ADHD and Sleep Disorders: Brain Defrag Details – CorePsych Radio

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ADHD Medication Management Often Overlooks Sleep and The Brain Defrag

The Brain Research is there: Without carefully watching sleep patterns ADHD can devolve into:

  • at worst paranoid psychosis/bipolar,
  • at the least “the meds are simply not working!”

If you don't defrag your brain mainframe, and sleep experts say you need 8.25 hr for a complete defrag process, your prefrontal cortex will not be tuned in to effectively manage changing reality.

Even service workers like doctors and Army Rangers can become paranoid without adequate sleep, – and these dramatic regressions are all treatable and preventable – with just a few basic facts and easy interventions.

Tune in this Thursday to CorePsych Radio for the ADHD Sleep Defrag and Treatment Plan: Essential Lessons for ADHD medication management. Not only will we cover sleep diagnosis, but sleep correction, from ‘sleep hygiene‘ to treatment and why documentation of TAH [Total Average Hours] at each med check.

At CorePsych we make these commonplace issues easy to address with every ADHD intervention. Interestingly, this program ties in with the last on Protein Breakfast!

See ya there Thursday 4PM EDT and 1 PDT

cp

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12 Comments

  1. Hugo Suarez says:
    June 26, 2014 at 4:03 AM

    I have been switched to Pristiq (desvenlafaxine) and Vyvanse – doses have been dialled in carefully and they have turned me around mentally.

    I do however find myself waking at 4am or 5am – before my alarm goes off at 7am. I do not take coffee or alcohol and try to practice the ‘hygiene’ steps most recommend.

    Any medications i.e melatonin or zopiclone useful for sleep maintenance insomnia?

    • Dr Charles Parker says:
      June 26, 2014 at 4:35 AM

      Hugo,
      Yes, one can find that SSRIs do create sleep problems that’s why we strongly rec that they are
      1. Dosed in the AM – too many give them at bed,
      2. Taken with protein, cuts down the agitation in a few.

      One can take either of those sleep aides, not a problem from drug interaction point of view w Pristiq or Vyvanse.
      cp

  2. Josh says:
    May 20, 2009 at 10:37 PM

    Dr. Parker,

    Nope. Just an unusual interest in neuroscience. 🙂 I’ve got the CorePsychBlog on my RSS reader so I try to make contributions where I can in the comments.

    Sincerely,
    Josh

  3. Josh says:
    May 20, 2009 at 12:35 PM

    Dr. Parker,

    Sure! Actually, after reviewing the issue more deeply, it seemed that results on stimulant therapies leading to reduction in nocturnal movement weren’t completely homogeneous. One study, PMID 11780875, was very clear in that it found a reduction in limb movement as a result of methylphenidate treatment but noted that ‘further study is warranted’. Another more recent study, PMID 18363314, did not report a statistically significant reduction in nocturnal movement. This study did refer to the study I mentioned first and said ‘A major difference between the two studies lies in the different doses of methylphenidate, with a mean dosage of 36.7 mg/day in our study and 51 mg/day in the actigraphic study. Further studies are needed to clarify whether methylphenidate exerts a marked effect on periodic limb movements during sleep.’.

    So the evidence seems conflicted but still a possibility. All studies agree on one thing though: stimulant therapy improves sleep. While pushing the onset of sleep back a little later and even making the rising time a little earlier, sleep quality still improves and it, therefore, looks like stimulants consolidate sleep and make it more effective.

    Hope this helps!

    Sincerely,
    Josh

    • Dr Charles Parker says:
      May 20, 2009 at 9:58 PM

      Josh,
      Once again excellent comments – we all appreciate the depth of your thinking and your helping us with the reference details – many thanks!

