Research Recap with Skye: Sleep Problems
Welcome to Hacking Your ADHD. I'm your host, William Curb, and I have ADHD. On this podcast, I dig into the tools, tactics, and best practices to help you work with your ADHD brain. Today, I'm joined by Skye Waterson for our research recap series. In this series, we take a look at a single research paper, dive into what the paper says, how it was conducted, and try and find any practical takeaways.
In this episode, we're going to be discussing a paper called "Prevalence, Patterns, and Predictors of Sleep Problems and Daytime Sleepiness in Young Adolescents with ADHD." And so this is a study that's investigating the high prevalence of sleep-related issues in adolescents with ADHD, and this paper is also trying to distinguish between, like, nighttime sleepiness disorders and daytime sleepiness. So the story here being that, hey, maybe ADHD might not be caused by poor sleep quality alone, but there are, like, strong links to other things like sluggish cognitive tempo, which we'll all get into. So how about that? Let's dive in.
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William Curb: All right. Welcome to Hacking Your ADHD. I'm your host, William Curb, and I have ADHD. On this podcast, I dig into the tools, tactics, and best practices to help you work with your ADHD brain. Today, I'm joined by Skye Waterson for our research recap series. In this series, we take a look at a single research paper, dive into what the paper says, how it was conducted, and try and find any practical takeaways. In this episode, we're going to be discussing a paper called "Prevalence, Patterns, and Predictors of Sleep Problems and Daytime Sleepiness in Young Adolescents with ADHD." And so this is a study that's investigating the high prevalence of sleep-related issues in adolescents with ADHD, and this paper is also trying to distinguish between, like, nighttime sleepiness disorders and daytime sleepiness. So the story here being that, hey, maybe ADHD might not be caused by poor sleep quality alone, but there are, like, strong links to other things like sluggish cognitive tempo, which we'll all get into. So how about that? Let's dive in.
Skye Waterson: Yeah, this was a very interesting study, and they were basically going in and saying, okay, like you said, ADHD has been considered to be related to sleep problems. I think in some cases, especially with young people, they will literally check for sleep conditions as part of the diagnostic process. But let's figure out what is going on. So they describe daytime sleepiness as something that affects upwards of 50% of adolescents with ADHD, and this is specifically about adolescents. Can you give us a sense of what daytime sleepiness looks like? Because I feel like this was something that they didn't necessarily go into enough, because it just sounds like what it is, right? It's just being sleepy in the daytime.
William Curb: Yeah, it... yes. Yes and no, 'cause it is basically, yeah, it's just being sleepy in the daytime and it is just... But it's also like when it's being diagnosed, it's more of a chronic thing. It is more of, you're being slow, foggy, and it's something where I feel like it really feels a lot like the inattentive side of ADHD, where people are just like, "Oh yeah, you're not quite there sometimes." Where you're just... people are like... I will have things with my ADHD where someone is talking to me and I am not hearing them at all and they say something and I'm like, bloop, right back into reality and I'm just like, "I don't know where I was." And that's a lot like what I feel like daytime sleepiness feels like, where you're just like, "Oh, I'm in a fog during the day, and occasionally I break out, but it's weird."
Skye Waterson: Yeah. Have you ever experienced daytime sleepiness, what you would consider versus just not getting enough sleep?
William Curb: That would imply I had times where I got enough sleep, so that's hard.
Skye Waterson: That is true.
William Curb: I was like, times that I got enough sleep and then also... there are certainly like, you wake up and you're like, "Man, I felt like I got enough sleep." But it is, I think, would be very hard to tease out from not getting enough sleep, maybe not eating enough, maybe all the other things that you need to do. Maybe look up, "Oh, am I daytime sleepy because I'm sick, or is this something indicative of something else?"
Skye Waterson: Yeah. I will say, as we kind of go into this, I feel like it is worth me talking about our own sleep experiences a little bit before we go into what they found. I get pretty good sleep. I've done pretty well. I crash in the afternoon like everyone, like a lot of people. I try and work or move to solve that. When I was in university, I did experiment for a while with that system where you slept for a couple of hours, and then you got up and you did something, and you slept again for another couple of hours. Yeah, I got into that. I don't think I did it for very long. It was the year before I burned out really hard, so I don't know what that says. But, yeah.
William Curb: Yeah, the... they presented... it was polyphasic sleep was definitely presented as something with a lot of "Oh, this is how early humans lived because of..." And this is really not supported by anything other than some weak anthropology.
