Sleep Soundly Every Night, Feel Fantastic Every Day (36 page)

Some adults with ADHD symptoms become alert as the day progresses and are more ready to work or socialize in the evening, delaying their sleep onset as well as their ability to awaken the next morning. These sleep–wake problems can be attributed to significant changes in the circadian rhythms of adults with ADHD. As compared with control groups, adults with ADHD show decreased sleep duration and reduced quality of sleep.

Cortisol levels are also a factor. Cortisol is usually high when we are awake, alert, or working. For most people, cortisol levels are at their lowest at 11:00 p.m. and highest at 9:00 a.m. For those with ADHD, cortisol levels peak toward evening when they should be dropping. This also delays the production of melatonin, a hormone that promotes sleep. Melatonin supplements proved effective in helping my patient James.

James was 42 years old and appeared to be moderately obese. James had a fairly successful business, but had a hard time focusing and tended to lose interest in things quickly. James explained that he had been diagnosed with adult ADHD seven years prior and was taking Adderall. He described himself at work as hyperfocused to the exclusion of everything and everyone else.

I noticed when James and his wife sat down in my office that his legs were moving after a short time. I guessed he had a hard time staying still and was more restless than relaxed at home also. During our initial conversation about his sleeping patterns, I watched him impulsively jump into my sentences with “Let me explain …” or “I think.…”

James described his sleep problems as trouble falling asleep and further difficulty staying asleep. I attributed some of this to his moderate obesity. Then I questioned his wife and she said, “He snores.” That's when we started talking about scheduling James for a sleep study. I advised him to get a diagnostic polysomnogram in the sleep lab, and the results showed that he did have sleep apnea.

He went on CPAP and has shown significant improvement. He no longer wakes in the middle of the night, suggesting his inability to remain asleep had to do with the sleep apnea. His ability to stay asleep has improved by taking melatonin about one to two hours before going to bed. Now, he is less sleepy and better functioning during his workday.

There is a good chance that by addressing your sleep problems, you will improve your ADHD.

Trouble getting to sleep:
Practice good sleep hygiene, especially eliminating all sources of blue light (computers, televisions, and other electronic devices). Consider taking a low trial dose of melatonin, 1 to 3 milligrams, an hour or two before bed. Insomnia could also be related to medications
you may be taking for ADHD. Ritalin, Adderall, and dextroamphetamine are commonly used in ADHD and all cause insomnia, especially if dosing is too close to bedtime. Discuss options with your health care provider.

Trouble staying asleep:
A sign of an underlying sleep disorder, such as insomnia.

Early morning awakenings:
Rule out depression as part of the problem.

Snoring:
A sign of possible sleep apnea. Speak with a sleep specialist. Sleep apnea treatment can yield significant improvement.

Discomfort in the extremities, usually the legs:
If movement relieves discomfort, then it may be RLS. Antidepressants, antipsychotics, and over-the-counter sleep aids that contain diphenhydramine can cause or exacerbate RLS. Low iron levels are also a cause; have your doctor check your iron levels with a test called ferritin. If none of these predisposing conditions are found, then treatment with medications for RLS is very effective.

Q.
 
My six-year-old has sleep apnea. I have been told that he should have his tonsils and adenoids removed, but I am a bit reluctant to do this. What type of benefit might he get from having this done? He is somewhat hyperactive.

A.
 
A recent study, funded by the NIH, involved 464 children. The study demonstrated the benefits of surgery in children with sleep apnea. Children who underwent surgery showed improvement in sleep quality, impulse control, and quality of life. Beneficial effects were observed, even among overweight children in whom there has been particular uncertainty about the role of surgery. I hope that answers your question.

Q.
 
My nine-year-old granddaughter was diagnosed with ADHD. She only sleeps seven hours a night. I know that can't be enough. Can it be contributing to the ADHD?

A.
 
Yes, it may be a contributing factor. Recent studies have shown that we need a proper amount of sleep for our memory to function during the day. In fact, the type of memory called declarative is particularly abnormal in ADHD. Declarative memory is particularly dependent on slow wave sleep (deep sleep). If this is impaired because of lack of sleep, it may further inhibit the ability to learn. So it is very important that children with ADHD get enough sleep. A nine-year-old requires at least 10 hours of sleep each night.

Our job as parents and professionals is to be aware of children's sleep needs and sleep habits. If left untreated, sleep problems suffered in childhood will persist into adolescence and adulthood. It's imperative to treat childhood sleep problems early, especially if the child has ADHD. In many instances, dealing with a child's sleep problem will improve his or her ADHD. If you have a child with ADHD, take the time to notice any of these behaviors:

  
Snoring

  
An inability to fall or stay asleep

  
Complaints of always feeling tired and fatigued

  
Frequent leg movements at rest or while asleep

If you suspect your child has a sleep disorder, schedule an appointment with a sleep doctor and use the checklist earlier in this chapter to help you discuss your child's symptoms.

 

 

Start where you are.

Use what you have.

Do what you can.

—ARTHUR ASHE

Sleep … the time for you to balance the internal systems and recalibrate your circadian clock. You've now read how sleep is the healing elixir for emotional memories, a clear mind, and a positive mood. How ingenious of nature to provide sleep cycles to restore balance. Take the opportunity now to change what is not working for you. Make a positive intention to sleep well every night and feel great every day.

If changing your sleep hygiene and habits seems overwhelming, then start where you are. Choose your first step, close your eyes, and see yourself take that step successfully. Jenna had difficulty knowing what her first step would be
after her husband died quite suddenly of an undiagnosed heart condition. They lived their dreams for seven years, and suddenly her greatest difficulty in sleeping in their bedroom was memories of her husband. She knew she had to firmly decide to take the first step of changing the room to suit her personality, changing out somber earth tone bedding and furniture that so suited her husband. She wanted bright blue skies, white walls, and soft bedding that hugged her to sleep. She wanted comfort, respite, and calm—the qualities her husband brought to their relationship. She took the first step of choosing her sleeping style.

Where will you start? Most people like to organize and prioritize. What can you organize now to make your sleeping space inviting? Is there clutter you want to clear? How about that lamp you don't like or the stack of books you haven't read yet? Clean this one sleeping space, and you'll be amazed at how inviting it feels to go to sleep now. Trust that the next step will be easier, and keep visualizing your deep, comfortable sleep.

Are your nightly rituals a priority now that you understand how restorative sleep can improve how you feel? Use the new knowledge and checklists from this book to review your nightly rituals, eating habits, and any delay tactics that exacerbate your moods or actions. Put an end to the delayed sleep, the late night snacks, and the electronic games that keep you awake. Do you need to keep a sleep diary? Evaluate your diet before bed? Why not jot down some notes on using what you have to make your sleep better, and in another column, list what you would like or feel you need to sleep better: a different pillow, perhaps? A journal for listing negative thoughts? Or possibly a gratitude journal to review your day with
a sense of fulfillment? What you have are qualities of common sense, knowing what you need to change, and the willingness to make that change. You have strength, and from this book you have knowledge to get a good night's sleep every night.

In the Introduction, I mentioned that in the United States alone, 50 to 70 million people suffer from chronic sleep issues. The huge number astounds me because it presents a world health problem for this century. The adverse effects of sleep deprivation drain people's focus, energy, health, and optimism. The enormous importance of that sentence is brought home every time I see a patient succeed in his or her sleep programs. They never fail to share their success stories with others who also suffer from sleep disorders.