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Let’s talk about ADHD and sleep!
Cause if you talk about ADHD at all, eventually someone is going to pop up and say something about sleep. But we’ll get into that in a second.
First, let’s just talk about sleep and humans.
Cause if you talk about ADHD at all, eventually someone is going to pop up and say something about sleep. But we’ll get into that in a second.
First, let’s just talk about sleep and humans.
So first of all, adults are recommended to get at least 7 hours of sleep per night. That's why you hear 7-8 or 7-9 hours in articles and from general population. But we hear 7-8 and think of 7 as a ballpark number, right? It's not. It's at least 7.
https://www.jstor.org/stable/24857917?seq=1
https://www.jstor.org/stable/24857917?seq=1
One night of sleep deprivation needs 2 nights of sleep recovery to restore global brain efficiency, but still doesn't restore local brain efficiency.
This is all in just your average neurotypical brain. https://academic.oup.com/sleep/article/41/suppl_1/A85/4988255
This is all in just your average neurotypical brain. https://academic.oup.com/sleep/article/41/suppl_1/A85/4988255
Now, let's add in ADHD. It's commonly known that a whole lot of people with ADHD report poor sleep quality. And there are some really interesting studies around that. https://www.cambridge.org/core/journals/european-psychiatry/article/effects-of-emotional-lability-mind-wandering-and-sleep-quality-on-adhd-symptom-severity-in-adults-with-adhd/10ACA51435F49C6C94568B95757AEB8B
Now if you ever talk about ADHD, you may have gotten someone in your replies saying "it could just be sleep apnea instead! They did a study!"
They did multiple studies, here's a meta-analysis. It's not an "instead", it's an "as well". https://www.ncbi.nlm.nih.gov/pubmed/21808754
They did multiple studies, here's a meta-analysis. It's not an "instead", it's an "as well". https://www.ncbi.nlm.nih.gov/pubmed/21808754
Part of the problem is the use of the term “attention deficits” in sleep research. Because, yes, people with poor sleep quality are going to have attention deficits. But our lay-brains like to go “hey, attention deficits=ADHD”. No, folks. No.
A lot of people with sleep apnea also have ADHD. And fixing the sleep apnea helps with “attention deficits”. But ADHD is more than attention deficits, and I don’t just mean the two extra letters.
For example, as part of my diagnosing process, I went to a sleep clinic. They found two really interesting things:
1. Excessive daytime sleepiness. Like “do not operate heavy machinery” sleepiness.
2. A sleep abnormality where my brain was bypassing delta wave sleep.
1. Excessive daytime sleepiness. Like “do not operate heavy machinery” sleepiness.
2. A sleep abnormality where my brain was bypassing delta wave sleep.
When you first fall asleep your brain should go through a cycle where it hits REM sleep at the 90 minute mark. I was skipping over the delta wave cycle and dropping into REM at the 60 minute mark.
This is not uncommon if you’ve had a really long and stressful day. It’s that kind of dead to the world sleep where you feel like a rock and you dream a lot. You wake up feeling maybe physically refreshed but mentally groggy. That was my regular sleep.
Because of that, my doctor decided that vyvanse was an excellent medication for me to try. His reasoning? Because the half-life was so long, it would essentially force my brain to stay awake long enough to go through that delta wave (N3 for the nerds) stage I kept skipping.
Trick is, if I stay up so late that the half-life isn’t there anymore, I drop right back into that shitty sleep.
So what does the brain do in delta wave sleep? What was I missing out on? “Sleep-dependent memory processing”
https://en.m.wikipedia.org/wiki/Slow-wave_sleep?wprov=sfti1
So what does the brain do in delta wave sleep? What was I missing out on? “Sleep-dependent memory processing”
https://en.m.wikipedia.org/wiki/Slow-wave_sleep?wprov=sfti1
Ahh yes, an entire process by which your brain sorts and stores memories. Semantic memory (factually information), episodic memory (specific personal experiences), and a little thing called “systems consolidation”.
This is where it gets interesting.
This is where it gets interesting.
Systems consolidation is “where hippocampus-dependent memories become independent of the hippocampus over a period of weeks to years.”