Skye Waterson: I know. I think my... like, I was just trying to figure out how to get everything done, you know. And also, the reason I bring that up is 'cause I wonder if that was my way of trying to combat daytime sleepiness, was essentially to sleep.
William Curb: Yeah. Yeah, and there are, as we mentioned earlier, there are a ton of sleep-related issues with ADHD. I want us to look at a paper that I saw a couple days ago that was about linking delayed circadian rhythm to ADHD. And it's just one of those things where there's a lot that can be going on, and so a lot of people with ADHD are dealing with all sorts of sleep problems and being tired during the day. And yeah, they're trying things like polyphasic sleep or just... I know people that are like, "I'm gonna be sleepy anyway, so I'm not even gonna try and get to sleep."
Skye Waterson: That's really interesting, because we'll come to in a minute what they found. That's very relevant. So basically they had 262 young adults in sixth through eighth grade. 73% male, so back on more males than women. Comprehensively diagnosed with ADHD, which is interesting. Yeah, we'll talk about that. And in terms of the procedure, it was a lot of surveys, basically. So they were going through the Child Interview for Psychiatric Syndrome. They were looking at... It just says, "So again, no diagnosis," in my notes. They were doing the Vanderbilt ADHD Diagnostic Rating Scale, Behavioral Assessment System, Child Sleep Habits Questionnaire, and Sleep Self-Report, and then the Pediatric Daytime Sleepiness Scale, and a bunch of other ones. They did a lot of surveys.
William Curb: Yeah, but mostly filled out by the parents, sometimes filled out by adolescents.
Skye Waterson: So let's talk about the diagnosis piece, 'cause I think it's always important to note how people are being diagnosed.
William Curb: Yeah, 'cause in this one they were doing the Vanderbilt, which is a great assessment. But for mine, it was just being done by parents, which is not a full assessment.
Skye Waterson: Yeah. Parents and caregivers rated how frequently each symptom occurred on a four-point scale. And, yeah, then they used the system. So it wasn't being done by an expert in any kind of expert way. And if you have kids, you'll know that, like, some of the answers don't necessarily lead to an ADHD diagnosis. They may just be, um, yeah, kids run around a lot.
William Curb: So this is an interesting conversation in itself because one of the components of an ADHD diagnosis is that it is happening both at home and at school or work, where it's just... so this is not just a single-place issue. And usually people are more concerned about it happening at schools than they are it happening at home. But, specifically often because of the masking that often happens at school, you might see people having more ADHD symptoms at home than they do at school. Nonetheless, if you are only looking at one side of the picture, it is hard to really give that diagnosis.
Skye Waterson: Yeah, I thought this was really interesting. I know we probably talk about this a lot, but I think it's so crucial because I had a conversation yesterday on a podcast and someone was like, "Do you have to be diagnosed? How do you get diagnosed? What is that process?" And I still continue to find it interesting that the papers that are published in academic journals that are for the purposes of building a body of work about how ADHD works—for the purposes of prescribing medication or sleep support or diagnosis in itself—are based on such ephemeral ground compared to that.
William Curb: Yeah, it's... If we're trying to have empirical data, it needs to have a solid base of where it's coming from. Otherwise, we don't know if we're actually comparing all the same things.
Skye Waterson: Yeah. And I do feel like most people who are not listening to this wonderful episode—you guys are in the know—but most people don't know that. Most people have no idea.
William Curb: Yeah, and I think it's important. Yeah, if you are not in a science study, I don't really care how you got your diagnosis. If you were doing... Yeah, I'm like, self-diagnosis is fine in this case. You're not gonna get medication with self-diagnosis 'cause you need a doctor to do that, and they're not gonna do that, and that makes sense to me. But if you're just like, "I have ADHD, and I need to do these things to help me get through the day," that's fine. Do what works for your brain. But if you're doing a study, you need to know what's really going on because the way that lack of sleep can mimic ADHD, and then not having a super comprehensive "this person has ADHD and not just sleep issues" makes it so I'm like, that's hard to get my head around. And I think the study itself makes sense. It's all written out there. It's all easy to see. What I feel a little bit frustrated about is I know how these sort of academic things go, and so this paper will be read at a conference by a certain person, and then it will be meta-analyzed into a variety of papers, and then eventually it will become something that gets given as just a line or two to a person who is helping with really important diagnoses.
