Trazodone for sleep…..HEADACHES and DROWSINESS

[gracious]

Hi everyone…

I hope I’m not repeating any previous conversations here…..but I need some one else’s perspective…

I have always had sleeping issues…..but recently my doc added an extra dose of Concerta (36 mgs) late afternoon. It works fairly well for me to get through cooking supper and the evening routine with my kids. But it made my sleeping issues even worse……and so I felt like a walking zombie again through the day due to lack of sleep. I went back to my family doc and he prescribed me Trazodone, and didn’t want to switch the Concerta. My ADD coach suggested asking to switch to Adderall….she says that it may work better for me. So…the dr. decided to prescribe me this med to help me sleep, and I HATE it!! I am drowsy during the day, the 2nd dose of Concerta doesn’t even phase me……and I have had a constant headache since starting them (Traz) about 5 nights ago. When I mentioned this to my coach, she was concerned. She said it didn’t make sense to stimulate my brain at 5 p.m. and make it go to sleep at 10 p.m. So, as part of my To-Do List, we decided I would call my family doc and ask for another referral to the diagnosing psychiatrist.

My question is….anyone else out there have this experience? And how do you know if Concerta is the right one? How do you know if it isn’t? Any help would be greatly appreciated!!!

Thanks!!!

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[Patte Rosebank]

The trouble with meds for mental issues is that they’re never one-size-fits-all. So finding the right one(s) and the right dose(s) involves a lot of trial-and-error.

However, it sounds like you should be seeing a psychiatrist, or someone who has more experience with ADHD medications.

Concerta and Adderall are both stimulants, which means they rev up the central nervous system. So if you take them late in the day, you’ll be wired until long past your bedtime. Adding the Trazodone to fight that is just adding more chemicals to the soup, to try to solve a problem that was created by improper dosing of the Concerta.

It’s generally recommended not to take long-acting stimulant medications after about 2:00 in the afternoon, to give them time to wear off before bedtime. Concerta’s release system causes it to gradually ramp up the drug for the first 4 or 5 hours, and then it very gradually tapers off the drug for the next 4 or 5 hours. So, if you take it at 5 p.m., it’s reaching its peak around 10 p.m., and will stay there until about 3 or 4 a.m. Which is why you haven’t been able to fall asleep.

Concerta contains the same drug as Ritalin (methylphenidate), but regular Ritalin is the short-acting form, which only lasts a few hours. That’s why a lot of us who find that Concerta wears off in the late afternoon, will extend it by taking a regular Ritalin. If you take a regular Ritalin around 5 p.m., it should have worn off by 9 p.m., so you’ll get the focus you need for preparing dinner and getting the kids through their homework and bedtimes, but you’ll be able to relax for your own bedtime. If you need a little help to relax at night, try meditation and a Melatonin tablet (a natural supplement).

Dr. Kenny Handelman is an expert on ADHD, and he has a very informative blog on the subject, which includes a detailed post on combining Concerta and Ritalin: http://www.addadhdblog.com/concerta-ritalin/#851a1 . Read it yourself, then print it out and take it to your family doctor. Adults with ADHD often have to become their own advocates, and that often includes educating their doctors. Bringing along this information from an ADHD specialist, should carry more weight with your doctor than if you just said, “I heard…”

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[Anonymous]

It is weird… I’m at the point right now that I really don’t know if the meds at time effect my sleep or it is how I have been my whole life with having A.D.H.D.

I’ll explain. My whole life I have been the type that I only have two speeds, all out or nothing at all.

I have always been able to fall asleep ( Fast) Normally exhausted at end of long day.

But I always wake up in about 2 hours or so. ( not always to go the washroom) Then fall back to sleep to wake up n couple of hours.

For me a five hour sleep is a dream and a four sleep seems to be my normal. This has ben like this as long as I can remember.

And it is weird, in the fact that some of time fours seem to be enough. But I guess not most of the time.

Hey”g”, so when you say that your having trouble sleeping . Is it falling asleep or waking up and staying awake.

How will Trazodone effect your other meds?

One question. IS not being able to sleep long or having at times this ” Movie like” dreams normal for you folks.

Although I do find since on the med’s that a lot of the chatter has gone with in my head. So I can not remember my dreams as well.

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[gracious]

Thanks guys…..

I have been cutting the Traz in half……as I have a tendency to stay up way too late and still have to get up with the kidlets. It still helps, and I feel less drowsy in the morning. I made the horrendous mistake of forgetting to take my 2nd Concerta (I remembered at 6:30 but decided that was a little too late to take it) and it was a very bad night. I was flying off the handle and so tired and dragging my feet. My poor children…..! Anyway….to describe my sleep issues a little more…..

