people then assume that if they take this medicine they will get the side effects and will be expected to just put up with them indefinitely and so they are reluctant to take the medicine. Quite naturally.
In general, if someone gets one of the possible side effects of any medication, if they can tolerate it for 10 days, it will usually get better. Or they can reduce the dose. If it doesn’t get better, they can stop it and almost always any side effects will go away.
Me: “One of the possible side effects of this medicine is weight gain.”
Patient: “Oh, then I don’t want to take it.“
“Neither of us want you to gain weight. If you try the medicine, there’s only a 10% chance of that and a 90% chance it won’t happen. But we can watch your weight and if you gain two pounds we’ll stop the medicine and you’ll stop gaining weight. How does that sound?”
“No. I don’t want to take that medicine. I don’t want to gain weight.“
“OK, let’s try another medicine that doesn’t have weight gain even as a slight possible side effect. We’ll talk about the other possible side effects of this other medicine, which again , you probably won’t get any of.”
See the problem here?
The fact is, most people won’t get any side effects and if they do they can usually be managed, and if not , they can stop taking medicine and the side effects will go away.
ADHD Tip: Try the medication. If you don’t like it, you can stop it. You don’t need to be stuck with side effects.
doug
Bonus Repetition O the Day, In Other Words:
Consider medicine A. Its for people with a serious illness that hasn’t responded to anything else. It works well for 50 % of them. It has a serious possible side effect which occurs in one out of 100,000 patients; 999,999 do not get the side effect.
Consider medication B. It has a mild possible side effect which doesn’t bother most people who get it but there is a 30% chance of getting it. Most don’t and for those who do, its generally not a big deal.
So these two medicines are very different – 30% chance of mild side effect vs .001% chance of serious side effect.
Links:
Bonus Link O the Day:
@addstrategies #adhd #add @dougmkpdp
Me off meds
ADDadultstrategies 
awesome post. thanks for sharing.
I do have a kinda-related question–is it possible for adhd medications to mess with your sleep cycles other than insomnia?
for example with me I find that going to sleep at night hasn’t really been a problem, it’s staying asleep. I can go to bed at 9-9:30 but consistently wake up (often several times) between 1:30a-4:30a.
I keep wondering if the meds could do that or if it’s anything else
again–thanks for making the post, it was very informative
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dino,
if it was the medicine, it probably would be initial insomnia. middle insomnia is probably something else. have you checked your sleep hygiene?
best wishes
doug
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been working on sleep hygiene quite a bit but i suppose it could always be improved.
i’ve got a nighttime routine now (1. wash dishes 2. pick out clothes for tomorrow 3. brush teeth 4. kennel dogs 5. put on sleep-tracking watch), what i’m executing as the lights in the apartment are dimming. temperature set to 71°F. i try not to read or watch anything particular engaging.
i’m not really sure what keeps waking me up.
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dino – sound like you have a good program. unclear whats waking you – noise, dreams, bladder, stomach? alcohol before bed or anything else that would wear off in the middle of the night? the hygiene trick of course is to not stay in bed awake more than maybe 15 minutes and dont return to bed til you feel sleepy.
insomnia is a booger
best wishes
doug
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