While sleep may seem like a common topic of discussion, its significance cannot be overstated. Understanding the role of sleep in our lives is crucial for our overall well-being. We have always known sleep was important, but research shows how critical it is. Sleep is vital.
Evidence is proving that sleep allows our bodies to:
- Conserve and store energy.
- Repair and recover from daily activities and injuries.
- Rest, reorganize, and re-catalog your brain.
Here is a brief overview of how it does this:
- Stage 1: Non-rapid eye movement. We are transitioning from wakefulness to sleep, usually taking only a few minutes. We are still aware of what is happening, but our heart rate and breathing slow. Our muscles also start to relax.
- Stage 2: We are still in non-rapid eye movement, and eye movements stop. This stage is when we consider ourselves asleep because we are no longer aware of what is happening. The heart rate and breathing continue to slow, and muscles continue to relax. Our body temperature decreases. The brain has theta waves or slow-wave activity. This stage takes about 30-60 minutes.
- Stage 3: Also known as non-rapid eye movement, this stage is often called deep sleep. We are still slowing down and relaxing, and our blood pressure decreases. Our brain moves from theta waves to delta waves. During this stage, repairs to every cell in our body occur, tissue regeneration occurs, hormones are released, and digestion occurs. It is this stage that helps us wake up feeling refreshed. This stage lasts 20-40 minutes.
- Stage 4: Rapid eye movement because our eyes dart in all directions. Brain activity increases, but our voluntary muscles are temporarily paralyzed, so we don’t make the movements in our dreams. Our heart rate and blood pressure increase to awake levels, and our breathing is faster and irregular. In this stage, the brain categorizes and stores memories into long-term memory. However, not all short-term memories are converted to long-term memory; some, like our daily grocery list, may not need storage. The same happens with information, emotional regulations, and skills.
- And this cycle of sleep stages repeats throughout the night, with each stage occurring multiple times. The number of repetitions depends on various factors such as age, health, and individual sleep patterns.
Most of my clients have ADHD or Autism, so I am keeping my focus on sleep issues related to these neurodiversities.
ADHD: Starting about puberty, sleep problems start to show up for people with ADHD. 30-56% of adults and 40% of children report having sleep issues. Many report having shorter sleep times, trouble falling asleep or staying asleep, and a high risk of developing a sleep disorder. Children with ADHD commonly report having nightmares. Unfortunately, sleep problems tend to increase with age. Many children (and adults) procrastinate going to bed because they are going from a stimulating environment that their brain enjoys to an under-stimulating environment that their brain doesn’t enjoy.
People with predominantly hyperactive-impulsive symptoms are likely to have insomnia, and those with predominantly inattentive symptoms are more likely to delay bedtime; people with combined types often experience both.
- Racing thoughts mark insomnia because quiet time with few to no distractions becomes an opportunity to hyperfocus on projects, work, things that need to be done, things that didn’t get done, and negative self-talk. These thoughts make it difficult to settle into sleep. Over time, people complain about daytime sleepiness, waking often during the night, trouble waking up, and negative feelings about bedtime.
- Circadian rhythm sleep disorders are marked by increased alertness, which is caused by irregularities in the internal clock and a delay in melatonin release. One common disorder is Delayed Sleep-Wake Phase Disorder (DSPS). This disorder can delay feeling sleepy by 2 hours or more, making it hard to fall asleep at night and filling the morning or next day with grogginess, excessive tiredness, and confusion. Up to 20% of adults with ADHD report a circadian rhythm delay.
- Sleep-disordered breathing (SDB), which can include snoring and sleep apnea, affects up to one-third of patients with ADHD. It leads to disturbed sleep and daytime sleepiness and can also exacerbate ADHD’s problematic characteristics. Helping SDB can improve these characteristics.
- Sleep Apnea, which is a sleep disorder-related breathing issue, is found in a third of people with ADHD. Snoring and obstructive sleep apnea are common and associated with obesity—about 40% of people with ADHD struggle with weight problems.
- Restless Legs Syndrome (RLS) feels like tingling in the legs, making it hard to fall asleep. About 50% of all people with ADHD have RLS and other types of periodic limb movement disorders. There is evidence that children with RLS spend longer in stage one of the sleep cycle. Researchers believe RLS is caused by iron and dopamine deficiencies, which are commonly associated with ADHD.
