Get better sleep
If you’re finding your ADHD symptoms harder to manage after a few late nights then you’re not alone. Not giving our bodies the rest they need can have an incredibly negative impact on how we manage our ADHD. But it’s not as easy as just saying “go to bed earlier” - our brains don’t tend to respond to that. So what can we do?
I recently had the pleasure of speaking with Melanie Davies, of Melanie Davies Mind Solutions, all about this topic. Melanie is a Clinical Hypnotherapist and Sleep and Stress Consultant, specialising in sleep stress and anxiety. She has had great success with helping people turn around their sleep habits, so I was interested to see how ADHDers could benefit from her knowledge and experience.
So Melanie, let’s start with a question you probably get asked a lot, how much sleep do we actually need each night?
You want to be looking at getting between seven to ten hours sleep each night. We have a sleep cycle of about 90 minutes, and at the end of each cycle there's a moment of wakefulness. Very often, we don't notice that wakefulness - we roll over and go back to sleep - but there are times where we are aware that we are awake and that’s where anxiety can set in.
Now, if you are expecting to put your head on the pillow and not to wake up at all until the morning, just that little moment in the night itself can become a source of irritation or stress or even anxiety because you start to tell yourself this lie: “I can't sleep”. And then the moments of wakefulness begin to extend and become more and more uncomfortable.
So the first thing for anybody to understand is it's actually normal to have a little night-time waking and that in itself isn't a problem, but there are things that you can do to then help yourself drift back to sleep if your busy brain starts spinning.
That’s great, because in addition to these natural wakings I’ve found that I’ve become a lighter sleeper over the past six years - so when my husband gets in late, or snores loudly, or when my daughter gets into our bed in the night, I’m immediately awake. This often switches my brain on with random thoughts or a song lyric running on a loop through my head. So what could I be doing to quiet this in the middle of the night?
Well, I used to run baby and toddler yoga classes filled with sleep deprived parents, and I would teach them something called Ujjayi breath (I still teach this now to those experiencing disrupted sleep). It's the kind of breathing that your body does when you're naturally very deeply asleep - some people think it sounds like the sea, others like a little raspy snore.
The idea is that you nourish your body with a very deep, soothing breath. So sometimes if you can't actually have a sleep or you can't get to sleep, if you practice that rhythm of Ujjayi breathing, you can at least reassure yourself that you're giving your body some nourishing breath quality that's relaxing. The best case scenario is it actually helps you drift off to sleep, but if it doesn’t you will at least be able to say: “well, I'm doing something that's healthy, that's soothing, that's calming for my body and my brain”.
So, jumping back to how much sleep we need, what do you suggest for the night owls among us? For ADHDers, night-time is often where we can find our flow so we tend to stay up a bit, but if we’re then up early for work or childcare that might not fit with the minimum of seven hours sleep…
There are very clear scientific signs that people fall into two chronotypes - early birds and night owls - so staying up late, in itself, isn't a bad thing, but you need to manage the timings of the rest of your day so that you can still get that optimum 7 to 9 hours sleep. It becomes a problem if you've got family responsibilities or caring responsibilities or work responsibilities that are not flexible.
There's a whole heap of stuff that you can do in terms of meal timings and managing light and dark during your day, to set your circadian rhythm so that you will be more likely to be able to go to sleep at a time that fits with the cycle that you have to work to.
The other thing that you can do if you're not able to get that block of sleep is look at having a daytime nap. These have been scientifically shown to be very beneficial, but they do need to be managed carefully because it depends on what the other issues are around your sleep. So if you're someone who doesn't sleep very well at night and can't get to sleep, and then you end up having a daytime nap, and you extend that, that can actually become disruptive in itself. But if you make sure that you don't nap for any longer than 90 minutes, and don't nap any later than 3pm in the afternoon, it can actually be a helpful tool to give you the extra sleep that you wouldn't otherwise have had that might be impacting on your health or your cognitive function.
Oh, brilliant. So that would count then, having a short nap in the day plus your night-time sleep?
