Sleep & Mornings

Wired, Tired, & Sleep Deprived

Kept awake by a buzzing brain or a faulty sense of time? Sleep deprivation is no joke, and ADHD symptoms often take it from bad to worse. Use these strategies to get your body — and your ADHD brain — to settle down.

ADHD Adults: Wired, Tired & Sleep Deprived
ADHD Adults: Wired, Tired & Sleep Deprived

“My husband insists he’s going to bed at 10 each night,” says Christine, “but that’s actually when he starts thinking about it. It’s midnight or later before Jake is in bed, and we must be up at 5 in the morning.” Christine is suffering from ADHD sleep deprivation, too, because of Jake’s disruptive restlessness.

Mari doesn’t dawdle getting to bed, but she doesn’t know when to go. “Activities don’t have a natural ending for me,” she explains. “Whether it’s watching TV or chatting on the phone, I keep going until some external force stops me.” She relies on her husband to provide the bedtime cue, but shuteye doesn’t come easily. “Lately,” she says, “I’ve been dozing off in the middle of playing Angry Birds on my iPhone in bed. I play it under the covers, so my husband doesn’t see and ask, ‘Babe, are you still awake?'”

Based on appearances alone, sleep specialists might insist that Jake and Mari don’t have ADHD, despite professional diagnoses and vastly improved daytime functioning, thanks to stimulant medication. Instead, these experts might advise Jake to make a better effort to get in bed by 10 and Mari to refrain from taking her iPhone under the sheets. That way, both could have more sleep and enjoy improved cognitive ability during the day. Voila! ADHD cured!

When it comes to ADHD, however, appearances can deceive. Jake’s poor sense of timing is a lifelong trait; he is the poster boy for ADHD’s two kinds of time: now and not now. Mari has battled “brain chatter” when trying to fall asleep since she was a child. Playing iPhone games is not the cause of her delay in going to sleep; it’s her latest strategy for dealing with boredom.

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ADHD is Always Awake

Jake’s and Mari’s trouble with sleep remind us that ADHD neurobiology doesn’t go off-duty when the day ends. ADHD works 24-7 to distract, delay, and disorder one’s capacity to get restorative sleep. The result? ADHD symptoms get worse.

Research during the last five years substantiates what ADHD experts have suspected for decades: ADHD carries with it intrinsic challenges to sleep. In fact, “restless sleep” was part of the 1980s-era diagnostic criteria for ADHD. It was dropped because specifics as to the causes were lacking.

Today, terms such as delayed-onset sleep phase and sleep-disordered breathing (sleep apnea) crop up in studies done on ADHD populations. But just as ADHD symptoms vary among individuals who may also have co-existing conditions, such as anxiety, the nature of sleep disorders varies among individuals with ADHD. Generally speaking, though, up to 50 percent of children and 80 percent of adults with ADHD have problems going to sleep, staying asleep, getting restful sleep, and getting up the next morning.

Some sleep disturbances spring from core ADHD symptoms. What is more boring to the hyperactive person than lying in the dark waiting for nothing to happen? Other sleep problems, such as restless leg syndrome, are increasingly being linked to dopamine pathways. Research studies focusing solely on adults with ADHD are mostly small and preliminary, but they show higher-than-average rates for nocturnal motor activity and restless leg syndrome; periodic limb movement disorder; sleep disordered breathing (such as snoring or sleep apnea); and hypersomnia (sleepiness throughout the day that is not due to lack of sleep or interrupted sleep at night).

“It’s important to remember that ADHD is a medical, physiological disorder,” says ADHD expert and physician Patricia Quinn. Some adults with ADHD say, “I like to stay up late because it’s quiet, and I can get a lot done.” In other words, daytime distractibility and disorganization can lead to too-late bedtimes. But sleep deprivation with ADHD is not something you choose. “EEG studies done since the 1980s have found that people with ADHD have less REM sleep, don’t enter stage-4 sleep, and have more arousals,” she says.

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Time to Go to Bed

What is the best way for sleep-deprived souls to get more and better rest? Sleep professionals’ first line of advice is to practice good sleep hygiene — establishing a regular sleep/wake schedule, limiting caffeine, getting daytime exercise, keeping the bedroom dark and cool. So that’s a good place to start. For many individuals with ADHD, it won’t be enough. If that’s the case for you, try these ADHD-specific strategies.

