What I didn’t realize, until over a decade ago, was that sleep problems and ADHD are highly correlated. It made sense to me as I delved into the scientific literature. People with ADHD are prone to sleep problems (usually undiagnosed). Sleep problems — like sleep apnea, restless leg syndrome, or delayed sleep phase syndrome — exacerbate ADHD symptoms. Sometimes people are misdiagnosed as having ADHD when they actually have a sleep disorder.
ADD and Sleep Apnea: A Personal StoryEven as an infant, my sleep was irregular. I liked the nighttime. I wasn’t colicky or irritable. I wanted to start the party at midnight. I am the youngest of three children, and my mom had to be awake during the day for my siblings. (As genetics and karma had it, neither of my two children slept through the night until they were over a year old.)
In my childhood, I didn’t want the day to end. Even when I was exhausted, I felt there was more to squeeze out of the day. I didn’t feel tired at night, I felt energized. To surrender to sleep seemed wasteful. Procrastination played a role. When I put off doing things, I could get them done at night. I knew no one was going to interrupt me, and there was nothing good on TV.
My habit was to exhaust myself, so it would be easy to fall asleep when my head hit the pillow. If I wasn’t exhausted, I would lie in bed thinking. Sometimes I had anxious thoughts, other times I thought about the concert I was looking forward to, a great meal I had, the meaning of life.
I had problems staying awake and alert during boring activities — namely, school. For me, school days were a school daze. It is hard to explain to someone what this was like. Fatigue overwhelmed me, as if my brain were barreling into shutdown mode. Digging my pen into my leg until it hurt, even puncturing the skin a bit, seemed reasonable — a defibrillator, if you will.
I wanted to pay attention; I physically could not. This daytime “narcolepsy” still affects me, although I have more options as to the environments I place myself in. I could have benefited from fidget toys, stand-up desks, and one-minute breaks. In graduate school, I assigned a designated kicker to hit my leg when I got drowsy in lectures.
Could Sleep Apnea Be the Culprit?Then came my sleep apnea diagnosis in 2006. I had always been a snorer. My brother said that I sounded like a chainsaw at age nine. He couldn’t believe that a sound like that could come from a short, skinny kid. I had never heard myself snore, and I never woke up gasping for breath. It was when I was treating a patient with ADHD, who had severe sleep apnea, that I decided to educate myself about it in order to help him. As I checked off the symptoms, some of them resonated with me — chronic, loud snoring, never feeling rested in the morning. Others did not: headaches, mood disorder, and impotence. I decided to get a sleep study done to see whether I had the condition. That decision was a lifesaver.
In the sleep lab, I was hooked up to so many wires I looked like something out of The Terminator. The staff told me they were assessing the number of hypopnea (abnormally shallow breathing events) or apnea (pauses in breathing of at least 10 seconds and decrease in blood oxygenation) events during my sleep. If I had more than 20 events in an hour, they would put me on a CPAP (Continuous Positive Airway Pressure) machine and see if that helped. I’d have to sleep for at least three hours to get a stable reading.
After what felt like 20 minutes, a technician came in my room, wheeling the CPAP machine. I was puzzled. “I thought you needed me to sleep for at least three hours? It’s only been 20 minutes.” She said, “Sir, you have been asleep for three hours.” They attached the CPAP to me and, the next thing I knew, I was awakened at 6:30 in the morning and discharged. I was told to meet with the sleep doctor in five weeks, after they went through my sleep data.
After a week, the doctor’s office called, saying she wanted to see me sooner. The doctor told me that I had a severe case of sleep apnea. Twenty events in an hour warranted the diagnosis. I had 98 events! She said that it was one of the highest scores she had seen. “I am an overachiever,” I joked.