Sleep is a non-negotiable biological necessity. It is a free, natural physical and mental reset system. However its many benefits may well be passing you by.
Here are some quick links:
Your perfect 6-step wind-down
Firstly, a few facts:
Sleep has two distinct phases. REM, Rapid eye movement, is associated with muscle relaxation, faster breathing, and dreaming. The duration of bouts of REM sleep increases as the night progresses and ideally we should experience 6 – 7 cycles. We need REM sleep to prepare our brains for learning, and also to consolidate our memories, like transferring files from a usb stick to the safety of a hard drive. Deeper sleep is associated with physical restoration and cell renewal. We should have as much sleep as it takes for us to wake up on time, without an alarm clock.
What happens when we don’t get enough?…
Lack of sleep is linked to various cancers, diabetes and infertility in both men and women. It is also associated with obesity. With less than four hours’ sleep, the ‘eat more’ hormone dominates the ‘I’m full’ hormone. A recent study in Finland has shown that men who regularly have less than 7 hours sleep are 3.12 times more likely to draw disability pension than those who have 8. In countries where the clocks go forward and everyone loses an hour’s sleep, heart attack rates are reported as increasing by 24% the following day.
Our mental health suffers. We feel sluggish, moods vary, we lose focus and executive functions dip drastically. As a stark illustration, car accidents increase by about a fifth on the days after we all adjust the clocks. Even judges’ decisions are recorded as being harsher on those days.
Why is this particularly relevant for those with ADHD?
For those with ADHD, difficulties with sleep can be considerable. In fact, until 1980 problems with sleep were listed among the diagnostic criteria for ADHD. It was dropped, however as it couldn’t be usefully measured.
We, more than most, need our sleep to optimise our executive functions. However, well over half of all adults with ADHD report have difficulty going to bed on time, getting to sleep, staying asleep and getting up in the morning. There can be specific causes, like sleep apnoea, ‘sleep-disordered breathing’ which affects 25% of people with ADHD, as opposed to 3% in the population in general. Restless Leg Syndrome, present in 44% of ADHDers, compared with 2%, causes a feeling of agitation in the legs, interfering with peaceful sleep.
ADHD sleep problems may be a side effect of impaired arousal, alertness, and regulation circuits in the brain. Crucially, however, we are prone to having trouble with our internal clock or circadian rhythm which triggers the production of melatonin, the chemical which makes us feel sleepy. Our circadian rhythm might be off naturally; everyone is hardwired to be a certain chronotype, with two extremes being evening, and morning types.
HOWEVER, IT COULD JUST AS EASILY be our own behaviour which encourages this rhythm to be off kilter. This is where we can make a difference by realising just how important sleep is, treating it with the respect it deserve and taking steps to get enough.
How can we access the right amount of sleep? With three important elements:
During the day:
1. People with ADHD need sufficient sleep. This is non-negotiable. However, stigma says it’s just not cool to go to bed ‘early’. It’s associated with laziness rather than wisdom. Be a pioneer and set a new, better-informed trend!
2. Think passive, not active. It’s called ‘falling asleep’ because it’s passive. It’s a shutting down of thoughts and a handing over to the natural signals of sleep hormones.
3. Take time to practice breathing techniques so you become accustomed to not having to act on your thoughts (also known as mindfulness, this is quite a skill, and well worth pursuing!)
4. Take time to exercise daily, outdoors if possible, but no later than two hours before bedtime.
5. Care for your body with the right foods for good sleep. Tryptophan, an amino acid associated with melatonin, is present in many proteins,
especially in yogurt, milk, oats, bananas, dates, poultry, eggs and peanuts. Avoid spicy foods in the evening, which interfere with body temperature during sleep.
6. Care for your body with adequate hydration. Ensure you have drunk the recommended 1.6l (for women) and 2.1L (for men) of water, in good time for your sleep not to be disturbed for bathroom breaks! Your last hot drink could be one which promotes anxiety-reducing GABA, like valerian or passionflower or a nerve-relaxant like chamomile. A malt-based drink or warm milk contains tryptophan, and poured over cereal, crosses the blood-brain barrier faster.
