Blog by James Leinhardt
It’s 1AM. Everyone is asleep (including the snoring dogs) but me. This is when my brain decides it’s got the most energy. The window of tiredness has passed and the 3hr hyperfocus kicks in.
Wide eyed, I’m scrolling my phone, adding reminders to notes for tomorrow’s meetings and shooting off emails. 4 AM. At last, my eyelids begin to feel heavy. I can no longer focus on my phone…I will get four hours, if my kids have any mercy in the morning. Sound familiar?
It couldn’t be more ironic that I’m a 'Sleep Expert'.
I have worked in complex neurology for the last 15 years and taken our interventions in the NHS and brought them to elite sport and now YOU! I am going to show you how your can legitimately improve your sleep even when you have the clinical challenges that ADHD brings to our sleep.
I was diagnosed with Combined Type ADHD in 2021. I was 42.
It's fair to say adults with ADHD have struggled their entire lives with symptoms that have often gone unexplained. Looking back, it’s quite funny no one connected the dots. My mum just said “I had ants in my pants.”
When I was 4 years old, I drank a whole bottle of sleeping medicine. I was shipped off to the hospital, had my stomach pumped and the doctors said that I had drunk so much I would be asleep for the rest of the night – so they would call my parents in the morning.
Two hours later, they were called back to collect their nuisance child, wide awake, running down the hospital ward, pulling all the curtains down. Extreme? Yes, but in some ways I enjoyed not needing to sleep throughout my life. For years prior to joining the sleep industry, I bought into the glamourization of no sleep… As NAS stated in his debut album, "sleep is the cousin of death"!
After receiving my diagnosis, it became clear that throughout my life my condition and sleep have been close allies and enemies.
This caught up with me when I hit 40. Still undiagnosed, I began to experience the relationship between sleep, anxiety and cognitive function. Literally, like night and day my life changed from someone who hated sleep and could function on little to none (literally), to someone who was now feeling like death without it.
Prior to my diagnosis, these symptoms I was now feeling made me seriously think I was getting dementia. I had nothing left in the tank. In addition to being mentally exhausted, various symptoms of my ADHD became more prominent and difficult to manage, especially the emotional dysregulation.
However, at this point I had no idea what was happening and why. It was not until I became diagnosed with Combined Type ADHD that the sleep paradox became clear.
Challenges with sleep as an ADHDer
When it comes to sleep, there are basic challenges that come with ADHD, and are totally out of our control. Here are a few that are personal to my own experiences.
Challenges with sleep can vary depending on the type of ADHD. Inattentive symptoms can lead to going to bed later, hyperactive-impulsive symptoms can result in insomnia, whereas with combined ADHD, one encounters both a diminished quality of sleep and later bedtimes.
The various medications taken by an ADHDer can work against helping you get to sleep. I take Elvanse (Lisdexamfetamine). It focuses on the area of the brain in charge of self-control. It makes these areas more efficient, helping with attention concentration and impulsive behaviour. On the flipside, it is a stimulant and as a result it can make getting to sleep very difficult. There are nonstimulant medications that can also affect sleep by making people drowsy — so you can’t win either way.
Rumination of thoughts, replaying themselves in an infinite loop can make it impossible to switch off and get to sleep.
I hate bed sheets and pillowcases if they are worn out and pilling - the texture causes sensory overload for me, especially around my face and feet.
That’s out of our control (perhaps apart from the bed sheets and pillowcases).
Thankfully, there are bits we can control, and even more thankfully, they make a difference.
Sleep hygiene for ADHDers
What can you control?
Take your meds consistently and early in the morning - [particularly if you are on stimulant meds similar to Elvanse that are slow release (meaning the medication can last 12-14hrs)
Make your bedtime routine the same each day. This means heading for the bed at a similar time. Also, reduce activities like phone scrolling that stimulate the brain and instead use relaxation techniques to help the mind become more rested. You don’t have to be perfect – I’m still learning myself.
Melatonin. It has been shown to help people with ADHD sleep longer and fall asleep faster. It can be a challenge to get GPs to prescribe it, especially the dose… For me that’s 20mg - in the US you can buy it off the shelf!
Regular exercising throughout the day is a great and healthy way to make your body produce the natural hormones that not only stimulate growth, but that encourage rest as well. During the pandemic my running saved my mental health for sure - but don’t run or exercise late at night, you will be wired.
Adapting to my diagnosis has not come without its challenges. Now I realise the way that symptoms of ADHD can affect my sleep and how problems with my sleep can affect my ADHD - it is a cyclical relationship, a challenging existing by the virtue of our condition.
Despite ways of managing the symptoms, we are always going to have ADHD.
Pound for pound, versus a neurotypical person, I will get less quantity of sleep than they do.
However, this does not mean there aren’t any controllables and this is where my clinical work kicks in.
Sleep posture is a possible solution
I work in complex neurology, where our patients are bed bound with often awful body shape deformity. Even in these cases we have demonstrated that we can improve their quality of life by improving their sleep posture.
Optimising your sleep posture is the single most significant intervention anyone apply to improve their sleep quality…And I can prove it!
I don’t get the ‘magic 8h’ that all the sleep experts will tell you you need, but I have not had any neck and back pain in the last 12 years. The quality of my sleep is second to none - and this due to me optimising my sleep posture.
"The quality of sleep is just as important to your well-being and often more strongly relates to your overall health than does the quantity of sleep." National Sleep Foundation
Improving your sleep quality through optimising your sleep posture is very much in your control. It’s simple and consider two things…
1. Your Sleep Position
To achieve an optimised sleep posture, sleep on your side in a semi-foetal position. It puts the least amount of tension through your spine and can help you achieve neutral spine alignment. It is important to select a right sized pillow - one that is not too high or too low. Ideally it should fit the space between the earlobe and the tip of your shoulder. Pillows, like shoes are NOT a one-size-fits all situation. To help your hips remain neutral, place a second pillow between your knees and ankles.
If you tend to sleep on your back then this is fine too, but only if you optimise it. To help optimise your posture in this position, simply put a pillow under your knees - this will tilt the pelvis and reduce the gap between your back and the bed surface, especially for those with lower back pain.
2. Your lying surface
Uncomfortable beds = restless nights. If you find that your body sinks into your soft mattress, you are not in control of your posture. It is vital you find a mattress that provides comfort and pressure relief yet is firm to ensure optimal postural support. Your mattress and pillow is the Hardware and here are the benefits of addressing sleep posture.
A more restful sleep
Reducing your neck and back pain
Improving your digestion and circulation
Lessening tension in neck and shoulders
Boosting your energy levels
Increasing your lung capacity
Increasing your core strength
The ADHD sleep paradox is not going to go away, so do all you can to optimise whatever sleep you manage to get – if nothing else your spine will love you for it!