More than three years ago, we walked out of our son’s developmental pediatrician’s office, where his “…extreme hyperactivity and impulsivity…” (Dr. D’s diagnostic report, page 5) led to a diagnosis of combined type ADHD. Medication was recommended, because his symptoms were “…causing significant functional impairments in all aspects…” (page 5) of his life.

Since then, we’ve been playing medication pinball. Pull the plunger of a certain medication, engage the flipper of a certain dose, and try to keep Tony’s hyperactivity or sleep from going down the drain. The past few months we’ve been swapping out plungers and flippers one after another in an effort to increase the sleep score while managing his symptoms, because the Guanfacine he’s been on for more than 3 years now has been causing rebound waking that will keep both of us up for hours in the middle of every night. There’s no way to get either of us a winning score at anything with years of that.

So Dr. D began swapping out pieces of our medication pinball, replacing a 1 mg plunger of Guanfacine with .1 mg of Clonidine because that should help him sleep through the night. A month later after bouncing off tons of bumpers because the Clonidine wasn’t controlling his hyperactivity as well, missing most of the increased sleep targets, and spending lots of time awake in the drain we conferred with the fabulous Dr. D and who changed out the Clonidine flipper with a .2mg dose and instructions to call her in a couple of days if it wasn’t working. Two days later she increased the dose to .3 mg. I thought surely that must be enough to tranquilize an elephant, and perhaps it could have been…but it wasn’t enough to keep Tony’s sleep ball rolling long enough to keep us out of the drain for half of the night.

So a little more than a month ago she switched out the Clonidine plunger entirely for 25mg of Trazodone. Helping individuals with ADHD sleep through the night is an off-label use for this particular medication, which is more commonly used to treat depression. About two thirds of the nights we managed to get a sleep score high enough for Tony to reach eight hours before that ball landed in the drain, but the hyperactivity still had us playing a fast-paced response game during the day.

Dr. D’s goal is to get our little man sleeping through roughly 80-90% of his nights and control the ADHD. So, she changed out the Trazodone flipper for 50 mg on June 7, and added another .5mg Guanfacine flipper this week. Right now we’re still playing the game daily, tracking our scores, to see if this combination of plungers and flippers will get us the sleep and hyperactivity scores we want. Right now, the hyperactivity is better managed, but we have had four night’s sleep that ended two hours earlier than desired.

Our days are long. Even with all of that medication, Tony can still be bouncing around filled with all the energy I wish I had, jumping on his trampoline, or playing apps on his tablet until well after 9pm every night. Monday through Friday, our therapy days go until 7pm.

I turned 45 last month, and I can honestly say that getting shorted that much every night for sleep becomes harder with every passing year. There isn’t anyone wanting to find the winning combination for how to work the flippers and win this game more than me. So often I hear people ask “isn’t there a medication that can fix that?”

Sure, there are medications, but fixing anything with them isn’t a given. It’s more like a game where we play one shot after another hoping to get a score that’s only just good enough. Medication pinball each and every night, trying to find a way to keep us mostly out of the drain.

You can click on this sentence for link to a brief healthline article explaining combined type ADHD if you aren’t familiar with the differences between the different diagnostic categories for ADHD.