AD/HD & SLEEP: 8 tips for getting Those zzzzzzzzzzs!

Have trouble going to sleep? Sleep either too lightly or too solidly? Have trouble waking up?

You are not alone! The culprit may be AD/HD.

According to the National Resource Center on AD/HD, before 1980, the  Diagnostic and Statistical Manual of Mental Disorders actually included sleep disturbances in its diagnostic criteria for AD/HD. Recent data suggests that some 25 percent to 50 percent of children and adolescents diagnosed with AD/HD have reported sleep problems clinically. One AD/HD practitioner reported that up to 80% of adults in his practice reported some sleep disturbance.

The National Sleep Foundation cites research regarding the link between AD/HD and sleep problems in both children and adults. Yet, definitive research is lacking regarding which of the two is the chicken and which is the egg. Among children, some research suggests that excessive sleepiness of any causation can both mimic and/or heighten AD/HD symptoms:

• A large study demonstrated that inadequate sleep in children can heighten inattention, hyperactivity, impulsiveness, and oppositional behavior.
• [O]ne study found that treating sleep problems may be enough to eliminate attention and hyperactivity issues for some children.  

At the same time, research also links AD/HD directly with a number of sleep-related problems:

• [O]ne study found that children with AD/HD had higher rates of daytime sleepiness than children without AD/HD.  
• Another study found that 50% of children with AD/HD had signs of sleep disordered breathing, compared to only 22% of children without AD/HD.  
• Research indicates that restless legs syndrome and periodic leg movement syndrome are also common in children with ADHD.
• Other recent research suggests that the neurobiology of ADHD itself contributes to both duration of sleep and time in REM.

A relationship between sleep problems and AD/HD has also been reported among adults. Some research raises the question of possible diagnostic confusion between AD/HD and conditions such as narcolepsy and excessive daytime sleepiness, warning of possible misdiagnoses of AD/HD and sleep disorders in adults. Certainly, common co-existing conditions, such as anxiety or depression, can interfere with sleep as well.

So, what to do? The following eight approaches may be helpful.

1. Rule-out medical problems and/or specific sleep disorders. Conditions including allergies, asthma, and pain can disrupt sleep. Snoring should be noted as a possible factor affecting slee as well. Ask your doctor to help you rule-out any other sleep disorders too. 
2. Discuss medications with your doctor. For some individuals, a stimulant dose, if used, should be moved earlier in the day so that it does not interfere with sleep. On the other hand, certain individuals fall asleep more easily with a small dose on board to focus a restless mind. Discuss any other medications you take to assure that side effects are not contributing to trouble sleeping. Symptoms of, and possible treatment for, any co-occurring anxiety or depression can also be discussed. Some individuals talk with their doctors about melatonin as a natural sleep aid.
3. Develop consistent routines. A daily routine with a consistent bedtime, waking time, meal times and built in relaxing time can help develop internal rhythms promoting sleep. Keep as close to the same bedtime as possible on weekends as weekdays and develop a relaxing transition ritual to ease into sleep at night.  (Consider meditation as part of the ritual)
   
4. Get plenty of exercise.  Regular exercise promotes sound sleep. Can you take a daily walk? Are you a more vigorous athlete? Whatever your preference, avoid exercise in the three hours before bedtime or it may be difficult to settle down. 
5. Evaluate your food and drink. Caffeine is a no-no in the afternoon and evening for anyone with a sleep difficulty. Alcohol before bed can also disrupt sleep cycles. Although a small snack before bed is o.k., a large meal too close to bedtime can contribute to difficult sleep as well.
6. Try a hot bath before bedtime. Because sleep typically follows the cooling phase of the body’s temperature cycle, a hot bath followed by bedtime in a cooler room might encourage sleep.
7.  Create a supportive sleep environment. A quiet, dark, and cool bedroom promotes sleep. If quiet is a problem, ear plugs or a white noise machine (fan/humidifier) can be helpful. Since television and other media/electronics can be stimulating, avoid them for several hours before bed. If the computer must be used before bed, consider blue-blocking glasses. Finally, using one’s bed only for sleep (or sex) helps cue the body that it’s really bedtime
8. Stay calm.  If you have trouble sleeping, try to stay calm and avoid anxious thoughts about being awake. Stress and anxiety will only make it harder to sleep. Try reading, meditating, making a list of the thoughts running through your head, getting up for a glass of warm milk, visualizing a favorite place, or listening to relaxing music for a while before giving sleep another chance.

If you want some help working on your own sleep issues, talk with your psychiatrist and primary care provider, and consider working with an AD/HD coach. 

Wishing you a “good-night”!