| These 10 Tips Provide Specific Treatment | | | | issues is untreated ADHD and/or depression |
| Considerations for Any ADHD Symptoms Associated | | | | associated with worry and prefrontal cortical |
| with Sleep Disturbance. Untreated each of these | | | | dysregulation. Comorbid major depression, mood |
| issues aggravates symptoms of ADHD. | | | | disorder, and other psychiatric problems may also |
| 1. Measure TAH: Evaluate the Onset of Sleep, and the | | | | interfere with all three levels of sleep. |
| Duration in Total Average Hours -TAH. Sleep, | | | | 7. Excessively Treated ADHD: If stimulant [or other |
| according to circadian rhythm research, is best begun | | | | psychiatric] medications are adjusted inappropriately |
| before midnight, and should last, according to research, | | | | high, and duration of effectiveness of the stimulant |
| 8.25 TAH. Less than 7 TAH should always be | | | | medications is not properly adjusted, medications will |
| systematically addressed, at any age. Consistent | | | | interfere with sleep on many levels. Paradoxically, |
| length of unbroken sleep is important, and better than | | | | when stimulant medications are well adjusted, and |
| napping to correct the next day. | | | | comorbid depression is corrected, often sleep |
| 2. Assess Sleep Levels - Level 1: Falling asleep, Level | | | | medications are not necessary. Always dose |
| 2: Staying asleep, Level 3: Waking too early in the AM | | | | psychiatric medications according to the principles of |
| and being unable to fall back asleep. Each level | | | | the Therapeutic Window noted in my other articles |
| suggests different clinical and treatment considerations. | | | | here. |
| Some may claim no problems with either of these first | | | | 8. Assess for Hormone Dysregulation: Estrogen |
| two points, but may have problems with this next | | | | Dominance will significantly effect sleep patterns, and is |
| measurement. | | | | always associated with other hormone related |
| 3. Assess Overall Sleep Architecture: Sufficiently deep | | | | difficulties that need specific correction independently |
| sleep, with feeling of adequate rest in the AM. Levels | | | | of the ADHD work. Other hormone dysregulations can |
| of perpetual dreaming, and levels of physical sleep | | | | also occur, such as increased cortisol with stress or |
| activity often demonstrate significant problems. | | | | adrenal dysfunction, which will also affect sleep. ADHD |
| 4. Assess Lifetime Duration of Sleep Problems: Many | | | | medications do not correct hormone imbalances. |
| live for years with sleep issues and only in middle age | | | | 9. Assess for Medical/Metabolic Dysregulation: Many |
| begin to show the significant wear. Just because | | | | medical conditions will significantly affect sleep patterns. |
| someone has previously done well with 4 hr of sleep | | | | Restless Legs Syndrome, for example, is often |
| and naps doesn't help the defragmentation process | | | | associated with simple magnesium deficiency. A |
| that takes place in a 8 hr sleep at night. Sleep | | | | variety of nutritional issues can significantly alter sleep |
| treatment for these challenges usually results in | | | | patterns and, again, cannot be treated by ADHD |
| excessive sleep for days to weeks until the body sets | | | | medications successfully. |
| a new calibration. | | | | 10. Assess Sleep Hygiene: Watching television and |
| 5. Assess for Sleep Apnea: So many snore or have | | | | eating in the bed, using the bed for stimulating activities |
| significant airway problems. SPECT brain imaging | | | | will break the association of bed with sleep. If bed is |
| studies often show specific areas of brain | | | | for regular play, then where and when can sleep take |
| hypofunction secondary to sleep apnea, and sleep | | | | place? |
| apnea, with decrease of brain oxygen, will always | | | | Sleep challenges with ADHD appear at first as almost |
| aggravated ADHD. Sleep apnea issues are | | | | inconsequential, with apparently little relevance for |
| correctable with specific interventions, and require | | | | either recovery process. However, upon careful |
| sleep lab assessment. | | | | review, co-occurring sleep and ADHD issues can |
| 6. Untreated ADHD or other Comorbid Psychiatric | | | | complete a toxic, impenetrable cycle of deterioration |
| Problems: The most frequent cause of Level 1 sleep | | | | that requires simultaneous intervention. |