ADHD, Sleep and College

Recently, a new client told me that his greatest concern was poor sleep. “I have so much trouble falling asleep and waking up,” he said.

“Then, I am drowsy during the day and its harder to focus – in fact, everything seems harder!”

Left to his own devices, he thought he might sleep until noon daily, like on weekends, but that wouldn’t work with his school schedule.

“I don’t know anyone with ADHD who does not have an issue with sleep,” says Roberto Olivardia, Ph.D, an ADHD expert and clinical instructor in the department of psychiatry at Harvard Medical School, in an article on Psych Central.

ADHD and Sleep Disorders

According to The National Sleep Foundation, ADHD is linked with a variety of sleep disorders. For example:

• Restless legs syndrome  and periodic leg movement syndrome are common in children with ADHD.
• Some adults with ADHD have symptom overlap with narcolepsy (falling asleep during the day) and idiopathic hypersomnia (frequent episodes of extreme sleepiness).

In fact, ADHD and some sleep disorders may be affected by some of the same neurotransmitters (brain chemicals), most notably one called dopamine.

In some cases, treating an underlying sleep disorder can lead to marked improvement in ADHD symptoms. So, it is very important to take sleep concerns seriously and talk with your doctor. about them. Also, be sure to mention that you have ADHD.

ADHD and Difficulty Falling Asleep & Waking Up

Like my new client, individuals with ADHD often report difficulty falling asleep. Dr. William Dodson calls this “initiation insomnia.” It often occurs because a very active or restless mind kicks into gear when the eyes close. “

At least 75 percent of adults of both genders report that their minds restlessly move from one concern to another for several hours until they finally fall asleep. Even then, they toss and turn, awaken frequently, and sometimes barely sleep at all.”

Difficulty waking up is common too, as the ADHD brain can be difficult to rouse. 

Dr. Dodson says that “More than 80 percent of adults with ADHD in my practice report multiple awakenings until about 4 a.m. Then they fall into “the sleep of the dead,” from which they have extreme difficulty rousing themselves…. Many of them say they are not fully alert until noon.” Some experts suspect that the circadian rhythm or “internal clock” of those with ADHD is not working typically.

Impact of Poor Sleep on ADHD Symptoms

Children with ADHD have higher rates of daytime sleepiness than children without ADHD according to recent research. This may be true for adults as well.

Poor sleep (too little sleep or symptoms of sleep disorders) can not only lead to sleepiness during the day. it can also profoundly impact the symptoms of ADHD, leading to greater  inattention, increased restlessness or hyperactivity, greater impulsiveness, and more frequent irritability or oppositional behaviors.

Inadequate sleep can also contribute to a lower threshold for stress, impaired memory, and lower immune function.

ADHD, Sleep and College

So, what’s a college student to do?

1. First, talk with your doctor.

• It’s important to rule out any serious sleep disorder. 
• If your mind races at night, you can also talk with your doctor to see if a low dose of a stimulant might help you get to sleep – sometimes that can do the trick
• Another option Dr. Thomas E. Brown recommends: consider a medication with sedative properties at bedtime.  
• Some people use melatonin, a natural hormone, at bedtime – discuss this option with your doctor too.

2. Develop consistent bedtime routines – also called “sleep hygiene.”

• Aim for close to the same bedtime and wake time every day to get your body in a consistent pattern. Yes, even during mid-terms and finals!
• Avoid electronic media (yes, this includes yuor laptop) for 1-2 hours before bed – if that’s not possible, use “blue blocking” glasses.
• Avoid exercise 3-4 hours before sleep (but do exercise!).
• Avoid alcohol and caffeine in the evening.
• Try to do “mindless activities” to relax before bed – tidying up, setting things out for the next day.
• Take a warm shower or bath.
• Listen to relaxing music or quiet nature sounds.
• Try meditation, like a body scan, or some gentle yoga, or use progressive relaxation exercises.
• Consider a warm drink – perhaps a tea containing chamomile.
• Consider aromatherapy – lavender is one relaxing scent.

3. Set your room up to promote sleep.

• Reserve your bed for sleep – no studying in bed!
• Work out quiet time with your room-mate so you will both sleep better!
• Assure that your shades/curtains block light.
• Do what you can to make your mattress comfortable –  add a foam pad or thick mattress pad if need be.
• Research suggests that a cool temperature supports optimal sleep. Dorms can get hot – do you need to crack a window?
• A quiet room – no TV or radio – or white noise promotes good sleep.
• Wash your sheets regularly! (According to the National Sleep Foundation, people sleep better with fresh-smelling sheets.)

4. Arrange your daily schedule to support good sleep habits.

• If waking up is tough for you, try to pick classes that start later in the day.
• If you need plenty of down-time to fall asleep, try to avoid scheduling evening classes.
• Make time for regular exercise.
• Spend time outside to get some sun!
• Allow yourself a bit of down-time every day. 
• A regular schedule of meals can also help get your body in a rhythm.
• Plan to get your studying done early in the day so you can avoid late nights.
• Plan ahead to avoid all-nighters!!
• If you get off schedule, do whatever it takes to get back into good patterns of sleep!

5. Tips for waking up in the morning!

• Regular sleep patterns will help, as will getting to bed at a reasonable hour.
• Try not to vary weekend sleep and wake times more than 90 minutes from your weekday schedule, otherwise it will be hard to wake up on Monday! 
• Before going to bed, set out what you’ll need for the morning.
• Use more than one alarm if need be – research ADHD-friendly alarms if you need extra help – and put one across the room!
• If waking up is particularly tough, try setting one alarm half-an-hour before the other, take your morning stimulant, and sleep until the 2nd alarm rings – many find they can then wake up more easily. 
• Having your morning plans in mind will help motivate you to get moving!

This is a lot to think about – what steps might you prioritize to take first?

photo: graur razvan ionut, freedigitalphotos.net