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A Sound Slumber In my practice working with adults with ADHD, most report some difficulty related to sleep. The majority struggle with two significant issues – going to bed at a reasonable hour, and waking up in the morning. While little research exists to directly explain the relationship between ADHD and sleep disturbance, and the DSM-IV TR does not include sleep disturbance as a criteria of the disorder, experience tells us that there certainly is a connection. Without adequate sleep, we lose the ability to regulate emotion, focus, sustain attention, and retain information. We react more slowly, can’t remember simple information quite as well, and our judgment becomes impaired. Additionally, a number of physical problems have been linked to inadequate sleep including heart disease, stroke, and obesity.
When working with clients who come in for treatment of ADHD and executive dysfunction, I am careful to assess sleep habits as part of my initial evaluation. Often I learn that clients suffer from “night owl” syndrome and are often awake easily until 2 or 3 in the morning. This in turn makes getting up for the next work or school day very difficult. I frequently hear of clients sleeping through multiple alarms. Clients will tell me that they begin to feel tired around 8 or 9 at night but don’t go to sleep at that time, and then get a burst of energy around 11 or midnight. Sometimes I learn of this problem through circumstantial conversations about difficulty getting up and out in the morning and the stresses of a pressured and harried morning routine (or lack thereof). Further questioning unveils that there is no nighttime routine to help the brain and body wind down and prepare for sleep.
As part of the treatment for ADHD, I am constantly working with clients on developing good sleep hygiene. This is not an easy task and like any habit, takes time to develop. Additionally, old habits die hard, and getting clients to “log off” can be challenging. The following are “do’s” and “don’t” strategies that I begin with as a foundation for learning to develop healthy sleep habits: Do:
Don’t
If you are taking stimulant medication, it is important to examine your body’s sensitivity to these drugs. Some people actually experience a “rebound” effect to coming off of medications which can actually feel like a burst of energy. Taking medication too late in the day can also interfere with going to sleep at night. It is important to examine this and discuss an appropriate medication regimen with your prescribing physician.
Additionally, if you are described by a roommate, spouse or partner as a loud snorer, there may be an underlying sleep disorder called Obstructive Sleep Apnea. This sleep disorder involves the body waking itself up when the individual actually stops breathing and the body is becoming deprived of oxygen. Individuals with OSA can experience hundreds of awakenings per night without knowing. So while you may have thought you slept a solid 8 hours, this was not solid sleep at all. Diagnosis of OSA requires a referral to a sleep specialist and participation in a night time sleep study.
For more information about Dr. Wells, please visit her page by clicking this link.
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