It doesn't work for everyone, but it is a way that you can manage things. We have to look at the whole picture though, because one of the problems with people who are suffering from chronic insomnia is that they become very dysregulated in their whole sleep rhythm. So if they haven't slept well, they then don't get up in the morning, or they then sleep during the day, and that sabotages their night time sleep routine. So it does need to be used quite carefully but, if you get the timing right, it can be quite helpful for some people.
So you're saying it's not a bad thing if you go to bed late, so long as you're getting up later (or utilising naps) to make sure you've had the right amount of sleep?
Yeah, and there's a big thing on the internet, isn't there, about the 5:00am club - how you should get up at 5:00am and do your workout etc. and be super productive. It’s what we’re told all the great leaders and innovators do. I don't really think that's true. It's all very well getting up at 5:00am if you went to bed at the right time in the evening, so that you still had that 7 to 9 hours sleep. But if you're skimping on that and you're only going to bed at midnight and you're getting up at 5:00am, you're really seriously sabotaging your health, your cognitive function, and your emotional regulation, and everything else in between, really.
I’ve heard some people say they function well on just four to five hours sleep a night, but what's really happening? What are they not seeing?
The long-term effects of that chronic sleep deprivation has a massive impact on your immune system, apart from anything else, and it will affect your ability to remember things and to learn.
So, while some very driven people convince themselves that they can manage like that, the long-term scientific evidence does not support that. But, I think when you're carrying a chronic sleep debt, or even chronic stress, any of those things, that becomes your normal, so you don't recognise how it is affecting you. And that's the real danger point for people when they've got into that mode.
You mentioned sleep debt there, so I have to ask, is it possible to catch up on missed sleep?
Not really. It doesn't work like that. Let's say, for example, I only got five hours sleep last night. If I go to sleep the next night, and then I have two extra hours sleep, is that going to fix everything that the sleep deficit the night before has caused? No! It's not going to be able to repair the things that got lost.
A really interesting person to follow, actually, is somebody called Dr. Sherry Marr, a sleep physician who works with elite athletes. These athletes often have to travel across time zones and then perform to their peak in competitive games, so she inevitably has to help people manage sleep disruption. Her findings and her studies suggest that you can't exactly pay back a sleep debt, but there is some element of recovery - it takes about two weeks. So, if you’re thinking, oh, I'll have a lie in on a Saturday and everything will be fine - sorry, it doesn't work like that!
So, are you saying we shouldn’t be having our weekend lie-ins?
If you are someone who is struggling with a good sleep pattern then when you lie in for any longer than about an hour past your usual wake up time, you're actually creating more problems for yourself, because you put yourself in a state of social jet lag. So, if anybody has got any sleep problems, the best thing they can do for themselves is to actually get up at the same time every day, even on weekends, until their sleep cycle has regulated itself.
I know that's really hard to hear because people like to have a lie-in. I do like a little bit of a lie-in sometimes, but I don't do it for any longer than about an hour, because if you go beyond that, it can start to throw out all the other circadian rhythms, and then it's going to mess up your next night's sleep.
Here’s the science bit: once we wake up, we get this chemical that is produced called adenosine and that creates our sleep drive. Now, if you've slept in until 11 o'clock on Sunday, your adenosine isn't going to be where it needs to be to give you a good night's sleep that night, which is not going to give you the best start to your week. That often compounds that dreadful Monday morning feeling that people get when they don't want to go out for work. So, if you can get yourself out of bed a bit earlier on Sunday morning you would actually be saving yourself a lot of aggravation.
So, would you set an alarm to make sure you’re waking at the same time every day?
What often happens now is I just wake up because it's so set. I don't have an audible alarm, I use a Lumi lamp, which lights up gently for about half an hour before I need to wake up. I also sleep with a sleep mask, which might sound a bit counterintuitive, but the Lumi lamp still wakes me on time.
If I had something really important happening and was worried about not waking in time then I would also set an audible alarm. But, I actually can't remember the last time an audible alarm woke me up, because I always wake up before it goes off.
