Friday, 9 March 2012

ADHD: Sleep and Body Clocks

Over 50% of adult attention deficit hyperactivity disorder (ADHD) sufferers report on-going sleep trouble, with 27% of suffers fitting the criteria for chronic insomnia [1]. In the past few years several studies have looked at the relationship between sleep, the body clock and ADHD. Does ADHD cause sleep problems? What can be done to help?

There are many ways to monitor rhythms in human body clocks. We can look at an individual's sleeping patterns, their hormone levels, and even their genes. We've already mentioned that sleeping problems are significantly linked to ADHD, but as we examine these other body clock markers we can see how deep the problem lies.

Cortisol, the stress hormone, is released at higher intensities in the night (see post on asthma). In ADHD patients whilst they maintain a daily rhythm in cortisol, the peak shifts to later in the day, effecting their sleep at night.

The rhythm in cortisol occurs later in ADHD patients (C) Baird et al 2011

Some of the clock genes, which are used to signal time of day information throughout all the cells in the body, were also found to not be functioning at all in the ADHD patients tested [2].

All this evidence combined shows that it is not just sleep that is a problem with ADHD, but there are underlying issues with a dysfunctional body clock. In fact, the more severe ADHD rating a patient had, the weaker their body clock rhythms were.

Melatonin is a hormone that is released at night, induces sleepiness, and communicates time of day information around the body. Melatonin is produced much later in chronic insomniac ADHD sufferers who stay awake at night.

Luckily, melatonin can be taken as a pill (it is often used to help overcome jet-lag). When taken at the correct dosage and time of day, melatonin can fix broken body clocks and improve sleep patterns.

Melatonin, a sleep-inducing hormone, is being used in trials to treat insomnia in ADHD (C) 

A few small trials have reported significant benefits in using melatonin to treat insomnia in ADHD sufferers. In one trial with approx 100 children, after 3 years, 88% recorded improved sleep at night. They were also able to perform better during the day, both mentally and physically [3].

Daily melatonin intake led to no serious side effects in this trial. However, only 9% could stop the melatonin treatment without reverting back to suffering insomnia, so the treatment needs to be continued long term.

Parents' responses after a 3 year follow up when using melatonin to treat ADHD (C) Hoebert 2009 

Melatonin is one method to realign a person's internal body clock to the external day, and is showing positive benefits in ADHD sufferers day to day lives. With the amounting evidence of the relationship between ADHD and a broken body clock there will hopefully be trials conducted in adult ADHD patients and more treatments available.

Please note, I am not a medical doctor and cannot advise ADHD patients on melatonin treatment. However I would love to hear from you if you have ADHD and sleep problems. Please write in the comments box below.

Enjoy this blog post? You may want to check out Nocturnal Asthma or Around the Clock Doc.

[1] Coogan, A N. et al (2012). Adult attention deficit hyperactivity disorder: translating research into practice. Attention deficit and hyperactivity disorders, 41-51. doi:10.1007/s12402-012-0073-7

[2] Baird AL, et al (2011) Adult attention-deficit hyperactivity disorder is associated with alterations in circadian rhythms at the behavioural, endocrine and molecular levels. Mol Psychiatr. doi:10.1038/mp.2011.149

[3] Hoebert M, et al (2009) Long-term follow-up of melatonin treatment in children with ADHD and chronic sleep onset insomnia. J Pineal Res 47(1):1–7. doi:10.1111/j.1600-079X.2009.00681.x

9 comments:

  1. Yes, I do have sleeping problems and suffer from ADD/ADHD (combined type), taking Melatonin didn't help for me. Taking an extra dose of Ritalin did help but I was having to much side effects because then my daily dose would get to high.
    What did help was cutting back on processed food, caffeine and sugars and exercise (2-3 times a week).
    I don't know if it's true but in my experience it get's worse when it's 'that time of the month' (my meds don't work as well then). Then I go a week on maybe 2 hours of sleep a night.

    ReplyDelete
  2. Thanks for your comment Layla! It's amazing to hear firsthand (and not just in the research papers) the profound effect sleep problems and ADD/ADHD can have!

    When your doctor put you on melatonin did you try different dosages or different times in the evening? Some people need to start taking it a lot earlier than others, hence why it is difficult for me to suggest when you should take it.

