Can't Sleep?
Here’s almost all you need to know
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Sleep disturbances are one of THE most common problem areas for people with ADHD and Bipolar Disorder (BD). They also happen to be an area that has a very pronounced and dramatic effect on the larger picture of both ADHD and BD. In other words, ADHD and BD folks do much better overall if their sleep cycle is good; they do much worse if their sleep cycle is not good.
There have been news stories questioning whether poor sleep might be a "cause" of ADHD. Sleep disturbances are a fundamental part of ADHD. They can worsen ADHD symptoms, but they are NOT the root cause.
Sleep difficulties are also some of the basic symptoms in many other mental health problems.
Recent sleep research has shown that everyone needs at least 7-8 hours sleep per night. Those getting less as well as those getting more on a regular basis will suffer negative consequences.
Typical Sleep Problems:
Difficulty falling asleep
Staying up late (past midnight)
Awakening regularly at night
Awakening early in the morning
Sleeping less than 7 hours or more than 9
Restless sleep
Sleep-talking
Sleep-walking
Nightmares
Sleep Apnea
Night Terrors (in toddlers or young children)
Bed-wetting (past 5 years old)
Sleep Hygiene:
The Basics -
Go to sleep roughly at the same time each night.
Awaken at roughly the same time each morning.
Have a comfortable bed.
Try to minimize noise or other distractions.
Do Not fall asleep with the TV on.
If you tend to be a "clock-watcher", move the clock so you can’t see it.
Do Not force yourself to go to sleep.
Over-the-Counter Sleep Aids:
Diphenhydramine - (e.g., Sominex, Nytol, Tylenol PM) and doxylamine (e.g., Unisom) are the two antihistamines that are currently marketed as OTC sleep aids. Diphenhydramine is the only one that is considered to be safe and effective by the Food and Drug Administration. The safety and effectiveness of doxylamine has not been evaluated adequately for FDA approval. Other uses for diphenhydramine include
allergy, motion sickness, and cough suppression. Scientists believe that diphenhydramine and doxylamine cause sedation by blocking the action of histamine in the brain, but the exact mechanism of action is not known.
Benedryl – an anti-histamine; causes sleepiness in some individuals.
Milk – contains a protein, alpha-lactalbumin, that is rich in tryptophan, a chemical that tells the brain to sleep.
Melatonin – a hormone that occurs naturally in the human body; controls the sleep/wake cycle. Several studies indicating that 1-3mg one hour before bedtime helps induce sleep. Scientific evidence mild-moderate.
Valerian – plant extract; 150-300mg before bedtime; said to improve quality of sleep; scientific evidence mixed; not recommended for use more than 30 days.
Kava Kava – plant extract; said to induce a state of mental/emotional calm; scientific evidence good; not recommended for use more than 30 days.
Camamile - usually a tea made from the flower; said to induce a state of physical calm; scientific evidence fair; does not produce a significant effect.
a-Lactalbumin – see above "Milk"; the active ingredient in milk that is said to help induce sleep; scientific evidence fair; only for mild sleep problems.
Mellodyn – combination of Melatonin, Valerian, Chamomile, Passion Flower, & Lemon Balm; scientific evidence fair-to-good; should not be taken with any psychotropic medications.
Prescription Sleep Treatments:
(These should only be used for occasional sleep problems. Sleep difficulties that persist beyond 2 weeks are generally looked upon as an indication of a larger clinical problem.)
Restoril – generic = temazepam; benzodiazepine; rarely used now; habit forming.
Dalmane – generic = flurezepam; same as above.
Ativan – generic = lorazepam; benzodiazepine; habit forming; still used.
Xanax- generic = alprazolam; same data as above.
Sonata – new generation sleep treatment; non-benzodiazepine; meant for those having difficulty falling asleep, not for those having difficulty staying asleep; 7-10 days use only.
Ambien; Ambien CR – new generation sleep treatment; non-benzo; for difficulty falling asleep, difficulty staying asleep and early morning awakening; 7-10 day use only; generally well tolerated by most people.
Lunesta – new generation sleep treatment; non-benzo; reported to be helpful for all aspects of insomnia; OK for long-term use; many reports of unpleasant taste (20-35%).
Rozerem – new generation sleep treatment; non-benzo; not a controlled substance; primary impact on Melatonin (sleep hormone).
Trazodone – old anti-depressant, traditionally used for insomnia; seems to work for insomnia primarily by inducing drowsiness.
Helpful Web Sites:
Mike Gingerich, LCSW, Ph.D.
550 H St., Ste. 2N
Crescent City, CA 95531
707-464-6075
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