I tend to feel a bit off kilter if I’ve been woken by an audible alarm…
Well alarms are meant to be alarming - they’re meant to make you alert - and your body's natural response to that is to fire off the stress hormone cortisol. Now, we naturally have a rise in cortisol in the morning anyway, because it's our body's way of waking us up. But if you are someone who is experiencing anxiety and you are topping up your natural cortisol waking response with an alarm clock, that's going to really rattle you.
And then the other thing that people often do because they feel sluggish in the morning is they then have coffee straight away to wake them up. And that again, heightens that anxiety response. So all of those things can be really counterproductive to your sense of calm and wellbeing and your ability to focus.
Oh, that's making a lot of sense of my past! So, no morning coffee then?
I'm not saying that you can't ever have coffee, but if caffeine is okay for you, and you do enjoy it in the morning, the best thing to do is wait an hour after waking up. This should be enough time for the adenosine to clear your system and the natural cortisol spike that woke you to level out.
Have some fluid - either just water or a fennel tea or lemon water etc. - because you will be dehydrated after the period that you've slept. But definitely save your coffee for about an hour after you've woken up.
So, what if you’re doing all the right things, getting your seven to nine hours each night, but still waking up feeling groggy and tired?
It might be to do with the depth of your sleep and the restorative quality of your sleep, because within that sleep cycle we've got different phases of sleep.
There's your deep sleep, which is there for the rest and repair of your body and for consolidating things that you have learned. It's almost like those things will get put in the little filing cabinet in your mind - all your experiences from the day.
Then you have your REM sleep, which makes connections between the things that you've learned - and that’s when you dream. Dreaming is a really important function to process and make connections between the things that we learn. It’s also been proven to help with creativity and problem solving, because when you're in that part of your sleep, your mind is making connections between things that might not appear to have been connected. There’s wonderful stories about musicians and creatives who've woken up and written a song or solved a problem they’ve been ruminating on, because their mind has been working out all those disparate pieces of learning in that REM phase of sleep.
But in terms of you waking up and feeling tired still,it might mean that one of those parts of sleep hasn't been able to be as effective as it should have been.
Some things that might affect that are…
Temperature: It's really important that our core body temperature drops when we sleep - an ideal bedroom temperature is between 16 to 18 degrees centigrade. That sounds quite cool, but we often sleep in bedclothes and under duvets, which make us a lot hotter, so it's worth being mindful of what bedding you're using. I personally don't have a duvet on most of the time now, I just use the duvet cover like a sheet and then I have layers of blankets so they can go on and come off very easily and that can keep me cool.
It might sound counterintuitive, but if you have a warm bath or a shower about an hour to an hour and a half before you go to bed, you will have raised your body temperature and that will then promote a cooling process. So when you go to bed, your body's cooling down.
Look at what you're eating or drinking and when. A lot of people say, oh, I have a (alcoholic) drink in the evening, it relaxes me for bed. But if you follow somebody on a sleep monitor graph, the architecture of their sleep with alcohol is not the same. So they might be sedated, but they're not asleep in the way that their brain needs for it to do all the important jobs it needs to do when you're asleep. So that actually is another reason why you might wake up not feeling well rested.
Full confession here, I'm not teetotal. I don't drink a huge amount, but I do like a drink and I do enjoy nice wine. So sometimes I need to ask myself how much do I want that glass of wine and how much do I want a deep, restorative night’s sleep? It’s ok if I choose the wine, I know I’m making an informed choice.
And is there like a minimum time between having a drink or having something to eat and going to bed?
I think ideally in terms of your evening meal, you want to finish that about 3 hours before you go to bed, to give your body time to digest. Otherwise, you're asking your body to do too many things at once.
We make this assumption that when we’re asleep we're not doing anything, but actually, sleep is a really important time for our body - it has lots of jobs to do! Our brain literally rinses itself out. So we have a system in our brain with the glial glands and it rinses out all of the proteins in our brain that could become harmful.