7. Be kind to yourself - no coffee after lunchtime and cut down on alcohol. Think about the effect of other stimulants you take; are your meds correctly timed to phase out by bedtime? Nicotine is a stimulant, so try not smoking during the evening. If you enjoy sugar,
avoid an energy boost at sleep time.
8. Care for yourself – are there obvious points you could discuss with your doctor, for example sleep apnoea or RLS? Take control and make an appointment.
9. Avoid daytime naps.
10. Go to bed and wake up same time, including at the weekend.
On waking, open the curtains. This exposure to sunlight will reinforce your circadian rhythm.
11. Many people find the timing of their medication can really help. Think of having it ready by the bed to be taken before even stepping out of bed.
Your sleep-friendly bedroom should ideally:
1. Have no electronic devices.
2. Not contain anything work-related.
3. Have a jotter and pencil by the bed
4. Be as dark as you can make it and cool, with a maximum of 20 degrees. A slightly open window may help.
In the evening have a ritual:
1. Two hours before bedtime, finish your last meal of the day. This allows it to be fully digested.
2. At the same time, two hours before bed, stop using screens. The blue light they emit confuses the brain and melatonin is not released. This is the time for calming the mind off-grid with books, magazines, music, yoga, meditation, podcasts or the radio. Set a recurring timer for your food and screen cut-off, it’s so easy to do!
3. Cool down. Step outside or open the window for a few breaths of fresh air,
or run a warm bath and enjoy the cooling effect after stepping out.
4. During this wind-down, if you find yourself ruminating,
do a brain-dump. Simply make a note on your bedside jotter and free up your short-term memory.
The jotter is useful for any mid-sleep brainwaves too. Capture them immediately and you won’t wake your whole brain up worrying you’ll forget them!
5. You'll be transferring your thoughts and memories to your mental 'hard drive' when you're asleep. Make sure these aren't self-reproaching mental patterns as sleep will only reinforce them. Think of three lovely things that happened today and turn them into firm memories instead!
6. The darkness will, over time become your signal to stop thinking. Now is the time for breathing, being comfortable, and falling…..
7. This isn’t a time for disappointment or self-judgement. Allowing yourself to be engulfed in sleep normally takes 10 – 20 minutes, and can take longer for those with ADHD. Simply repeat step 5 and 6…
What can you do now to help you get the best from your sleep? What tips have you learned or re-remembered from my blog? Make a note now. Set your recurring timer! Buy yourself an alarm clock so the phone has a bedroom-ban! Make an appointment with your doctor, think where else you might charge your phone, start collecting lovely things to think about tonight….
Most important of all,
sleep well!
Just a few add-ons.....
To app or not to app? I would generally recommend keeping the phone out of the bedroom, but for those who struggle here, ADHD friends enjoy:
Nothing much happens – bedtime stories where – yes, you guessed it!
White noise to aid the ‘letting go’ of the mind
Relaxing music
Sleep cycle analyses your sleep depth and allows you to track your pre-sleep activities to identify their impact
Many of my ADHD friends find their weighted blankets comforting and reassuring and wouldn’t be without them. The blankets restrict movement and act a bit like a big hug, as well as replicating the weighty feeling of falling asleep. Not recommended for snorers though, and some say they find them too hot.
Silent alarm clocks. Ensure the light they omit doesn’t disturb your sleep!
References and enormous thanks for inspiration to:
Laurie Dupar https://www.iactcenter.com/
Emma Slade https://en.wikipedia.org/wiki/Emma_Slade
Jessica McCabe, speaking on How to Get to Sleep When You Have ADHD - YouTube
Matthew Walker, Professor of Neuroscience and Psychology at University of California, Berkelely writing in BMJ Journal Occupation and environmental medicine speaking on BBC World Service - The Big Idea, The science of sleep
BBC – healthy advice What should I eat for a good night's sleep? - BBC Food
Sleep Foundation www.sleepfoundation.org/mental-health/adhd-and-sleep