MeAndPD,

You may be interested in an app that I've written:

Parkinson's Disease Measurement: PwP, surveys, trials, analysis

You input details (time, size, drug) of each dose that you take in a day, and using pharmacokinetic parameters it draws a graph showing how your levodopa equivalent levels change minute by minute during the day. (Unfortunately it doesn't, as yet, deal with the Neupro patch.)

You can reduce the spikes by:
- taking more, but smaller doses;
- taking meds with a longer half-life;
- using meds with continuous delivery, e.g. the patch;
- timing your doses;
- basing your dosing on need, not time.
- combining with food, but not protein.

Regarding my own daily regimen, I have strong foundations of drugs which have limited variability (8mg ropinirole CR, 1mg rasagiline). Then I have five 75mg Stalevo to take as required. Often I take fewer, rarely I take more. The trick is to read your body so that you take the medication before it's needed, but in time to come on stream when it's required. For me, basing this on tremor and stiffness seems to work. (I'm trying to develop an automated decision making system, but progress is slow.)

I'm no doctor, but the limitations on the QOL that you describe seem to me to make a good case for increasing your daily dose.

John