It’s long-term memory and context building.
It’s long-term memory and context building.
It also has a lot to do with spatial awareness (hello bumping into door frames in the apartment I’ve lived in for 5 years). https://twitter.com/erynnbrook/status/1175547752207605766?s=21
Does the stimulant work? Hell yeah, my sleep is a lot better than it used to be. Do I have normal or even good sleep now? No clue. But it’s better.
But trust me, you can have ADHD, be sleeping 10 hours a night and not be getting the kind of sleep you need.
But trust me, you can have ADHD, be sleeping 10 hours a night and not be getting the kind of sleep you need.
ADHD isn’t just forgetting where your keys are, or what day that paper is due. And sleep issues aren’t instead of/independent of ADHD. You can have ADHD and sleep apnea, and getting treated for sleep apnea will improve “attention deficits”. Will it cure ADHD? Nope.
Look, better attention is good for everyone. We all want to be alert and attentive. When you have ADHD, and you’re not consolidating memories or context building, you know what makes you alert enough to function?
It’s called your amygdala. Yeah. The fight or flight spot.
It’s called your amygdala. Yeah. The fight or flight spot.
ADHD=everything is a bear and I’m always being chased until I’m so exhausted I collapse and my body repairs itself enough so I can keep on running tomorrow. But my brain never gets out of red alert long enough to document what went wrong.
That delta wave sleep I mentioned? “Systems consolidation”? That’s the equivalent of an executive meeting where all the higher ups get together for 3 hours to figure out what went wrong and walk out with new process documents to prevent it from happening again.
So are ADHD and delta wave sleep linked? Yep. Absolutely. And not just anecdotally, science-ly too.
Not a lot of studies, but we’re getting there. https://www.nature.com/articles/s41398-019-0659-3
Not a lot of studies, but we’re getting there. https://www.nature.com/articles/s41398-019-0659-3
So what can you, ADHD sleep-deprived brain haver, do to improve your sleep hygiene? (Oh yes, that’s what it’s called). Well, you can talk to your doctor.
You can also start to redefine your sleep process. Falling asleep is actually an active process for me.
You can also start to redefine your sleep process. Falling asleep is actually an active process for me.
I’m still working on this, but I’ve noticed that waiting til I’m exhausted is bad sleep-times for me. I sleep better if I’m a little more awake and am actively trying to fall asleep.
I’m sure I have a life-long backlog anyway, I know I’ll fall asleep soon when I’m in bed.
I’m sure I have a life-long backlog anyway, I know I’ll fall asleep soon when I’m in bed.
I’ll lie down, get comfy, make sure there are no annoying sounds, close my eyes and then concentrate on falling asleep. I do this visualization where I actively sort thoughts and toss them into a tub of water. If a thought comes up again, just keep tossing.
When I feel like I’ve picked up all the thoughts, I pull the plug on the tub and watch the water drain away. I’m usually asleep before it’s done.
I have to tell myself not to worry, that I’ll remember the important stuff, that it’s okay. That I know it’s scary to let go.
I have to tell myself not to worry, that I’ll remember the important stuff, that it’s okay. That I know it’s scary to let go.
This was really hard when I first started doing it. I’d find thoughts squirreled around corners or clinging to the side of the tub, my brain desperate to hang on out of fear that I would forget important thing forever.
But I have to be awake enough to do the visualization, if I’m too exhausted and just collapse into sleep, it’s never as restful.
Wild huh? I have to be awake enough to fall asleep properly.
Wild huh? I have to be awake enough to fall asleep properly.
PS Getting a lot of “how come my doctor never told me about this?”
Could be anything but it’s good to remember that even ADHD specialists spend a lot of their time trying to prove that stimulant medication is not about some secret government plot to turn children into drones.
Could be anything but it’s good to remember that even ADHD specialists spend a lot of their time trying to prove that stimulant medication is not about some secret government plot to turn children into drones.
PPS: you can always toss a coin to your Witcher if you have a coin to spare. This Witcher has one cat with diabetes and another cat with an autoimmune disorder and thus can always use extra cat-coins for her expensive cats. https://ko-fi.com/erynnbrook