    Did your doctor look at what your melatonin levels were doing naturally? I don't know if this is done routinely in diagnosis, but it is done often in research experiments. Urine samples can be taken intermittently throughout 24 hours and can be screened for the metabolites of melatonin (when it's broken down in the body), and from this you can see when your body is naturally producing melatonin, and then decide when to give extra.

    It's interesting that you say that exercise has helped your sleep problems. Exercise can be a good time cue for the body, and help the internal clock adjust to the correct time of day. I wonder if this is why exercise is helping your sleep? There could be other reasons too, of course.

    Bright light therapy, melatonin and exercise are all good things to help people resynchronise their body clocks (e.g. overcome jet lag), and I wonder if they, and other chronobiological time-cues could help ADHD/ADD sufferers. So if melatonin doesn't help, others courses of action can also be used.

    ReplyDelete
  3. They didn't check my melatonin levels but I did try different dosages/time. I got the best results when I still had a working dosage of Ritalin. But I switched to a medication that I only have to take once a day because of the side effects (weight lost, dry mouth) so the melatonin didn't have any effect anymore.
    I could have taken an extra dose of Ritalin next to my normal medication, but my limit is 30mg a day, so I only do it when I have no other choice.
    I must say that the problems of sleeping did get worse when I started my medication. I think it has to do with the fact that you get used to the 'quietness' in your head during the day and when you go to bed the effects of the drugs are gone and the chaos seems to get worse then if you weren't taking the drugs.
    I've been without meds for a week once and after a few days I had less trouble sleeping.
    But that could also be effected by the fact that I need to put in a lot more effort into everything then so I could be that I was just really tired and would fall a sleep anyway.

    I don't know why the exercise helps me, because for me my ADD/ADHD is not so much physical. But when I don't I get restless (both mind and body) and I have lost of focus. Same goes for eating healthy (processed foods).

    ReplyDelete
  4. Thanks for your comments, really interesting. I'll keep an eye out for any further research that might help you.

    h:)

    ReplyDelete
  5. I have ADHD without Hyperactivity, and I have had trouble sleeping for most of my life. Strangely enough I have less trouble when I take my Methylphenidate (Ritalin) later than proscribed. Especially because it's a stimulant.

    Every 2 weeks I go without medication for a few days, just to see what it will do for me, and the sleeping problem gets worse than usual. I spend complete days feeling drowsy only to 'wake up' when it's time for bed.

    I've been curious about melatonin for a long time, but I've never tried it. Next time I see my doctor I'll ask her about it and I'll let you know if, and how well it works for me.

    The reason Layla finds relief in her work-outs is because they release endorphines, which is a good replacement for Ritalin. Also it makes you physicaly tired and that's a big help for sleeping aswell.

    ReplyDelete
  6. Dear Helen Moore,

    The doctor diagnosed me with ADHD too. At first I was put on cencerta 5mg. Then I couldnt sleep properly, as in there are alot of thoughts in my head. So the doctor change me to strattera from 10 mg up to 60mg, still not much different.

    I realised I am always tired during the day time. And when it comes to night time I am always tired. Then around 4-5am I can start to sleep, but by 7am I have to wake up to go to work. Is this normal for adhd patients?

    ReplyDelete
  7. maggie.danhakl@healthline.com28 October 2014 at 09:21

    Hi Helen,

    Healthline just published this infographic outlining ADHD statistics and numbers in a visual guide. You can see the graphic here: http://www.healthline.com/health/adhd/facts-statistics-infographic

    Our users found this info very useful as it showcases the high cost of ADHD and which states ADHD is most prevalent in, and I thought it would be a great resource for your page: http://sleepless-days.blogspot.com/2012/03/adhd-sleep-and-body-clocks.html

    Please take a look at the guide and consider adding it to your page. The graphic is also embeddable, so you can embed just the images if you choose to do so.

    Thanks again and let me know if you have any questions.

    Best,
    Maggie Danhakl • Assistant Marketing Manager
    Healthline • The Power of Intelligent Health
    660 Third Street, San Francisco, CA 94107
    www.healthline.com | @Healthline | @HealthlineCorp

    About Us: corp.healthline.com

    ReplyDelete
  8. Thanks for sharing this useful info. Check it on: Buy Mattress

    ReplyDelete
  9. Initially, you have to realize that a wheeze is caused by a blockage with the aviation routes of a man when they're dozing consequently causing breathing commotions. Anti snoring devices

    ReplyDelete