Improving Sleep

What can I do to improve my sleep?

Each brain is believed to need a specific amount of sleep during a 24-hour period. Studies have discovered many tips for how to get a better sleep. Although sleep is independently linked with longevity, in today’s world, many are not excited about following the tips. Here are a few examples (and more are listed on the Sleep Foundation website):

    -  Have a regular sleep time, starting preferably 1-2 hours before midnight as sleep before midnight has been found to be more restorative

·      - Go to bed the same time on weekends as during the week

·   -- Avoid the use of electronics for 1 hour prior to bedtime unless you are using blue-light protective glasses

·   - Avoid exciting movies or video games just before going to bed to reduce brain stimulation and/or the production of adrenalin

·      - Sleep in a cool room that is as dark as possible

·       - Keep all electronics out of the bedroom unless you are on call

·       - Eat dinner by six pm so food is out of your stomach by bedtime.

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Caffeine & Athletics

I just heard that caffeine may be approved for use in athletic activities. Do you know anything about that?

Caffeine is a stimulant that impacts the brain (central nervous system) to stimulate the release of acetylcholine, a neurotransmitter, which increases alertness and attention. It can be found in a variety of plants, including cocoa, with the best-known source being the coffee bean. Caffeine is said to be the most widely consumed psychoactive drug on Planet Earth, being seen as socially acceptable in most cultures. Caffeine can cause a mild drug dependency that, when discontinued, is associated with several withdrawal symptoms—including sleepiness, headache, and irritability. The severity of these symptoms may relate to the regular amount of caffeine that an individual has used on a daily basis. Reportedly, pure powdered caffeine that is touted as a dietary supplement can be lethal in tablespoon-sized amounts. For at least the last decade, there have been anecdotal reports about caffeine, in moderate doses of about 5 mg per kg of body weight, being able to improve results in some types of athletic endeavors. You may have seen a news item about research in this area. More tomorrow.

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Diagnostic Differences

Unfortunately, one single test to diagnose ADHD does not yet exist, at least I do not know of one. The symptoms of hyperactivity that males with ADHD exhibit tend to be more bothersome and disruptive to parents and teachers. Hence, males tend to be referred for testing at a younger age and receive a diagnosis earlier than do females. Females tend to present with less overt symptoms. They may be inattentive but display it less prominently, so adults may miss the condition. Inattention symptoms in females with ADHD are more likely to occur in structured educational environments, such as high school and college, which may delay the diagnosis. Females may also develop better coping strategies to compensate for their ADHD-related difficulties. Female inattention may also be exhibited as anxiety and/or depression. Combined, this means that females are more likely to be diagnosed with a personality or other internalizing disorder, further delaying diagnosis and treatment of the underlying issue of ADHD. 

Age of ADHD Onset

Studies reported that boys may exhibit elevated symptoms of ADHD from childhood, easily meeting the criteria for age of onset. Parents may overrate symptoms of hyperactivity and impulsiveness in boys, taking them in for diagnosis much earlier. On the other hand, parents may underestimate the severity and impairment of hyperactivity and impulsiveness in girls or attribute the symptoms to something else such as hormonal problems, anxiety, or depression and may not take them to the doctor for ADHD testing.  Females are more likely to show increases in symptoms in early adolescence. Therefore, if the females are taken to the doctor, clinicians may exclude girls from an ADHD diagnosis because the age of onset criteria works for boys but can occur several years later for girls. The good news is that an increased awareness of male-female differences in onset and exhibition of symptoms, can help in providing earlier diagnosis and treatment for females.

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Estrogen, Dopamine, & ADHD

Dr. Michelle Frank has raised a number of interesting questions related to the impact of estrogen on ADHD behaviors. Females typically have higher levels of estrogen than males. Also, estrogen has an impact on dopamine, the feel better brain chemical and a neurotransmitter that is quite strongly implicated in ADHD. Fluctuating estrogen levels can impact the intensity and presentation of ADHD symptoms. Women also continue to face gender-role expectations that do not always align favorably with the strengths and challenges of an ADHD brain. Females tend toward higher rates of self-harming behaviors along with lower levels of self-esteem than males with ADHD. Dr. Frank has also pointed out that in all individuals regardless of gender-identity, it is likely that gendered expectations of behavior might complicate how symptoms are perceived along with to what the symptoms are attributed or linked.

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M-F & ADHD Differences

Attention deficit hyperactivity disorder, better known as ADHD, is  a neurodevelopmental disorder characterized by atypical levels of three symptoms: inattention, hyperactivity, and impulsivity. In terms of male-female differences, studies have shown that females are more likely to be more severely inattentive. Males are more likely to have combined symptoms with higher rates of impulsivity and hyperactivity. In a nutshell, males tend to exhibit externalizing disorders, such as: substance misuse, conduct disorders, and antisocial personality disorders. Females are more likely to exhibit internalizing disorders, such as: anxiety, depression, somatic symptom disorders, and bulimia. In addition, hormones can worsen ADHD symptoms in females, and the changes in symptoms, perhaps functioning as a ‘red herring,’ may delay diagnosis. 

ADHD & Gender Differences

Her high school teacher just suggested I take my daughter to the doctor to be evaluated for ADHD, since symptoms are different for males and females. Is that really true?

 Studies by the National Institutes of Health reported that in general, symptoms of Attention deficit hyperactivity disorder, ADHD for short, are not sex-specific, meaning symptoms in males and in females are more alike than they are different. Nevertheless, there are definite differences that can be missed if parents and teachers are unaware of them. Males are much more likely to be diagnosed with ADHD—three times more common, actually—than are females. Therein lies some very interesting nuances. It appears that referral bias is a problem. Males are much more likely to be referred for ADHD testing than are girls. Consequently, more males are likely to be diagnosed. Parents are more likely to take their son(s) to a physician for evaluation than they are to take their daughter(s). Again, this makes it more likely that more males will be diagnosed. A referral bias means that females with ADHD are less likely to receive treatment than males with ADHD. Treatments are said to be equally effective in males and females. However, until referral bias is addressed, and equal numbers of males and females are enrolled in similar treatment styles, this conclusion may remain unverifiable.  

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