Did you know that many people with ADHD have sleep problems? Research is showing that the disorder itself
changes your circadian rhythm. That's what I'm talking about today. I'm Dr. Tracey Marks, a psychiatrist, and I make mental health education videos. Your circadian rhythm
is your biological clock that controls many of
your body's functions. The most common function is sleep, but it also controls when you're hungry, your body temperature, your emotional regulation, your thinking abilities and even certain executive functions like working memory, time
management, and organization. So when your body clock is out of sync, any of these functions can
be negatively affected. Some people refer to this misalignment to your environment as social jetlag. Your body clock is controlled by a pacemaker located in your brain. Not everyone is impacted
to the same degree, but those who are misaligned tend to have any or all of the
following sleep problems. Probably the most common is
trouble settling down for sleep, and then there's restless
sleep where you wake up several times during the night, and then there's having
significant trouble waking up in the mornings. Even if you had adequate
sleep the night before, you can fall into a really deep sleep in the wee hours of the morning and then when the alarm goes off, you sleep through it. You may need a couple of
alarms that are really loud to go off before you finally wake up and then even when you do get up, you may not feel fully awake
until later in the morning. Let's go back to the
problem of falling asleep. People with ADHD have a proneness to what's called eveningness or a delayed phase sleep problem. You experience more energy and desire to do things
later in the evening, so you put off going to sleep and it feels natural to stay up late, and it's easy for you to get engrossed in something like social media or a movie. And while you're focused on the mentally stimulating activity, you can miss your body's signals that it's time for bed and the signals may not be that strong. The person without ADHD
may start to feel drowsy at their usual bedtime or mentally slowed and subjectively, you feel tired and you start heading for bed. It's like your body says, "I'm getting ready to sign off. "You can put me in bed, "or we can make this
happen here in the chair, "you decide." On the other hand, with ADHD, your body signaling is a lot more subtle. It's like your body says, "I can go to bed if you let me. "I'm ready when you are, "but if you're not, I'll
just sit here and wait." If you're focused on something, you can miss these subtle tired signs and just keep going. To remedy this, you have to put yourself on a bedtime schedule and set an alarm or a reminder to start
your bedtime wind down. So let's say, you need to
be asleep by 11:00 p.m. You need to start your
wind down by 10:00 p.m. You'll need to set an alarm on your phone or have some other kind of
reminder that it's 10:00 p.m. and time to stop what you're
doing to prepare for bed. If you're the kind of
person who needs a warning before you have to stop, give yourself two alarms. The first is the reminder that you'll have to stop in 15 minutes and then the second one is
where you actually stop. If you do this and find that you're still
struggling to fall asleep, it could be because of the
medication that you take for ADHD if you're on one. There's a bidirectional relationship between the ADHD medications and sleep, and this includes both the stimulants like amphetamines and methylphenidate and the non stimulants like atomoxetine and the new one viloxazine,
brand name Qelbree. These medications decrease your sleep by pushing back the time
that you feel sleepy and they also make it easier for you to wake up during the night. Likewise, not getting
enough sleep decreases the effectiveness of the medication and this can make you feel
like you need to take more of it to get it to work
like you need it to. Under these circumstances, even if you set a good bedtime routine and have good sleep hygiene, you still may have trouble falling asleep. What's the answer to this problem? It's a combination of
sleep enhancing medications and sleep enhancing behaviors. Sleep medications are a temporary solution that can help entrain
your body to fall asleep at a certain time when
you don't have a routine. They can also serve the temporary purpose of helping you recover
from a sleep deficit that you may have accrued from several nights of
not getting enough sleep. The reason they should
be temporary is because most sleeping pills cause
you to develop a tolerance to their effect. They work successfully for a little while, and then the effect wears off and you have to take a break or switch to something else. Sleeping medications, both prescription and over the counter, can last longer if you only use them intermittently like a
couple of nights a week or several nights in a row, and then for a week and then taking a break from
them for a period of time. The behavioral interventions would be things that you
do to relax your mind and body naturally to help you fall asleep when you aren't
taking the sleeping pills. What would these look like? Regularly wearing blue
light blocking glasses two hours before bedtime, then the hour before bed you do something relaxing like listening to music, listening to a meditation like a progressive muscle
relaxation or a body scan. Tapping is a great intervention
that helps with anxiety and racing thoughts. You could do a meditative
coloring activity. You could give yourself a warm foot bath. Why? Because warming your body and then letting it cool
down is a sleep trigger. It's best though if you do this two hours before bedtime when you put on the glasses because you don't want to
warm your body too close to the time you're trying to go to bed. You need that time for your body to do the cool down thing. There are lots of things that
you can do to relax your mind and you have to decide or find one that works well for you, and that's easy for you to do so that it becomes routine like brushing your teeth. And then there still
may be nights when none of those things are good
enough to help you fall asleep. And you have to take a sleep aid. One more thing. Exercise during the day helps your body feel more tired at night, and it helps create new nerve connections in the brain through
brain-derived neurotropic factor. Watch this video where I talk more about the connection between
exercise and mental health. It's an important
intervention that plays big dividends later with your
thinking and your sleep. Check it out. Thanks for watching. See you next time.
