Long story short, I have had POTS for 7 years, thought I was misdiagnosed with narcolepsy for the first 4-5. It had previously been a real struggle for me, as I knew I did not have narcolepsy, but the medications they gave me really helped. I started on Provigil but bc it deactivated my BC, I moved on to Ritalin. When I started medical school, I had NO IDEA how hard it would be dealing with this. Before, in college, school wasn't really something i "had to" go to, and my absences really didn't affect my grades so I thought that my medication was working just fine. THEN, I had to try and figure out how I was going to take the time to let my medication to work in the morning and still make it to 8am class on time after studying until 1am every night. Ok so here is the summary of why I found 100% controls my "spells" from POTS...
- Two hours before I wake up every morning, I take 20mg IR or XR ritalin/Adderall
- So when I wake up, am I not only "wide awake" but I have energy, and my vascular tone is high enough that I am even able to immediately take a hot shower in the morning (I really missed those)
-- THIS DOES NOT WORK IF, I decide to indulge in one too many beverages the evening prior

Alcohol is a HUGE factor for me, so hydration is also VERY important. If I come home, drink a two bottles of water and take multivitamin, I'm usually ok... but I know that drinking kills my whole next day.
-- Another problem is, sleeping through my alarm

I'm way better about it now, but if you forget to take that dose in the morning... you are stuck in bed just like a normal day
--My second dose of the day is DAYTRANA PATCH, 15mg (I cut a 30mg in half), usually around 1pm or about an hr before the first dose wears off. To give you an idea of how much I LOVE this treatment option, I pay $200 every month for these bc my insurance won't cover it (some will mine just sucks) and it gives me a rash on my skin when I wear it but the positives still FAR out-weigh the negatives!!! Why? Ok, so Daytrana is pretty much a transdermal patch of ritalin... so what's the big deal? It lasts for 12 hours at least... AND if I decide I want to go to sleep... I just take it off two hours before I go to bed and I'm sleeping like a baby!
-Negatives- just as you have to rip it off two hours before you go to bed, you equally have to put it on two hours before you want it to start working. And if you forget to take it off... sleep will not be easy
+ Daytrana is also an appetite suppressant, WAY better than any of the other stimulant/ADD/ADHD drugs out there. So go ahead a disagree with me if you want, but if you have POTS, having energy to workout is next to impossible... and I gained about 40lbs the first year I had POTS. BC I was too tired to get out of bed, just sat around and ate food all day. Daytrana also not only makes you not think about food, but if you are hungry, you crave salty foods... which, we are suppose to increase our salt intake... so yet, another benefit! After I started with daytrana, I literally, was a functioning better than a normal person - as long as I didn't go out drinking that is

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**This may be a little much for some people with POTS, as my schedule is way more demanding than most peoples... and honestly, when I was just working over the summer... a 15mg patch of Daytrana was enough for the whole day... sure it was a pain in the butt to set and alarm 2 hrs before I woke up and put a patch on... but again... way worth it.
ONE LAST THING-
**DAYS I HAVE SPELLS...
- For me, it is impossible for me to have a spell and return to normal. I have to go to sleep and let my body recalibrate or I will continue to have spells all day long. So in that event, I will sometimes take melatonin (5mg) to help me go to sleep. I DO NOT RECOMMEND THIS ALL THE TIME... but it is way better than taking medications that depress your nervous system. A lot of people with ADD/ADHD take this regularly but from the pubmed articles I have read, it can cause problems in POTS pts, luckily I am not one of them, but if you are, please don't do this!
I would love to hear if this works for you! I have tried everything for the last 7 years and for someone with a demanding schedule, this has changed my life! Now I just need to get my health insurance to cover daytrana!!!