Dear Julia,

I completely agree with Laura K.  I was concerned when I saw the new times that you had chosen and wondered how those came about.  To mimick circadian rhythm, the BIGGEST dose of the day should be targetted towards that 8 AM peak.  Given that it takes HC about an hour or so to peak in the bloodstream, meaning when it reaches its highest levels of effect, that would mean that the biggest dose should be given in the 6-7 AM neighborhood. 

I think it is wonderful that you are doing whatever you feel necessary to insure the best treatment and outcome for your daughter, but I would hate to see you make all this extra effort, and not necessarily come out ahead.  In reading about all this dosing stuff, I have been increasingly concerned that people may be misunderstanding the role of the 3 AM dose.  The 3 AM dose is much less important than the 6-7 AM one.  Getting rid of the first-thing-upon-waking dose and substituting it with one in the middle of the night is not the point here.  Again, for all the trouble you are going to, I do not think you are going to end up ahead, doing it this way, so I would urge you to rethink the times.

Because of the short-acting nature of HC, I think that---if one were to go to a 3 AM dosing schedule, as has been discussed here---it would probably be very difficult to achieve good coverage without going to FOUR doses a day.  That is because, if the first dose is at 3 AM, and the second dose at ~7 AM (again, this one being the MOST important one, so it is really not negotiable), then it would be very difficult to adequately provide coverage for the rest of the day on only ONE more dose of HC.  See what I mean? 

If you look again at the Moeller article on chronopharmocology, which reported success with dosing starting at 3 AM, you will see that the patients were all on 4 doses a day.  There is a reason for that and, again, it is because---given the short acting nature of HC, it would probably be difficult to mimick circadian rhythm effectively without doing it that way.

This is where life-style and reality sets in.  IF compliance is not an issue on a 4 dose/day schedule, then giving the first dose at 3 AM is undoubtedly  a superior way of doing things.  But IF 3 doses is more realistic (and I think it would be for most people), then it may make more sense to divide the 3 doses in some logical manner among the waking hours of the day, again with that first, largest, most important dose targetted towards the 8 AM peak.