These 10 tips provide specific treatment considerations for any ADHD symptoms associated with sleep disturbances. If left untreated, each of these problems exacerbates ADHD symptoms.
1. Measure TAH: Evaluate sleep onset and duration in total average hours -TAH. Sleep, according to circadian rhythm research, is best started before midnight and according to research, it should last 8.25 TAH. Less than 7 TAH should always be systematically addressed, at any age. Consistent duration of uninterrupted sleep is important and is better than taking a nap to correct the next day.
2. Assess sleep levels – Level 1: Falling asleep, Level 2: Staying asleep, Level 3: Waking up too early in the morning and not being able to fall asleep again. Each level suggests different clinical and treatment considerations. Some may claim that they have no problem with either of these first two points, but may have trouble with the next measurement.
3. Evaluate the general architecture of sleep: sufficiently deep sleep, with a feeling of adequate rest in the morning. Perpetual sleep levels and sleep physical activity levels often demonstrate significant problems.
4. Evaluate the duration of sleep problems throughout your life: many live for years with sleep problems and only in middle age do they begin to show significant wear and tear. Just because someone did well with 4 hours of sleep and naps does not help the defragmentation process that takes place in an 8 hour sleep at night. Sleep treatment for these challenges generally results in excessive sleep for days or weeks until the body establishes a new calibration.
5. Assess sleep apnea – many snore or have significant airway problems. SPECT brain imaging studies often show specific areas of brain hypofunction secondary to sleep apnea, and sleep apnea, with decreased brain oxygen, will always aggravate ADHD. Sleep apnea problems can be corrected with specific interventions and require a laboratory sleep evaluation.
6. Untreated ADHD or other comorbid psychiatric problems: The most common cause of level 1 sleep problems is untreated ADHD and / or depression associated with worry and prefrontal cortical dysregulation. Comorbid major depression, mood disorders, and other psychiatric problems can also interfere with all three levels of sleep.
7. Over-treated ADHD: Stimulating Yew [or other psychiatric] medications are inappropriately set high and the duration of effectiveness of stimulant medications is not properly adjusted, the medications will interfere with sleep on many levels. Paradoxically, when stimulant medications are well adjusted and comorbid depression is corrected, sleep medications are often not necessary. Always dose psychiatric medications according to the therapeutic window principles outlined in my other articles here.
8. Assess hormonal dysregulation: Estrogen dominance will significantly affect sleep patterns and is always associated with other hormone-related difficulties that need specific correction regardless of ADHD work. Other hormonal dysregulations can also occur, such as an increase in cortisol with stress or adrenal dysfunction, which will also affect sleep. ADHD medications do not correct hormonal imbalances.
9. Assess Medical / Metabolic Dysregulation – Many medical conditions will significantly affect sleep patterns. Restless legs syndrome, for example, is often associated with a simple magnesium deficiency. A variety of nutritional problems can significantly alter sleep patterns and, again, cannot be successfully treated with ADHD medications.
10. Assess sleep hygiene: Watching TV and eating in bed, using the bed for stimulating activities will break the association of bed with sleep. If the bed is to play regularly, where and when can you sleep?
ADHD sleep challenges seem almost inconsequential at first, seemingly with little relevance to any of the recovery processes. However, upon careful review, concurrent ADHD and sleep problems can complete a cycle of toxic and impenetrable impairment that requires simultaneous intervention.