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Overall, my experience with Adderall has been wonderful. Life changing. I did, however, recently have an experience – a reminder – of how powerful the tiny blue pill can be. And how, if not used with good judgment and careful planning, has potential to do substantial harm.

My little reminder happened to occur (primarily) on the 4th of July (which fell on a Wednesday). But really, the cause of this particular incident is rooted in Monday night, with various judgment errors and circumstances accumulating and compounding over the course of several days, culminating late night July 4th and in the wee little hours of the morning of July 5th.

So – starting with Monday night…

As you know, if you read the “Adderall – Week 3″ entry, I slept fine on Sunday night. Monday night, however, didn’t go quite as well. I  took my normal dose of Adderall throughout the day. I don’t know what might have factored into the atypical effects of the Adderall that day, to prolong it’s effect through the night, but I didn’t fall asleep till nearly 4:00 am Tuesday morning. The only thing out of the ordinary on Monday was the first tingles of what was to become a somewhat severe case of laryngitis later in the week, and the massive dose of Vitamin C I take whenever I feel something like that coming on. By “massive” I mean eight or so 1-a-day doses. The Vitamin C seems to have a substantial effect of the severity of colds and sore throats and such (it didn’t this time – 1.5 weeks later, my voice is still a bit hoarse, and I’ve had a hard time getting to sleep with a lingering cough). I know that C is known to inhibit the absorption of amphetamines, and it’s actually recommended to avoid drinking any acidic juices shortly before or after taking Adderall for that reason. I believe the unabsorbed Adderall is simply passed in the urine (I’ve read that 40% of Adderall IS passed in the urine with normal dosing), so I don’t think the C factored in – but what do I know?

Regardless of the cause, I woke up very sleepy Tuesday morning after 3 hours of sleep. Here is where I made my first mistake, and later in retrospect, formulated my first (commonsense) rule:

DO NOT TRY TO MAKE UP FOR AN ABNORMALLY SLEEP DEPRIVED NIGHT WITH ADDERALL.

I ended up taking 25 mg’s of Adderall on Tuesday instead of the usual 20 mg’s. I’m fine with an extra 1/2th of a pill for an extra sleepy day under normal circumstances, but not to combat legitimate sleep deprivation. Not saying you should take any more than you’re prescribed without talking to your doctor – but personally, I’m comfortable playing (limited) games with my dosing as I see fit.

For whatever reason, I slept worse on Tuesday night than I did on Monday night. In fact, I didn’t sleep at all. Not a hint. I laid there for about 8 hours, and saw every hour pass by on the clock. I started getting anxious around 2:00am, very worried by 3:00am, “oh crap” by 5:00, and I finally left for work an hour early, getting up at 6:00.

That was my second  mistake, and from it, my second rule:

DO NOT GO TO WORK AFTER 48 HOURS WITH ONLY 3 HOURS OF SLEEP.

It was Wednesday, July 4th. Only me and one other person were at work that day, and only because I was leaving for a week of vacation on Thursday (technically Friday, but I needed Thursday to prepare), and wanted to get a couple of loose ends tied up at work.

So I went to work. I was going to leave work a couple of hours early, because I needed to make a 1-hour drive to a lake resort on which my in-laws rented a camp site for the year, to meet the rest of my family for 4th celebrations and fireworks. By 11:00, I felt awful. My eyes felt sunk in, my muscles were stiff (particularly my neck), and my right foot began cramping. By 1:00pm, I couldn’t handle it anymore, and went home. I had to drive up at 7:00pm, so I figured with 6 hours to try and sleep, surely I would get a little in before I had to drive. I had taken a little less than my usual dosing that morning, hoping for a sucessful nap.

I laid down at 1:45pm to sleep. At 3:30, I moved to the couch instead of the bed – sometimes that helps. I was back in bed by 5:00, panicked that I’d have to make the drive without getting any real rest. 7:00pm came, and I was now pushing 60 hours with only 3 hours of sleep.

Here is where I made my third mistake. No new rule for this one – it’s another violation of the first rule. Knowing I needed to make a 1 hour drive under the current circumstances, I combined 4 of my usual 2.5mg doses into one, just before I left. 30 minutes later, I was feeling ok. My body still felt awful, by I wasn’t feeling “drowsy.” I made the drive just fine. But by about 9:00pm, the Adderall crash came hard, and I continued my bad judgment by taking another 10mg dose. This one put me a little over dose for the day, but not much since I skimped in the morning.