There's a lot of research now around dementia patients that show that they've got a buildup of amyloid proteins in their brain and being able to sleep well in the deep sleep phase rinses that out. So again, a good night’s sleep can protect the long-term health of your brain.
Oh, that's really interesting. I've seen articles recently talking about link between ADHD and dementia and the similarities they're noticing. So actually, that's a massively important reason to make sure you're getting that good quality sleep to reduce that risk.
And on the flip side of that, when people are not sleeping well they may go to the doctors and they may ask for sleep medication and sedatives. But, as with alcohol, you might be sedated on sleep meds, but your brain doesn't have the same functionality as it does when you're not medicated. So even though you may be unconscious and feel as if you've been asleep, often when people are taking sleeping medication, it has a long-term effect on their memory and they wake up and feeling groggy. And that's because they haven't had a natural quality of sleep.
This has been really interesting, thanks Melanie. Is there anything I’ve not asked about that you feel is important to know?
Well I did talk earlier about setting the circadian rhythm, so perhaps I should expand on what that can look like.
So, if you're in a situation where you have to manage your sleep because you've got to get out for work or you've got to get your children to school, or whatever, then one of the best things you can do is manage your light. This means getting up at the same time every day, and then getting out into the morning light within that first hour of waking. This could be having a cup of tea in the garden, or a quick walk around the block - people who've got dogs are lucky because that makes them go out straight away - but however you do it, get outside into the light, even on a cloudy day. That will give you up to 10,000 lux, which is the bit that we need to hit the back of our eye that sends that message to our brain that sets our circadian rhythm. So that's a really important thing to do.
So up at the same time, out into the light?
Yes, and then towards the end of the day, dim the lights. And it's better to have lights coming from lower in the room rather than overhead. So, if you find that you do struggle to get to sleep, or to stay asleep, it's worth winding the light down one to two hours before you actually want to go to bed.
And what about our smartphones…?
I think most people know that they shouldn't be on their phones - the blue light in phones and laptops is really, really disruptive to sleep.
So what you can do is to put your phone on grayscale mode after a certain time in the evening, so that it just goes grey. I have that on my phone after 9pm, along with a do not disturb, which stops notifications and only accepts calls/messages from certain numbers that I’ve specified (i.e. my adult children).
The whole phone goes grey, so even if I'm tempted to look at it, it no longer looks very interesting and I'm not getting the blue light. But actually, even without the blue light, just looking your phone is going to be stimulating your mind and making you think about things. So the more people can remove that temptation for themselves, the better.
Would you suggest replacing it with something that can help get us ready for sleep?
Yes! We talked about having that bath, having that wind down routine, and if you’re somebody with a really busy head, it's sometimes worth having a kind of brain dump before bed. Grabbing a notebook and writing down whatever is on your mind. But don't do that in your bedroom! Do it out of your bedroom. So you kind of create a space in your bedroom where that is just for you to sleep and to rest. Anything else, do that somewhere else.
And I know people sometimes get into these work from home habits where they're sitting in bed and they're answering emails on their laptops and things like that. It's really not helpful because you're giving your brain and your body mixed messages about what bed is for.
For the same reason, would you suggest not having a TV in the bedroom?
Yeah, I've never had a television in my bedroom and I never want to have a television in my bedroom. I know not everybody has got that opportunity, because some people live in bedsits or studios and it's all in one space. If you're in that situation and you can do something to separate the zones that will help and instead of watching it in bed, watch it on the bed - make it more like a sofa. Those things will have a powerful effect on your brain and your body's connections with what bed is for.
So, Melanie’s top takeaways for better sleep are…
Aim for 7-9 hours (this can include an afternoon nap of 90 mins. max, if that works for you).
Get up at the same time each day.
Get out into the light as soon as possible and delay your morning coffee for an hour after waking.
Have your evening meal at least 3 hours before bed (and try to avoid alcohol).
Be mindful of the temperature of your room and have layers of bedding that can be moved on and off when needed.
Avoid having phones, laptops and TVs in the bedroom - make it your sleep sanctuary
Try not to panic if you wake in the night - use Ujjayi breathing to relax and restore.