William Curb: Yeah, or someone will see this as a... like it'll be posted on a science forum, and it's just the headline that people are reading.
Skye Waterson: Yes, all that, 100%. So in both cases, no one will know. Okay, so now that we've talked about that, let's go into what they found. So it was interesting. They talked about time spent in bed, sleep scores, bedtime resistance, sleep duration, sleep anxiety, night waking, parasomnias, sleep-disordered breathing, and daytime sleepiness. So they had a whole regime of different things that you could be struggling with. But what they found was that, yeah, ADHD symptoms were not related to a lot of them, which was not what they expected.
William Curb: Yeah. Although there are some interesting ways that... so like the bedtime resistance, not what I would have labeled as bedtime resistance, because they're like, "This was not from going to bed. It was more focused on sleep habits." And I'm like, "Why don't you just call it sleep habits then?"
Skye Waterson: The bedtime resistance one was interesting, 'cause I was like, "Oh, we're talking about, like," I think it's a colloquial thing we say, "revenge bedtime procrastination." But they weren't necessarily correlated, those two.
William Curb: Yeah. Also for adolescents it was weird too, 'cause it also included separation anxiety, which I was like, "These are not young kids."
Skye Waterson: That was really interesting. So they were really... 'cause I was like, "Are we... this is gonna sound so funny. For a second, I was like, "Are we talking about separation from sleep, or from your phone?"
William Curb: Specifically they have "afraid of sleeping alone" or "needs parents to sleep in the room." And I'm like, these are not... like I understand young kids, but that is not something I... maybe that's just how my cultural being is.
Skye Waterson: That made me wonder. I was like, "Oh, is there some different cultural conversation that we are missing here, where, for some reason, that would be a thing that would happen?" And yeah, that would make sense. If you have kids that don't wanna sleep alone, and you're making them sleep alone for whatever reason, they're probably not gonna get good sleep.
William Curb: Yeah. But yeah, back to the study itself. So they did find that daytime sleepiness was the most common issue, but it was still fairly low, in that it was just like 37% of parent reports or 42% from the adolescent report. And whereas the nighttime sleep problems were like 1% to 5% problems. So it was really daytime sleepiness was the biggest issue, but not highly correlated with other sleep issues.
Skye Waterson: Yeah. It was really interesting. And then they sort of just didn't know why. This is kind of an interesting example. Studies usually have some theory. I feel like this was a study that felt to me was very much like, "Does anybody know? Why is this happening?" Because it wasn't necessarily correlated. They came in so certain that daytime sleepiness was correlated with struggles with sleep, and when they found that that wasn't 100% the case, there were conversations about what was going on. And one of the conversations that really stood out to me was the idea of your dopamine or your stimulation levels during the day. 'Cause remember, these kids are going to school.
William Curb: Since this is not an in-lab study, they're just measuring time in bed, which is a great measurement for getting sleep. And so they're getting nine hours on weeknights during school days, and 10 hours on weekends. That's great. I love that. And my... I was like, "Were they really getting that?" is what I thought with these... 'cause I've woken up and been like, "Oh, why are there lights on in my house?" and found children awake at 5:00 AM. Yeah, it can feel like you're being haunted slightly. But yeah, so I don't want to completely cast... be like, we can't trust results from surveys, but it's also just... it seemed higher than I expected.
Skye Waterson: Yeah, there's levels of research quality, and a survey is obviously not gonna be as good as, like, having them in the space. But then again, if you have them in a room and you measure their sleep, then it's not an environment study, and this is kind of how studies go. I did wanna say, though, just as a personal experience, like, if you put me in school and I am not enjoying the subject that I'm learning—you know, like a really complicated chemistry class that was just not my subject—you will see me experience daytime sleepiness for sure.
William Curb: I mentioned the circadian rhythm issues earlier. That is a huge issue with when school happens; it's too early. There is straight-up data that says school happens before most kids should be awake. And so, yeah, they are going to be sleepy in the morning at school because their body is telling them, "You should be asleep right now."
Skye Waterson: Yeah. So I think really what this paper is telling us is we should probably find more, read more sleep papers, 'cause I know this is a big thing.
William Curb: Yep. Absolutely. It'd be great to be like, "Okay, so we have 40% of these kids saying they have daytime sleepiness, but they're getting nine to 10 hours of sleep." We need to know more about that. Is that just a data problem or is there more to it?