Sleep medicine and ADD medicine

September 30, 2014 7:48 PM

What is the best prescription sleep medicine for someone using Adderall to treat ADD? I will be speaking to my doctor of course, but I wanted to see if anybody had a sleep medication that worked well with your ADD medicine. Anecdotal help welcome.
posted by anonymous to Health & Fitness (17 answers total)

Don't also drink coffee. Take it early in the day. Lower your dose.
posted by k8t at 7:59 PM on September 30, 2014 [2 favorites]

IANAD, IANYD, etc, but since you're interested in anecdotes, what has worked well for me is clonidine. It was originally a blood pressure medication, but these days it is also used for anxiety, drug withdrawal, and in ADHD. It's not a super-strong, knock-you-out kind of medication (like Seroquel, for example), but it's still very effective for me. I take it every night for sleep, and very rarely I take a lower dose during the day for anxiety. I still need to be good about sleep hygiene, but it definitely makes a difference. I don't have any side effects, although it could be problematic if you already have low blood pressure since it is an anti-hypertensive. I like that it's not habit forming, and it doesn't leave me feeling hungover the next day. It's similar to guanfacine/intuniv which is also used in ADHD. Oh, and I take Vyvanse during the day for ADHD.
posted by litera scripta manet at 8:01 PM on September 30, 2014

obsessive sleep hygiene, taking the adderall early in the day (and at the same time every day), no caffeine after noon, and melatonin help me a bunch. Stimulants like Adderall have a pretty steep "wear-off" curve, from what my doc tells me, and my experience bears that out. I take it about 13 hours before I go to sleep every day, and I can tell it has worn off about 8-9 hours after I take it (extended release), or 6-7 hours for normal release. Having a good "go to bed" pattern, augmented by melatonin if I fall out of rhythm, has kept me good for probably 25 days a month for a while.

There's still nights wear sleep just isn't gonna happen, so I've taken a concept I heard Billy Crystal one talk about: just accept you're going to "rest" instead of sleep for some (or all) of that night, lie back and rest.
posted by DGStieber at 8:30 PM on September 30, 2014 [1 favorite]

I was just looking for information about this last night! It was late and I still felt wired from the day meds, but I didn't want to fall asleep around 3am again. I decided to take 50mg of benedryl (diphenhydramine hcl) to help me sleep. (It's also sold as a nonprescription sleep aid in the US.) Then I turned on the fan, put in earplugs and turned off the lights. End result: I got a lot of sleep and felt really great today! Still I don't know if I would recommend benedryl. It worked in a pinch (with a hearty side of better-than-usual sleep hygiene) but I don't like the specific drowsiness feeling it has for me. In the past it's caused bad hangover feelings too. Personally I am now thinking of asking my doctor for better options.
posted by thepdm at 8:32 PM on September 30, 2014

anecdotally? do not do ambien
posted by hejrat at 8:58 PM on September 30, 2014 [1 favorite]

idk, ambien has been fine for me occasionally (1-2x a week) although there are hilarious side effects like buying too much pretty soap online at 1am when I don't realize that I should just get into bed and stop goofing around online. I wouldn't take it any more regularly than that because the rebound insomnia is appalling.
posted by poffin boffin at 9:23 PM on September 30, 2014 [1 favorite]

Trazodone is a rock star for putting you to sleep. It might be more than you need.
posted by crazycanuck at 9:37 PM on September 30, 2014

I love trazadone and have been using it for years.
posted by foxy_hedgehog at 9:58 PM on September 30, 2014

Personally I think Dan Carlin's fifteen-hour Ancient Roman History podcast does the trick.
I kid. Sorta. I use extended release melatonin, which is over the counter. But have you considered Derrida?
posted by tapir-whorf at 10:31 PM on September 30, 2014 [3 favorites]

I've found that medications designed for sleep are too heavy-handed and make me feel funky (zombie/cracked out) the next day. What works for me is low dose (1mg) of Lorazepam (Ativan), which is a benzo. It gets my mind to STFU long enough to allow my natural sleepiness to take hold.
posted by ApathyGirl at 10:43 PM on September 30, 2014