      Do you have a blog or regular contribution out there?
      cp

  4. Josh says:
    May 17, 2009 at 11:37 AM

    Mike,

    If I recall correctly, there have been studies that show that, in people with ADD, long term therapy with amphetamine actually improves sleep via, among other mechanisms, a reduction in limb movement during sleep. This reduction in limb movement occurs due to an increase in dopamine in the right areas of the brain that are the cause of limb movement during sleep. I think this appears more as a side effect of amphetamine therapy and not something you can necessarily harness or leverage. Something to think about if you are trying to go about ADD without stimulant therapy…

    -Josh

    • Dr Charles Parker says:
      May 17, 2009 at 3:29 PM

      Hey Josh,
      Thanks for your comment. Interesting confirmation of a phenomenon we often see, but was not aware of that literature. If you have easy access to that reference I would love to get it together for my readers, – with full attribution of course. Just to be complete on this discussion: I have seen some have significant negative reactions with sleep, but I always ask myself the first question with sleep disturbance: are they on too much? – Top of the Therapeutic Window may be a sleep problem.
      Thanks,
      cp

  5. Josh says:
    May 14, 2009 at 12:00 PM

    Couldn’t agree with your more, Doc. I find that, as my sleep degrades, ADD symptoms and adverse side effects rise. Lack of sleep, in and of itself, is very capable of inducing attention deficits in healthy subjects. Not to mention, amphetamine can be very effective in masking the effects of lack of sleep… further aggravating the whole thing.

    The part about devolving into bipolar is interesting. Do you think this only occurs in extremely cases of sleep deprivation (perhaps, only 2 or 3 hours of sleep a night for a few nights). Also, do you think this could result in hypomania or full-blown mania?

    I’ve noticed that, at times, I feel, possibly, a little bit hypomanic. This maybe happens, at most, only once a month and isn’t terribly interfering (and, sometimes, has positive results) and I just attribute it being one of the various nuances of taking stimulants. Have you seen this at all in any of your patients?

    While wildly unhealthy, it is a fact, though, that many famous persons in history have attributed some of their successes to hypomania. If you are interested in reading on this, The Hypomanic Edge from John D. Gartner was recommended to me, at one point.

    • Dr Charles Parker says:
      May 17, 2009 at 9:52 AM

      Josh,
      I can’t begin to count how many second opinions, failures of treatment elsewhere, have been based upon the label of bipolar stamped on someone with sleep deprivation who is ‘acting crazy’ and regressed under the force of time, change, variables increased and ADHD. This specific observation led me years ago, when I was firmly awash in over-diagnosis of Bipolar, to reconnect historical details of unmanageable cognitive abundance. See my YouTube Video on this important topic.

      You are so right-
      cp

  6. Mike G says:
    May 14, 2009 at 3:31 AM

    Hey there, Dr Parker. Very happy to see your pre-show PDF on sleep that you Twittered for us to see.

    What do you recommend for the Catch-22 non-sleeper? I’m a depressed worrier with real problems, an ADD dad who values the quiet time after kids are to bed, and have restless legs to boot. In short, I HATE moving toward the bedroom and can’t imagine doing it before 3:30, no matter how much I know I should.

    My 2002 sleep study ruled out apnea, but the neurologist said “you’re not doing anything that remotely looks like sleep” when I’m asleep. Then Mirapex fixed the RLS, but it seems like my depression/ADD is more powerful now that I’ve been unemployed for years.

    How does one break the bed-hating habit? Would love to hear your thoughts during your radio show.

    Thanks much.

    • Dr Charles Parker says:
      May 17, 2009 at 10:07 AM

      Mike,
      Great questions, sorry I am just getting to your comments here on the weekend.

      Your several questions suggest a more subtle sleep issue with multiple possible causes. It would be quite inappropriate for me to take a stab at all of those different symptoms, and attempt to wrap them with a simple arm chair pronouncement.

      I can definitely suggest that you add these following additional workups to your investigations: Neurotransmitter testing, immune dysfunction review, and possibly hormone assessment come to mind. More comprehensive questions with precise history are definitely in order before even making those recommendations. I like NeuroScience Labs, will be blogging more about them in the future, and will be talking very specifically about neurotransmitter challenges in the CorePsych Radio Program on May 28, see the agenda there. They may have access to some providers who understand these issues in your area at their website.

      The easy assumption from your history: neurotransmitter imbalances with significant distribution more on the excitatory side. Do ask your doc for sleep meds, get some exercise, and follow all the sleep hygiene rules we discussed in the program.

      You need some more precise information,
      cp