Autism: Adults and teens report that falling asleep takes about 20 minutes longer. Sleeping issues in children with autism often stem from behavioral issues, so finding the root cause of that behavior, such as refusal to go or stay in bed, is important. Sometimes, it is sensory, so bedtime is physically uncomfortable.
- Like ADHD, people with autism may experience sleep disorders, including insomnia, sleep apnea, RLS, and other periodic limb movement disorders.
- Some people report that they move more than others at night, which disrupts sleep.
- Many also wake up very early. Some say at 4 am consistently.
- Parasomnias: Unusual and unpleasant nighttime experiences, such as nightmares, night terrors, sleepwalking, and bedwetting, often occur in children who have autism.
What can you do about it?
From improving sleep hygiene to seeking medical treatments, there are various strategies you can employ to manage sleep issues related to neurodiversity. Most professionals will have patients start with sleep hygiene, which is often poor for neurodivergents. It is essential to create a bedtime routine that you enjoy that isn’t over- or under-stimulating, so you will stick with it. The same is true if you create a bedtime routine for a child.
Here’s what you can do on your own:
- Go to bed and wake up at the same time every day, choosing a realistic time for getting the recommended sleep for your age group and for what time you need to be somewhere in the morning.
- Create a routine with the same steps every night, especially for children.
- Limit your sugar intake and cut it after a few hours before dinner.
- Cut off caffeine in the evening. Caffeine is a natural diuretic, which makes it more likely you will need to get up in the middle of the night to go to the bathroom.
- Cut off alcohol in the evening.
- Drink herbal tea with no caffeine that may be calming—or warm milk.
- Avoid taking naps.
- Avoid screen time for an hour before bed. Removing screens from children’s and teens’ bedrooms is a great idea. A traditional alarm clock with two alarms is also a great idea.
- Avoid stimulating activities and projects that may cause you to hyperfocus in the hours right before bedtime.
- Put a boundary around the use of your bedroom to be reserved for sleep and sex.
- Exercise during the day so your body is tired at night.
- Turn off screens at least an hour before bedtime.
- Activities like rereading a favorite book (it isn’t as stimulating as a book you haven’t read), spending time with pets, playing board games, or taking a warm bath can be good choices.
- Keep your room at a comfortable temperature for sleeping. This temperature may be cooler or warmer than during the day.
- If you feel understimulated, try listening to soft music, a bedtime story, or a podcast with a timer so that it stops on its own, so it doesn’t wake you up later.
- Use a weighted blanket. There are stuffed animals that are weighed, too.
- A blackout curtain might be great if you need complete darkness because you are sensitive to light. If complete darkness makes the environment too understimulating, there are stuffed animals with soft lights or lamps that have timers to turn off.
- There is anecdotal evidence that sunset/sunrise simulating lighting can be helpful; however, they are expensive.
- A reward-based system to manage children’s behavior at bedtime. It works for adults, too, sometimes.
- If you are already on a stimulant medication and waking up is an issue, try using two alarms; when the first one goes off, take your medication, and when the second one goes off about an hour later, get out of bed.
Here is what you can do with a medical professional:
(I am advising you to talk to a medical professional about this before trying anything below.)
- If none of the above have helped your sleep problems, then discuss your issues with your physician; be specific. Try to report what is happening by tracking your sleep for a couple of weeks, so you don’t under- or overreport your sleep problems. Your issues may be related to ADHD or Autism, but they may be a comorbid sleep issue that needs to be diagnosed.
- Light therapy in the morning to help wake up.
- Talk to your physician about splitting your dose, so you take one dose in the evening to quiet the thoughts bombarding you have at bedtime.
- Talk to your physician about taking an ADHD medication (or off-label uses for ADHD) that causes sleepiness, like clonidine or certain antidepressants.
- Talk to your physician about melatonin.
- Talk to your physician about taking supplements that support overall health or sleep.
- Talk to your physician about a prescription for a short-term sleep medication to reset your “clock.”
- Talk to an Integrative Health provider to see if herbs, like Valerian, Passionflower, Ashwagandha, or Skullcap, might be helpful.
- If your child or teen has trouble waking up, discuss trying Jornay PM, which is taken the night before but released into the bloodstream about nine hours later.
The long and short of it is that our brains and bodies work better when we sleep, which means life is better. We all deserve that.