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Sleep and ADHD – 10 Biological Tips For Consistent ADHD Recovery
These 10 Tips Provide Specific Treatment Considerations for Any ADHD Symptoms Associated with Sleep Disorders. Treating each of these problems worsens the 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 started before midnight, and should last, according to research, 8.25 TAH. Less than 7 TAH should always be treated systematically, at any age. The consistent duration of uninterrupted sleep is important, and better than the 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 AM and being unable to sleep. Each level suggests different clinical and treatment considerations. Some may claim no problems with any of these first two points, but may have problems with this measurement later.
3. Assess Overall Sleep Architecture: Deep enough sleep, with the feeling of adequate rest in the AM. Perpetual sleep levels, and sleep physical activity levels often show significant problems.
4. Assess Lifetime Duration of Sleep Problems: Many live for years with sleep problems and only in middle age do they begin to see significant wear and tear. Just because someone did well before with 4 hours of sleep and nap does not help the defragmentation process that takes place in a sleep of 8 hours at night. Sleep treatment for these challenges usually results in excessive sleep for days to weeks until the body establishes a new calibration.
5. Assess for sleep apnea: snore a lot or have significant airway problems. SPECT brain imaging studies often show specific areas of brain hypofunction secondary to sleep apnea, and sleep apnea, along with decreased brain oxygen, always worsens ADHD. Sleep apnea problems are correctable with specific interventions, and require a sleep laboratory evaluation.
6. Untreated ADHD or other Comorbid Psychiatric Problems: The most frequent cause of Level 1 sleep problems is untreated ADHD and/or depression associated with worry and prefrontal cortical dysregulation. Comorbid major depression, mood disorder and other psychiatric problems can also interfere with the three levels of sleep.
7. Excessive ADHD treatment: If stimulant [or other psychiatric] medications are adjusted inappropriately high, and the duration of the effectiveness of stimulant medications is not adjusted properly, medications interfere with sleep on several levels. Paradoxically, when the stimulant medications are well adapted, and the comorbid depression is corrected, sleep medications are often not necessary. I always dose psychiatric medication according to the principles of the Therapeutic Window noted in my other articles here.
8. Assess for Hormone Disregulation: Estrogen Dominance will significantly affect sleep patterns, and is always associated with other hormone-related difficulties that require specific correction independent of ADHD work. Other hormone dysregulations can also occur, such as increased cortisol with stress or adrenal dysfunction, which also affect sleep. ADHD medications do not correct hormonal imbalances.
9. Assess for Medical/Metabolic Dysregulation: Many medical conditions significantly affect sleep patterns. Restless Leg 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 by ADHD medications.
10. Assess Sleep Hygiene: Watching television and eating in bed, using the bed for stimulating activities will break the association of the bed with sleep. If the bed is to play regularly, then where and when can you sleep?
The challenges of sleep with ADHD appear at first as almost inconsequential, with apparently little relevance for any recovery process. However, after a careful review, sleep problems and concurrent ADHD can complete a toxic, impenetrable cycle of deterioration that requires simultaneous intervention.
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