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All right.

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Welcome to Hacking Your ADHD.

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I'm your host, William
Curb, and I have ADHD.

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On this podcast, I dig into the
tools, tactics, and best practices to

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help you work with your ADHD brain.

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Today, I'm joined by Sky Waterson
for our research recap series.

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In this series, we take a look at a
single research paper, dive into what

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the paper says, how it was conducted,
and try and find any practical takeaways.

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In this episode, we're going to be
discussing a paper called "Prevalence,

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Patterns, and Predictors of Sleep
Problems and Daytime Sleepiness in

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Young Adolescents with ADHD." And so
this is a study that's investigating

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the high prevalence of sleep-related
issues in adolescents with ADHD, and

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this paper is also trying to distinguish
between, like, nighttime sleepiness

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disorders and daytime sleepiness.

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So the story here being that, hey, maybe
ADHD might not be caused by poor sleep

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quality alone, but there are, like,
strong links to other things like sluggish

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cognitive tempo, which we'll all get into.

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So how about that?

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Let's gi- dive in.

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Yeah.

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this was a very interesting study,
and they were basically going

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in and saying, okay, like you
said, ADHD has been considered

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to be related to sleep problems.

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I think in some cases, especially
with young people, they will

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literally check for sleep conditions
as part of the diagnostic process.

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But let's figure out what is going on.

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So they describe daytime sleepiness
as something that, affects upwards of

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50% of adolescents with ADHD, and this
is specifically about adolescents.

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Can you give us a sense of what
daytime sleepiness looks like?

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Because I feel like this was
something that they didn't necessarily

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go into enough, because it just
sounds like what it is, right?

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It's just being sleepy in the daytime.

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Yeah.

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it... yes.

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Yes and no, 'cause it is basically,
yeah, it's just being sleepy in the

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daytime and, and it is just... But
it's also like when be- it's being

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diagnosed, it's more of a chronic thing.

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It is more of, you're being
slow, foggy, and, it's,

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something where, I feel like it really
feels a lot like, the inattentive side

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of ADHD, where people are just like, "Oh
yeah, you're not quite there sometimes."

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where you're just, people are like, the,
I will have things with my ADHD where

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someone is talking to me and I am not
hearing them at all and, they're like,

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they say something and just like I'm like,
bloop, right back into reality and I'm

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just like, "I don't know where I was."

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And that's a lot like where I feel
like daytime sleepiness feels like,

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where you're just like, "Oh, I'm, in
a fog during the day, and occasionally

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I break out, but it's weird."

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Yeah.

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Have you ever experienced, daytime
sleepiness, what you would consider

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versus just not getting enough sleep?

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That would imply I had times where
I got enough sleep, so that's hard.

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is true.

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I was like, times that I got enough sleep
and then also... there are certainly like,

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you are wake up and you're like, "Man,
I got enough s- felt like I got enough

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sleep." but it is, I think would be very
hard to tease out from not getting enough

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sleep, maybe not eating enough, maybe
all the other things that you need to do.

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maybe look up, "Oh, am I daytime
sleepy because I'm sick, or is this

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something indicative of something else?"

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Yeah.

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I will say, as we kinda go into this, I
feel like it is worth me talking about

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our own sleep experiences a little
bit before we go into what they found.

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I, get pretty good sleep.

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I've done pretty well.

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I crash in the afternoon like
everyone, like a lot of people.

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I try and, work or move to, to solve that.

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When I was in university, I did experiment
for a while with that system where you,

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slept for a couple of hours, and then
you got up and you did something, and you

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slept again for another couple of hours.

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Yeah, I got into that.

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I don't think I did it for very long.

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It was the year before I burned out really
hard, so I don't know what that says.

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But, yeah.

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Yeah, the, they pres- it was polyphasic
sleep was definitely presented as

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something with, a lot of "Oh, this is how,
early humans lived because of..." And it's

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this is really not supported by anything
other than some weak anthropology.

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I know.

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I think my, my, my... Like, I was
just trying to figure out how to get

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all, everything done, and you know.

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And, and also, the reason I bring
that up is 'cause I wonder if that was

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my way of trying to combat daytime,
sleepiness, was essentially to sleep.

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Yeah.

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yeah, and there are, as we mentioned
earlier, there are a ton of

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sleep related issues with, ADHD.

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I want us to look at a paper that I
saw a couple days ago that was about

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linking, delayed circadian rhythm to ADHD.

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and it's just one of those things
where there's a lot that can be going

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on, and so a lot of people with ADHD
are dealing with all sorts of sleep

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problems and being tired during the day.

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And yeah, they're trying things
like, polyphasic sleep or, just

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b- I know people that are like,
"I'm gonna be sleepy anyway, so

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I'm, not even gonna try and get to

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That's really interesting,
because we'll come to a second,

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in a minute, what they found.

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that's very relevant.

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So basically they, had 262
young adults, in sixth through

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to eight grade, eighth grade.

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73% male, so back on
more males than women.

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comprehensively diagnosed with ADHD,

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which is, interesting.

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Yeah.

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We'll talk about that.

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and, And in terms of the procedure, it
was a lot of, a lot of surveys basically.

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So they were going through the Child
Interview for Psychiatric Syndrome.

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they were looking at... It just says,
"So again, no diagnosis," in my notes.

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they were doing the Vanderbilt ADHD
Diagnostic Rating Scale, Behavioral

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Assessment System, Child Sleep Habits
Questionnaire, and Sleep Self-Report,

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and then the Pediatric Daytime Sleepiness
Scale, and a bunch of other ones.