The 2nd dose of Concerta gives me a wonderful boost of clarity and focus and energy (but does not take away my procrastination or distractibility) in order to cook supper, prepare kids for bed, etc. I take it usually at 5 p.m. If I take it earlier, the initial effect wears off too soon and bedtime becomes a nightmare. By 8:30 p.m., I am very exhausted after a long and busy day. By 10 p.m., however, I am wide awake. My coach and I came up with a plan to take the Traz at 10, go to bed, read, and then I’ll fall asleep at a good time. That was last Friday. This is a week and 2 days later, and I still haven’t gone to bed at 10. I usually go up to bed sometime between 11-12, then take my Traz, and then read, and then fall asleep probably usually closer to 12:30 or 1. My kids are early risers and are almost always awake sometime between 7-8 a.m. So, (hey, look at those butterflies!) to get back to the point, I fall asleep rather easily, once I get there. I wake up usually ever 2 hours or so, and sometimes am able to go right back to sleep and sometimes I am not. Sometimes, I wake up in the morning and feel like I didn’t really sleep at all. I will wake up at 4 quite often and feel tired but also wide awake, almost as if I didn’t really sleep yet. This was all before I became desperate and asked for something to help me sleep……..the trazodone has taken care of waking up in the middle of the night…….but I just feel that there is another answer. I don’t know….maybe it’s just wishful thinking. Perhaps I’m prone to sleep issues forever……and in reality, even long before I found out I had ADD, I had sleep issues. People always said to me….well the good thing is you’d be a good midnight shift worker!! So not true……I tried that (twice!) and totally and completely burned out both times.

To wrap it up……I am seeing the diagnosing psychiatrist again on Tuesday…..and hope to clear some of this up.

To N……I do have very visual lucid dreams……and they almost always involve people and houses. At times, I have to remind myself that it is not true, and it didn’t really happen. But this is not from meds…..I have always had those. The meds for me have helped with the chatter as well, but I still have problems with procrastination, distractibility, disorganization…..who knows? I’ll keep you posted on the journey. I am only about 4 months into this whole world of ADD…..so I’m still learning and probably always will be!!

Cheers!!

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[Patte Rosebank]

Sounds like you have a huge problem with lack of sleep. And even when you do get a few hours of sleep, you don’t feel like you’ve slept at all. You should be getting at least 7 hours of sleep (including several hours of full, deep, REM-phase sleep) per night. A lack of sleep as significant as yours will make ADD symptoms far, far worse.

For this reason, I suggest that you ask your family doctor for a referral to a sleep disorders clinic. They will do a thorough diagnosis of your sleep habits and your brain function during sleep. They will then give you the help you need to fix your sleep issues—starting with having a regular, relaxing bedtime routine that you do at the same time every night.

As I recommended in my earlier posting, when you see your psychiatrist, please tell him of your sleep issues, and show him Dr. Handelman’s instructions on augmenting Concerta with Ritalin. If you need to augment your morning dose of Concerta, you should be doing it with regular Ritalin, NOT more Concerta. Making this change will help your sleep issues somewhat, and will also extend the benefits of the Concerta (since it’s the same drug, just in a different form).

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[gracious]

Hi Larynxa…..thanks for all of your info!! I appreciate you taking the time to answer my questions…..

I have found this site to be awesome and it assures me that I am not alone in this!! I thought I’d post a quick update…..

I visited my psychiatrist yesterday, who confirmed that concerta should ONLY be taken in the morning, and definitely not in the afternoon. So instead of taking 36 mgs at 9 and at 5, I am now starting 54 mgs of the Concerta in the morning, and the Trazodone only if I need it. I also was given one of the Co-Pay assist program cards from Janssen-Ortho. So instead of paying 125 dollars, I only had to pay 65!!! That was awesome!!!! Anyways, I hope that this works out better for me; my psych. seems to think so. Her words were “…..you will sleep better and your symptoms will be more leveled out throughout the day. ” I am going to try for a while to go without the Trazodone and hope that I don’t need it, because I do not like the after-effects of it. If I still end up with trouble sleeping….I will certainly take your advice and ask for a referral to a sleep disorder lab.

Thanks again!!!!

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[Patte Rosebank]

You’re very, very welcome!

And I’m very, very glad that things are starting to get better for you!

Between taking the Concerta only in the morning, and getting into a regular bedtime routine (including a regular bedtime), I think you’ll find your sleep troubles greatly diminished.

Good luck!

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[Anonymous]

http://www.caddra.ca/cms4/index.php?option=com_content&task=view&id=97&Itemid=142&lang=en

This gives clear examples of sleep management strategies and covers the issues you are looking for. Watch for a new section on sleep management on TotallyADD.com soon.

Always speak to your doctor before making any changes to medications. Dr. Jain provides advice generically and not for any one person. Advice does not constitute a therapeutic relationship or promise of care. Please consult the privacy policy for more information.

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