Adult ADHD And Sleep Problems
A study by Harvard’s Joseph Biederman and others at Harvard/MGH in the November Journal of Clinical Psychiatry, which just went online, and reached one of the least controversial findings of the controversial psychiatrist’s career: adults with ADHD (and that’s the term researchers used instead of ADD) have more difficulty with sleep than do people without ADHD.
“Results: Adults with ADHD went to bed later than control subjects and had a wider range of bedtimes (mean ± SD = 18 ± 92 min vs 54 ± 69 min before midnight; P < .001), were more likely to take over an hour to fall asleep (OR = 5.22, P = .001), and were more likely (P < .003) to experience difficulty going to bed, going to sleep, sleeping restfully, or waking in the morning. Adults with ADHD experienced daytime sleepiness more often (OR = 2.23, P = .003) and reported more sleep problems (mean ± SD = 6.7 ± 2.5 vs 4.3 ± 2.2; P < .001) than controls. All sleep impairments were significantly associated with ADHD independent of contributions to sleep disruption from ADHD pharmacotherapy, comorbidities likely to contribute to sleep disturbance, and age at ADHD onset.
“Conclusion: Sleep disturbances that are not attributable to comorbid mental health conditions or ADHD pharmacotherapy are associated with ADHD in adulthood. Clinicians and researchers should consider the potential contribution of sleep disruption to the clinical presentation of adults with ADHD.”
While I don’t necessarily buy researchers’ implied argument that going to sleep before midnight is the gold standard of sleep (especially if someone works swing or graveyard shifts. Do Biederman et al. really believe that everyone works 8 to 5 and that that’s the appropriate standard for poking into sleep and ADHD? Ah, ivory towers and pharma dough!), I have no problem with the idea that sleep difficulties could be tangled up with adult ADHD (A dx I’m somewhat dubious of, but I’ll leave that be for now). The fact is sleep problems are entwined with several mental disorders, depression and bipolar disorder most prominently.
I’m not quite comfortable with the researchers’ assertion that the sleep problems can be determined to be independent of ADHD meds or a history of taking ADHD meds and other psychotropics. I mean, maybe they can get there statistically. But over the years of doing this site and hearing from readers and from just your basic workaday observations of people with depression, bipolar disorder and ADHD, I’ve come to the conclusion that psych meds are almost always at least partially implicated in sleep problems (both in sleeping too little and in sleeping too much and in general difficulties falling asleep). In the years since I became meds-free (and it’s nice to be able to say “years” in that regard), sleep has come more easily and been of better quality. Of course, if the Biederman crew took a look at what time I go to sleep most nights (2 a.m.), they’d be screaming “ADHD” at me. But I’ve been a late-night type since my college days. I had little choice since I was taking a full load, working five hours a day and studying six hours a night along with getting up at 6 a.m. to run three miles and go lift weights before breakfast. ADHD had nothing to do with that pattern establishing itself.
The other thing I’ve picked up on over the years from reader emails and the real world is that far too often people with depression, bipolar disorder and whatnot spend way, way too much time on their computers late into the evening. Computers and the ‘Net have become such deeply distracting, “You must multi-task on me or leave society” devices that I wouldn’t be shocked at all if they are as much at the heart of adult ADHD problems as are sleep problems and ADHD itself.
I know a psychologist in Seattle who’s been working with kids and teens and ADHD and conduct disorders and such for 30 years. I ran into her at a party perhaps a year ago and amidst telling me that she thought the entire bipolar child paradigm was BS, she said that when a new teen client came in with his or her parents she told them that if they didn’t agree to limit computer/call phone use at home to one hour a day, then she wouldn’t work with them. She couldn’t control how much a kid was forced to use a computer at school, but getting them to back off the many hours a day kids spent using computers (and MySpace and IMs and text messages) each day in almost every case went a long way to resolving the kids’ problems. They were less distracted and slept better. Or so she told me.
I wonder if the Biederman crew made any attempt to account for computer/Internet use confounds in its study. As far as I can tell, they didn’t.
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