donderdag 26 januari 2012

Sleep and ADHD

the problems
1) Going to bed
• Getting a second wind, i.e. feeling drowsy than waking up again, when everyone else is going to bed
• Feeling you need time to unwind / do own thing after everyone else has gone to bed
• Difficulty stopping doing something in order to go to bed: watching TV, reading book, computer etc
2) Getting to sleep
• Resisting sleep. Some adults with ADHD report resenting sleep / fighting it
• Often can’t shut mind off and relax
3) Sleeping
• Restless sleep- may disturb partner, may not feel refreshed
• Scary/ anxious dreams
• Staying asleep frequently waking up during the night and staying awake.
4) Getting up and daytime
• Often eventually fall deeply asleep (about 4pm) and have difficulty waking
• Feeling sleepy or falling asleep in the daytime
• Generally, lack of structure and regular bedtimes / wake times
5) Finally sleep problems may worsen as you get older both because older people (ADHD or not) generally have more sleep problems than younger people but that does not mean you need put up with insufficient sleep especially as it becomes harder to manage on insufficient sleep
Problem solving hints
People with ADHD often feel that standard solutions don’t address their problem- so I have tried to list as many as possible below- find what speaks to you or use a sleep diary to problem solve,
In general –
• Sleep problems can be caused by common health problems; acid reflux, asthma, B12 deficiency (a lot of people have problems absorbing this, especially as they get older).For severe sleep problems whatever the cause -do consult a doctor.
• Beware of high short term expectation. this is the ADHD Achilles heel in achieving change . Don’t try to change too much immediately. Credit yourself for your progress, do not berate yourself for your difficulties Don’t give up when you backslide.. If you have ADHD you will backslide, but that does not mean you are not progressing. You can achieve anything slowly!
The tips-
• Ambient temperature affects sleep - bedroom should not be too warm.
• Problems with circadian rhythm - Light and dark affect sleep rhythms .Get some sunlight / use light box in daytime
• Dim lights in the later part of evening, Avoid TV, computer screens, reading from a backlit device such as an iPad . Here is a link to a free program that moderates computer screen brightness with the time of day
• Meal times affect sleep rhythms. So establish regular meal times and avoid eating a large meal late in the evening (also because digestion process may disturb sleep in addition to circadian rhythm,). NB There is a theory that protein should be eaten in the morning and lunchtime and carbohydrates at evening meal (which supports serotonin production for sleep but mixed scientific evidence that this improves sleep quality). Protein also positively affects alertness levels, so may be useful if you wish to be alerter in daytime.
• Establish a winding down pre sleep routine- what works for you bath, read a book, meditation.
• All of the following can negatively affect sleep if taken in the evening alcohol (may help you fall asleep, but subsequent sleep is broken), caffeine, chocolate, exercise (good to improve sleep, but not the last few hours before bed), heavy meal. (Also as you get older metabolism slows, so foodstuffs and drugs and eating late may begin to impact sleep even if it did not do so previously). Caffeine may affect sleet in some individuals taken as early as 3 pm.
• If you are sleepy go to bed before you get a second wind.
• If that fails and you get a second wind- some find that reading something light, comforting, dry, or technical helps clear their mind and induce sleep. In my case trying to learn something by heart, vocabulary or a presentation for example exhausts me again quickly, but not doing something that demands deep thought such as writing the presentation.
• Relax, if you can’t sleep, it can be better to make relaxation the aim .Accept that some nights you won’t sleep
• Scary dreams-- some good evidence that rethinking the dream story and reframing it as more pleasant can diminish anxiety caused by nightmares over time. E.g. my ADHD grandson was having nightmares about a second big bang accompanied by a sense of loneliness and devastation, a solution is to think of him in a safe and returnable space witnessing one possible, incredible, fantastic, infinitely distant astrophysical event.
• Anxiety and worrying about sleep- keep a notebook by the bed- if you’re awake worrying about something make a note of it so you can deal with it in the morning. (Also useful for writing any good ideas you have going to sleep.)
• Difficulty getting up at your planned time, especially for those working from home. It really helps if you are getting up for something you want to do- an exercise session in the gym, time to watch a breakfast show, a run with a friend.
• Sometimes sleep problems are triggered by stress or illness and continue after the original trigger. Often this is because you have built negative associations with being in bed i.e. with lying awake, tired and worrying. Break the association using sleep restriction, get up as soon as you wake and can’t sleep- aiming to gradually extend the time you spend asleep.
• Needing a little relaxation time after everyone else has gone to bed more than you need sleep? - try to cut the time down spent relaxing- often you stay up after you have successfully wound down, or stay up on nights when you feel you could go to sleep immediately because this alone time has become a habit. Be aware of the minimum unwind time you need. Alternately or additionally , Try exploring the possibility of unwinding earlier (if you have family, partner you need to negotiate this and offer something attractive in return)
• Finally, don’t know where to start? Keep a sleep diary how much you slept, and anything that may have affected sleep: stress. Wine, caffeine, stimulants, dark chocolate, bed time, getting up time, illness.