It is a known fact that sleep is an essential function, both for the body and the mind to restore themselves.
Something I see regularly in practice is how the lack of impulse control has a negative impact on sleep (Grant & Chamberlain, 2018). My clients report racing thoughts, and an inability to get restorative sleep, even though they are exhausted.
As we get older, we develop a natural coping mechanism to poor executive function, by writing things down to remember them and surrounding ourselves with people who find our quirky character amusing, and who help us plan our tasks correctly. These coping strategies do not always transfer to getting a good night’s rest, however.
Have you ever noticed how after a long eventful week, you find yourself forgetting what you are doing mid task, you have a short temper and every task, even small, feels like a mountain of work? A person who has ADHD feels this way all of the time.
A lack of sleep results in poor executive function in any individual, whether they have an ADHD diagnosis or not (Lambiase, Gabriel, Kuller, & Matthews, 2014). This leaves me wondering often, when working with an individual diagnosed with ADHD, which came first? This is where listening to the individual, and not lumping everything under a diagnosis, is vital.
When an individual is unable to obtain restorative sleep, it raises their cortisol levels (Khan & Aouad, 2017). This is so that the body is able to redirect blood supplies where needed to support fight or flight. This is a natural stress response, because fatigue is stressful for the body (Manzar et al., 2020). Coping with having low executive function is also stressful. A cofactor to ADHD is anxiety (Reimherr, Marchant, Gift, & Steans, 2017).
In the integrative medicine approach, we break a problem down to the sum of its parts. In this way we are able to tackle the cause of the problem and find lasting results.
In a hormone cycle, guided by natural light, we are awoken when our body senses that the sun has risen, it raises our cortisol levels to arouse us (Marieb, 2014, p. 666). When the light once again begins to dim our pineal gland releases melatonin that has been produced from serotonin, and we start to feel drowsy (Marieb, 2014, p. 669).
It is easy to deduce then, that the stress associated with lack of sleep, and coping with the world’s expectation on people with ADHD causes a raised cortisol level. The raised anxiety means that the individual has a reduced serotonin level (Patrick & Ames, 2015), the precursor to melatonin. The individual is not only hyper aroused from raised cortisol levels; they do not have sufficient melatonin to successfully drift off to sleep.
Each case treated is individual, but considerations with this presentation would be around reducing cortisol levels. This can be done herbily. Reducing anxiety, depending on the severity, the treatment would vary. My next focus would be on promoting the release of melatonin at the appropriate time to support restorative sleep.
2] Grant, J. E., & Chamberlain, S. R. (2018). Sleepiness and impulsivity: Findings in non-treatment seeking young adults. J Behav Addict, 7(3), 737-742. doi:10.1556/2006.7.2018.71
3] Khan, M. S., & Aouad, R. (2017). The Effects of Insomnia and Sleep Loss on Cardiovascular Disease. Sleep Med Clin, 12(2), 167-177. doi:10.1016/j.jsmc.2017.01.005
4] Lambiase, M. J., Gabriel, K. P., Kuller, L. H., & Matthews, K. A. (2014). Sleep and executive function in older women: the moderating effect of physical activity. J Gerontol A Biol Sci Med Sci, 69(9), 1170-1176. doi:10.1093/gerona/glu038
5] Manzar, M. D., Noohu, M. M., Salahuddin, M., Nureye, D., Albougami, A., Spence, D. W., . . . Bahammam, A. S. (2020). Insomnia Symptoms and Their Association with Anxiety and Poor Sleep Hygiene Practices Among Ethiopian University Students. Nat Sci Sleep, 12, 575-582. doi:10.2147/nss.s246994
6] Marieb, E. N., Hoehn, K. N. (2014). Human anatomy & physiology (Pearson new international edition, Ninth edition ed. Vol. 9). Essex: Pearson Education Limited.
7] Patrick, R. P., & Ames, B. N. (2015). Vitamin D and the omega-3 fatty acids control serotonin synthesis and action, part 2: relevance for ADHD, bipolar disorder, schizophrenia, and impulsive behavior. Faseb j, 29(6), 2207-2222. doi:10.1096/fj.14-268342
8] Philip D. Zelazo, P., Nancy M. , John E. Lindahl. (2021). What is Executive function? Retrieved from https://www.understood.org/en/learning-thinking-differences/child-learning-disabilities/executive-functioning-issues/what-is-executive-function
9] Reimherr, F. W., Marchant, B. K., Gift, T. E., & Steans, T. A. (2017). ADHD and Anxiety: Clinical Significance and Treatment Implications. Current Psychiatry Reports, 19(12), 109. doi:10.1007/s11920-017-0859-6