1. Do Your Own Sleep Study
Good solutions depend on good data. Don’t depend on your memory when analyzing your sleep habits and patterns.

Remember Jake? In an effort to prove his wife wrong (that he indeed was coming to bed regularly by 10 p.m.), he gathered data. He downloaded a sleep-tracking app to his smartphone. (Two popular choices are the SleepBot Tracker Log and Sleep Cycle.) Jake was able to track when he puts his head on the pillow at night and when he gets out of bed in the morning. “My wife was right,” Jake admits. “I wasn’t getting to bed when I thought I was.”

Jake also gained a tool for monitoring improvement: “I can track the effect of changing variables on my sleep, such as when I watch the news at night or read a book. I also learned that getting exercise first thing in the morning helped me feel sleepier in the evening, so, instead of ignoring the alarm that tells me, ‘Time to get ready for bed,’ I go to bed.” In the past, without such data, Jake would have not been able to connect cause and effect, much less accurately remember whether he’d gotten exercise that morning.

Jake places the phone under one corner of the fitted sheet (to keep it from moving around), and tracks nighttime movements through the phone’s built-in sensors (accelerometer and orientation). Note: This can provide information for your physician to determine whether a formal sleep study might be advised. If you don’t have a smartphone, a pen-and-paper sleep log will do. The important thing is that you’re gathering hard data instead of relying upon your memory or perceptions.

All in all, Christine and Jake rest easier, now that she no longer feels the need to nag him to sleep.

2. Organize Your Brain
If, despite your best efforts at gathering data, you can’t improve your “sleep hygiene,” try to get organized — organize your brain, that is.

“A disorganized brain cannot go to sleep,” Quinn explains. By contrast, an organized brain can focus on the task at hand, while tuning out distracting stimuli, whether it is focusing on paperwork or sleep.

Stimulant medications help many people with ADHD “organize their brains” during the day. They can also help at night. For some, stimulants cause nighttime disturbances, especially in those with co-existing anxiety or mood disorders. But several studies show that taking a low dose of stimulant about 45 minutes before bedtime can promote the onset of sleep as well as improve its quality and duration for some children and adults with ADHD.

Initially skeptical, Mari was impressed when she tried taking stimulants a couple of hours before bed. Not only did she move through evening chores more efficiently, she also had better judgment about when to “turn off” the distractions. Moreover, she fell asleep within 20 minutes of going to bed and awoke refreshed.

Taking a stimulant at bedtime is not the only way to organize your brain, however, nor should it be the first option. You can try the following strategies:

3. Synchronize Your Internal Clock
Research supports the long-held observation that adults with ADHD underestimate and overestimate the passage of time. Many factors contribute to this, including distractibility and hyperfocusing. But now we are learning that a “dysregulated” internal clock can contribute to the problem. This internal clock is the so-called circadian rhythm in the brain, which regulates periods of rest and alertness. For most of us, the circadian cycle is mostly constant and in sync with the environment. When its rhythm is stable, we feel sleepy at roughly the same time each evening and awaken naturally at the same time each morning. Circadian rhythm is influenced by external stimuli, including exposure to light and the timing of exercise, bedtime, and naps, and hormones, such as melatonin, which is released in response to darkness.

If you suspect your body clock is out of sync (perhaps you fall asleep later and sleep longer than most people, but mostly experience good sleep), try resetting it by tweaking external stimuli.

  • GET A DOSE OF LIGHT first thing in the morning and dim household lights in the evening.
  • USE A LIGHT BOX, such as the type recommended for Seasonal Affective Disorder (SAD). Use the lights for about 30 minutes each morning, with the bright light shining indirectly — never directly — toward your eyes.

If, after steady practice for two weeks, these light-therapy methods don’t help, talk with your physician about over-the-counter melatonin, which is used to help shift workers and long-distance travelers adjust their circadian rhythm.

Remember: No amount of light therapy or melatonin will help if you are not having problems with circadian rhythm. The strategy that works for you is the one that addresses your problem.

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