I share your frustration.
It is so easy to cycle with good and not so good days, or days that are only half good. The biggest factors for me are sleep, nutrition, hydration, balanced with stimulant medication. I need stimulant medication to achieve “get stupid stuff done” energy as someone else put it in another blog. But, at that “therapeutic dose,” the side effects, diminished appetite, thirst, and sleep urge, increase proportionally. So you have to pay more attention to those basics, tracking them even. On the good days it’s so easy to neglect any one or all of these, but the effects accumulate and you crash or go back to “brain fog” and while you could try to up the dose of stimulant medication, it won’t work in my experience. That’s why I say I have a relationship with stimulant medications, it ebbs and flows as I learn how to work with it.
These days, I focus most on balancing stimulant medication against adequate sleep. I use Adderall (IR and XR) and a sleep tracker (“dreem” headband) that breaks down each sleep component (deep, REM, light, awake). Every morning, I write down how well I sleep in the context of the amount of stimulant medication I took the day before and anything else that happened or relates to my sleep. For example, waking up hot is often a problem, so I make sure my thermostat is set low enough. I usually take a melatonin formulation, and try different types and amounts. Antacid and magnesium seem to help too, but not always, so I don’t always take them. I sleep in total darkness too, and try to follow good sleep hygiene. I want to try active cooling sleep stuff (e.g. “ooler” and “Bryte”) because stimulant medications seems to mess with hormones related to maintaining body temperature.
It’s been trying and tracking stuff for years now. I make smaller adjustments now and focus on trying to get more of my day “covered” by ADHD meds without impairing sleep. You mentioned you use Ritalin. I tried methylphenidate (Concerta/, Ritalin) and its okey, but I found amphetamine salts (Adderall) takes away more “brain fog” but also is more likely to interfere with sleep. I want greater effect of Adderall and accept that I have to pay more attention to sleep and dosing.
That’s enough for now. I hope it helps.