Sigh. I remember the good old days when Adderall briefly kept me from sleeping. Now it sometimes makes me want a good nap. But the return of the ADHD symptoms after the Adderall wears off keep me from sleeping, and taking more Adderall isn't a viable option. After trying ambien, sonata, something else that starts with z or r, valium, klonopin, ativan, temazepam, seroquel, atarax, clonidine, trazodone (not in that order), I ended up with Xanax. It seems to be the only benzo I can tolerate without becoming agitated and/or overly sedated, it is also chemically in a different group than most other benzos. I am also very sensitive to meds that have antihistamine effects if they cross the blood-brain barrier at all. So much fun.
posted by monopas at 11:19 PM on September 30, 2014 [1 favorite]

Anecdotal? Okay. I take Zopiclone/Imovane (http://en.wikipedia.org/wiki/Zopiclone). It works well, but it can be as addictive as a benzo. I wanted to stop with it a while back and ended up with horrible sleep deprivation for days, so I keep taking it for now.

I have mixed feelings about it, because it works, but I don't like the fact that I cannot really stop with it for now.

(YMMV etc.)
posted by KTamas at 12:16 AM on October 1, 2014

I may not be the best person to answer this because I can take Adderall and promptly fall asleep for four hours -- for me, Adderall is not a stay awake/alert drug, but an anti-task-switching drug (even when that task is sleeping) -- but Ambien worked pretty well for me back before I developed a tolerance for it.

However, I do have a couple of caveats about taking Ambien:

1. Take Ambien on a VERY empty stomach. As is don't eat anything for the 6 hours before you're scheduled to take your dose. Any food left in your stomach when you take Ambien is both going to delay the onset and the time for it to leave your system so if your stomach isn't empty you'll still have a couple hours of insomnia and then sleep through your morning alarm.

2. Don't take your Ambien until you're already in bed -- WITH YOUR COMPUTER AND PHONE OUT OF REACH -- and ready to turn out the lights and lie there waiting to fall asleep. Don't take your Ambien and then jump up to do one last thing. The only thing you're allowed to do on Ambien besides sleep is have wild crazy Ambien sex you won't remember -- all other possible activities should be actively shunned and even boobytrapped to prevent your Ambien-self from getting into them. (If you go stir crazy while waiting for the Ambien to take effect, watching TV on a shut-off timer or light reading you don't need to remember are acceptable activities.)
posted by Jacqueline at 12:51 AM on October 1, 2014

Anecdotally, make sure you pay VERY close attention to your moods, cognitive processes, behavior, etc. for a couple weeks after you start taking a new sleeping pill just in case you're in the fraction of a percent of people who get the wacky side effects.

I was once prescribed Seroquel for insomnia and within a week of starting it I was overcome with difficult-to-suppress violent urges. It wasn't until I Googled "seroquel rage" out of curiosity that I found out that these urges were a known side effect that my doctor just hadn't bothered to tell me about because it was so rare. If I hadn't figured out the connection and stopped taking it there's a good chance that I might have ended up on the national news -- it was that mind/personality-altering for me. :(

I don't say this stuff to scare you off of taking something for insomnia. Being able to finally sleep is definitely worth the risk/reward ratio. Just pay attention to how your mind works after you start taking it and consider the possibility that any changes might be due to the new medication even if it wasn't one of the expected side effects.
posted by Jacqueline at 12:59 AM on October 1, 2014

Oh, and for something that doesn't require a prescription and doesn't have any scary surprise psychological side effects, you could try my current go-to sleep aid: 100-to-200mg diphenhydramine (aka Benadryl) washed down with a couple of glasses of wine.

Unfortunately, it doesn't work as well as prescription sleeping pills -- hence me answering your AskMe at 4am local time.
posted by Jacqueline at 1:02 AM on October 1, 2014

I'm also one of those weirdos who can take Adderall and fall asleep.

If I have trouble sleeping, I'll take 2mg of Lorazepam.

If that doesn't do it (rare), I'll take 10mg of Ambien (aka Zolpidem).

I know that many people say Ambien makes them all dopey, but maybe I've built up a tolerance: I don't have any memory problems or unexpected deliveries from Amazon.com or anything like that.

Note that Ambien will tend to put you to sleep, but it won't keep you asleep.
posted by doctor tough love at 4:31 PM on October 1, 2014

Seroquel was the only thing that worked for me when I took Adderall too.

And I'd second lowering the Adderall or seeing if you can switch a dose from XR to IR so it's not with you as long.
posted by mermaidcafe at 4:11 PM on October 2, 2014