These 10 Tips Provide Specific Treatment Considerations for Any ADHD Symptoms Associated with Sleep Disturbance. Untreated each of these issues aggravates symptoms of ADHD.
1. Measure TAH: Evaluate the Onset of Sleep, and the Duration in Total Average Hours -TAH. Sleep, according to circadian rhythm research, is best begun before midnight, and should last, according to research, 8.25 TAH. Less than 7 TAH should always be systematically addressed, at any age. Consistent length of unbroken sleep is important, and better than napping to correct the next day.
2. Assess Sleep Levels – Level 1: Falling asleep, Level 2: Staying asleep, Level 3: Waking too early in the AM and being unable to fall back asleep. Each level suggests different clinical and treatment considerations. Some may claim no problems with either of these first two points, but may have problems with this next measurement.
3. Assess Overall Sleep Architecture: Sufficiently deep sleep, with feeling of adequate rest in the AM. Levels of perpetual dreaming, and levels of physical sleep activity often demonstrate significant problems.
4. Assess Lifetime Duration of Sleep Problems: Many live for years with sleep issues and only in middle age begin to show the significant wear. Just because someone has previously done well with 4 hr of sleep and naps doesn’t help the defragmentation process that takes place in a 8 hr sleep at night. Sleep treatment for these challenges usually results in excessive sleep for days to weeks until the body sets a new calibration.
5. Assess for Sleep Apnea: So 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 decrease of brain oxygen, will always aggravated ADHD. Sleep apnea issues are correctable with specific interventions, and require sleep lab assessment.
6. Untreated ADHD or other Comorbid Psychiatric Problems: The most frequent cause of Level 1 sleep issues is untreated ADHD and/or depression associated with worry and prefrontal cortical dysregulation. Comorbid major depression, mood disorder, and other psychiatric problems may also interfere with all three levels of sleep.
7. Excessively Treated ADHD: If stimulant [or other psychiatric] medications are adjusted inappropriately high, and duration of effectiveness of the stimulant medications is not properly adjusted, medications will interfere with sleep on many levels. Paradoxically, when stimulant medications are well adjusted, and comorbid depression is corrected, often sleep medications are not necessary. Always dose psychiatric medications according to the principles of the Therapeutic Window noted in my other articles here.
8. Assess for Hormone Dysregulation: Estrogen Dominance will significantly effect sleep patterns, and is always associated with other hormone related difficulties that need specific correction independently of the ADHD work. Other hormone dysregulations can also occur, such as increased cortisol with stress or adrenal dysfunction, which will also affect sleep. ADHD medications do not correct hormone imbalances.
9. Assess for Medical/Metabolic Dysregulation: Many medical conditions will significantly affect sleep patterns. Restless Legs Syndrome, for example, is often associated with simple magnesium deficiency. A variety of nutritional issues can significantly alter sleep patterns and, again, cannot be treated by ADHD medications successfully.
10. Assess Sleep Hygiene: Watching television and eating in the bed, using the bed for stimulating activities will break the association of bed with sleep. If bed is for regular play, then where and when can sleep take place?
Sleep challenges with ADHD appear at first as almost inconsequential, with apparently little relevance for either recovery process. However, upon careful review, co-occurring sleep and ADHD issues can complete a toxic, impenetrable cycle of deterioration that requires simultaneous intervention.