Dream Catchers: ADHD & Sleep
Sleep is essential. I repeat, sleep is essential. If you follow my friend and colleague Allison Linney of Allison Partners, this is a familiar topic that she has written about on her company blog. There is a lot of data that validates prioritizing sleep for all humans. And if you think you "can get by" on a certain number of hours of sleep, I caution clients and friends to rethink that sleep deficit and the impact it just might be having on your ability to participate in the world as you intend.
According to the CDC's health survey data, 31.6% of U.S. adults reported getting insufficient sleep. A more recent survey indicated that 72.7% of students grades 9-12 are getting insufficient sleep. The NIH reports that nearly 40% of adults report unintentionally falling asleep during the day, and an estimated 50-70 million Americans have chronic sleep disorders. The statistics are profound.
Zzzz’s matter…
During this ADHD Awareness Month, I am revisiting all of the basics tenants of ADHD self-care and sleep is one of the best and often missed opportunities for improving cognitive function. Fun fact: losing one single hour can impact cognitive function, diminishing executive function, memory, and motor response. When I listened to Dr. Roberto Olivardia's ADDitude ADHD Experts podcast on sleep solutions for ADHD brains, I was prompted to reflect upon all of the potential challenges that ADHD brains experience with respect to finding a good night's rest and options that can help you find your best sleep.
So, why does sleep matter?
On a biological level, sleep is how our brain sheds and processes the day, allowing this state of rest to regenerate much-needed neurotransmitters like GABA and serotonin. GABA helps the brain manage inhibition and serotonin helps us regulate our mood. Both are naturally lower in ADHD brains, so sleep is even more important for ADHD self-regulation efforts during the day.
Dr. Olivardia stated in the podcast that more than 50% of individuals with ADHD also have sleep disorders or difficulties regulating their sleep. Disorders include restless leg syndrome, sleep apnea, narcolepsy, and sleep paralysis, or anatomical difficulties like a deviated septum or enlarged tonsils. The symptoms of sleep challenges are most likely described and experienced in the following ways: difficulty falling asleep, difficulty waking up, sleepwalking/talking, teeth grinding, decreased REM cycles, altered circadian rhythms that create "night owls" or interrupted sleep patterns, in some cases bedwetting. It is important to know that these challenges with sleep are universal across all genders, ages, socioeconomic statuses, races, and cultures.
As I reflected upon my own household, many of these sleep issues hold true for the ADHD brains under the roof. Bling, of course, is a solid outlier - sleep is his superpower. While he did have a tonsillectomy at age 5 that dramatically assisted his pediatric sleep cycles, he has always been a human who requires and seeks sleep to recharge. Perhaps this is because the hyperactivity helps create that much-needed state of exhaustion? On the flip side, when he is lacking in sleep, we can all attest to the increase in symptom presentation. He has mastered this strategy, even if he occasionally diverts from the path. He is, after all, a college student. The Emperor and Mr. Bigstuff have always struggled with shutting their brains off at the end of the day. It is our oldest child who happily rides that night owl's second wind, and his sleep hygiene requires a mindful practice in order to shift these hard-wired tendencies. Mr. Bigstuff has fine-tuned his sleep regimen over the last decade, including white noise, room darkening blinds, earplugs, strict bedtime and morning routines, and exercise. In recent years, I have experimented with these strategies to find my personal routine as well - setting the stage for sleep with nightly habits including warm herbal tea, low key brain games like sudoku, and a cozy comforter.
How can you increase the likelihood of finding restful sleep when you are already at a disadvantage?
Like much of ADHD, it is individualized for each of us. Finding your perfect formula often requires a bit of experimentation and an open mind. Sound familiar? Below are the eight most common strategies that have been helpful for my family, patients of Dr. Olivardia, and my clients. Hopefully, you will find them useful to help you determine what works for your body to find the appropriate amount of rest.
Sleep Journal: you might benefit from collecting a little data along your journey to a perfect night's sleep. Understanding how many hours you sleep, when you are sleeping, and any impacts on sleep can lead to insights before, during, and after any modifications to your sleep hygiene routine. So, find a pen or an app to capture the data. If you're worried about forgetting, make sure you set an alarm to remind yourself to write it all down.
ADHD medication: medication is helpful for the majority of ADHD brains. Knowing if and how it might impact your sleep cycles is important to understand. Some are negatively impacted by taking stimulants too later in the day while others take a short-acting stimulant before bed. Remember, each brain is unique, and stimulants help to regulate ADHD brains. As always, TALK TO YOUR DOCTOR about any and all medications first!
Caffeine Management: As with prescription medication, some adults who self-medicate with caffeine report that drinking a cup of coffee before bed helps them drift off to sleep. Others are better off avoiding caffeine after 2 pm, as recommended by more sleep experts. If you are a heavy coffee drinker, this might be worth experimenting with to see if there is a difference in your sleep.
Melatonin: ADHD brains do not produce melatonin as efficiently as their sleep-satisfied peers. Many ADHD brains find melatonin to be helpful to kickstart their sleep cycle. A word of caution: timing matters. Taking melatonin 90-120 minutes BEFORE you mean to be asleep is recommended. NOTE: As with all medications, over the counter or otherwise, I recommend that you consult your physician to help you manage this process.
Napping: naps may benefit or harm your ability to fall asleep at night. Make sure you are tracking both times of day and length of the nap in your sleep journal to determine if it is helping or hurting your sleep.
Exercise: exercise is always a booster for cognition and executive function. Some clients report late-night exercise helps them fall asleep faster at night while others find they operate better with earlier exercise regimens. Knowing when and what types of exercise impact sleep can be an important clue.
Stimulation: Figuring out what you need to remove or add to your hygiene is critical - sight, sound, touch, & smell. Fidgets and sensory tools (ex- weighted blankets) may be useful in calming the mind for bedtime. In addition, consider common strategies like removing digital devices from bedrooms, white noise in the form of sound machines and familiar audiobooks or songs, room darkening blinds, earplugs, sleep masks, fans, cooler room temperatures, and cozy bedding are all worth experimentation. Lowering the lights 30 minutes before bedtime can sometimes help signal a melatonin response in the brain. Adding tasks like a warm bath or shower are also ways to create a signal to your brain that it is time to relax.
Mindfulness: Relaxation and deep breathing techniques can lower blood pressure and calm the mind and body. A body scan mindfulness exercise like this one from Dr. Judson Brewer is a great way to physically walk through your body to relax each muscle. Dr. Olivardia also had a recommendation for those who are struggling with waking up in the middle of the night using positive self-talk. If you have difficulty simply falling back to sleep within 30 minutes of waking, most experts recommend getting out of bed and engaging in a non-stimulating activity until you feel tired. I particularly like Dr. Olivardia's suggestion of simply standing next to your bed until you feel tired, and I'll be giving this a try the next time I am stuck awake at 3:30 am.
What keeps you up at night?