That last dose did nothing.

The fireworks, by the way, were amazing - the most awe-inspiring display I’ve ever seen. They were done primarily by private parties in a “mine is bigger than yours” contest, with a grand finale being done out on the dock over the lake by professionals. Being within 100 (horizontal) feet of the shells was truly humbling. On several occasions with various parties synchronized, the colors filled the entire visual field, the explosions producing a powerful “thump” in the chest, and the echoes bouncing off the surrounding mountains into a dull roar that rivaled a thunderstorm.

Anyway, despite that last dose crash was growing in intensity. My body felt like it had been hit by a train. My muscles were stiff; I could barely look “up” at the fireworks at one point because of my sore neck. My brain felt dull. When I stood after sitting or kneeling, It was hard to balance. Compounding the misery, my throat was burning by this time from the laryngitis, and I could barely talk.

By midnight, as we were packing up to leave, I suddenly became very nauseated. My wife drove, and so I was able to recline in the passenger seat; I was massively tired - physically and mentally - but could not sleep.

The real problem at this point became the nausea. I have always had a reflex of quick, shallow breathing when I’m nauseated, to hold off actually vomiting. Because of that, even with a paper bag over my mouth, my fingers and toes started to grow numb with hyperventilation. I tried to breathe slowly, but with the mixture nausea, extreme fatigue and sore throat, I wasn’t exercising very effective self-control at that point, and the hyperventilation intensified. The trip home became long and complicated after a car accident shut down the highway, and traffic was routed through an unpaved, rural road. A very bumpy rural road, at that.

After holding the nausea back for about 45 minutes, it came, and I motioned my wife to pull over; she did, and I, in panic, stepped out of the car before it had even come to a complete stop, and stumbled immediately to the ground, dry-heaving. I hadn’t eaten most of the day (sore throat plus no appetite – I actually tried eating at one point, but gave up after a couple of bites), and so I didn’t have anything to throw up. This was where things got a little scary.

Apparently – and I may be wrong – when you are hyperventilating, the numbness follows the blood. If you recline for awhile, then hang your hand over the side of a bed, your hand will immediately go numb.

Stepping of the car, my legs, up to my knees, disappeared. That’s the best way to describe it.

If you’ve ever woken up at night with a completely, 100% “dead” arm due to cutting off blood circulation, you know what I’m talking about. Where you can’t feel your arm, and you try to move it, only to feel something hit you in the face, and realize after several seconds that it was your own hand.

So my legs disappeared, and I stumbled to the asphalt shoulder. As soon as I was on my knees, still dry heaving futilely, my arms disappeared. Now I was on my elbows and knees, desperately trying to throw up. But nothing would come, and I continued to hyperventilate. The numbness spread into my hips and shoulders, and I started to feel the tingle in my tongue and lips. My whole body was going numb.

I finally vomited a tiny bit of fluid, and the nausea immediately subsided. Now I was stuck on the ground, unable to move. My fingers were stuck in a bizarre, unnatural position, and to me they were absolutely stiff and without feeling. My wife was nearly panicked at this point, and called her mom, who had been behind us for part of the trip, until we lost them. After some discussion (without me), my wife decided we’d better head to the nearest emergency room. For a moment, I almost agreed.

After a few minutes, during which I nearly held my breath, enough feeling returned to my legs to make it back to the car, and we were back on our way. My fingers remained unusable for another 5 to 10 minutes. We debated going to the emergency room the rest of the way home, and I, perhaps unwisely, talked her into going home, then to the emergency room if I was unable to fall asleep within 4 or so hours, or if I had anymore extreme nausea/hyperventilation attacks.

When we got home, I immediately took Tylenol for my throat and ginger and cayan tea for the nausea.  I was able to relax in bed and concentrate on breathing slowly, and after 30 minutes or so, every last bit of numbness was gone, and the nausea was nearly gone. I fell asleep after about 3 hours.

I slept for maybe 5 hours, and felt perfectly fine upon waking. Of course I did end up taking a very substantial nap that day, paying back some of my accumulated sleep debt. I did NOT take Adderall that Thursday.

Anyway, in summary – respect Adderall. It’s meant (in my case) to alleviate acute, undiagnosed drowsiness; It’s NOT meant to be a magic solution to a horrible night’s sleep. It may mask the drowsiness temporarily, but the sleep debt will eventually catch up with you. In my situation, it became a nasty vicious cycle; bad night, Adderall, worse night, more Adderall, etc ad nausea. : )