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They did a lot of surveys.

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Yeah.

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but mostly filled out by the
parents, sometimes filled out by

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Yep.

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Yep.

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adolescents,

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So let's talk about the diagnosis
piece, 'cause I think it's always

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important to note if, like,
how people are being diagnosed.

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Yeah.

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'cause in this one they were doing
the Vanderbilt, which is a great

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assessment.

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but for mine, it was just being done by
parents, which is not a full assessment.

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Yeah.

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Parents, caregivers rated
how frequently each system

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occurred on a four-point scale.

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and, yeah, then they used the system.

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So it wasn't being done by an
expert in any kind of expert way.

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And if you have kids, you'll know that,
like, some of the answers, they don't

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necessarily lead to an ADHD diagnosis.

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They may just be, um, yeah,
kids run around a lot.

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so this is an interesting conversation
in itself because the, it is, i- a,

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one of the components of ADHD diagnosis
is that it is happening both at home

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and/or at, both at home and then, and
at school or work, where it's just so

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this is not just a single place issue.

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and usually people are more concerned
about it happening at schools than

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they are it happening at home.

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But, specifically often because of the
masking that often happens at school, you

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might see people having more ADHD symptoms
at home than they, they do at school.

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Nonetheless, it is being like, oh,
if you only, are only looking at one

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side of the picture, it is hard to
g- really g- give that diagnosis.

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Yeah, I thought this
was really interesting.

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I know we probably talk about this
a lot, but I think it's so crucial

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because, I had a conversation
yesterday on a podcast and someone was

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like, "Do you have to be diagnosed?

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How do you get diagnosed?

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What is that process?" And I still
continue to find it interesting that the

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papers that are published in academic
journals that are for the purposes of

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building a body of work about how ADHD
works for the purposes of prescribing

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medication or sleep support or,
diagnosis in itself are based on such

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ephemeral ground compared to that.

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Yeah, it's... If we're trying to have,
empirical data, it needs to have a

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solid base of where it's coming from.

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Otherwise, we're, we don't know if we're
actually comparing all the same things.

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Yeah.

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And I do feel like most people, who
are not listening to this wonderful

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episode, you guys are in the know,
but most people, don't know that.

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Most people have no idea.

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Yeah, and it's, I think it's important.

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Yeah, if you are not in a
science study, I don't really

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care how you got your diagnosis.

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if,

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Absolutely.

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I say it all the

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were doing... Yeah, I'm like,
self-diagnosis is fine in this case.

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I don't, you're not gonna get medication
with self-diagnosis, 'cause you need a

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doctor to do that, and they're not gonna
do that, and that makes sense to me.

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But if you're just like, "I have ADHD,
and I need to do these things to help

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me get through the day," that's fine.

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That's do,

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That's awesome.

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do what works for your brain.

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But if you're doing a study, y- you need
to know what's really going on because

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just... The way that lack of sleep can
mimic ADHD and then not having a super

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comprehensive, this person has ADHD and
not just sleep issues makes it so I'm

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like, that's hard, to get my head around

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And I think it's, like the
study itself is makes sense.

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It's all written out there.

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It's all easy to see.

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What I get... And I promise we'll talk
about what they found in a second.

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But what I, what I feel like, uh, a little
bit frustrated about is I know how these

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sort of academic things go, and so this
paper will be read at a conference by

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a certain person, and then it will be
meta-analyzed into a variety of papers,

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and then eventually it will become
something that gets given as just like

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a cer- a line or two to a person who is
helping with really important diagnoses.

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Yeah, or, and someone will see this
as a, like it'll be posted on a

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science forum, and it's just the
headline that people are reading.

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Yes, all that, 100%.

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So in both cases, no one will know.

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Okay, so now that we've talked about
that, let's go into what they found.

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So it was interesting.

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They found, they talked about,
like, time spent in bed, uh, sleep

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scores, bedtime resistance, sleep
duration, sleep anxiety, night

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waking, parasomnias, sleep-disordered
breathing, and daytime sleepiness.

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So they had a whole regime of different
things that you could be struggling with.

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But what they found was that,
yeah, daytime sleepiness was not

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related... ADHD symptoms was not
related to a lot of them, which was

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un- which was not what they expected.

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Yeah.

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although there are some interesting ways
that, so like the bedtime resistance,

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not what I would have labeled as
bedtime resistance, because it

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doesn't-- they're like, "This was you.

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No, it was not from,

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going to bed.

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It was more this focused on sleep
habits." And I'm like, "That's-- why

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don't you just call it sleep habits then?"

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the bedtime resistance one was
interesting, 'cause I was like, "Oh,

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we're talking about, like," I think
it's a colloquial thing we say, uh,

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revenge bedtime procrastination.

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But it didn't necessarily, they weren't
necessarily correlated, those two

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Yeah.

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Also for adolescents it was weird
too, 'cause it also included

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separation anxiety, which I was
like, "I-- these are not young kids."

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was really, that was really interesting.

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So they were really... 'Cause I was like,
"Are we ta- This is gonna sound so funny.

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For a second, I was like, "Are we
talking about separation from sleep,

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or from your phone?" I'm like...

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It's specifically they have
afraid of sleeping alone or needs

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parents to sleep in the room.

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And I'm like, these are n-
like I understand young kids,

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Mm-hmm.

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but that is not something I maybe I, maybe
that's just how my cultural being is, but

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That made me wonder.

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I was like, "Oh, are th- is there
some different cultural conversation

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that we are missing here, where,
for some reason, that would be a

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thing that would happen?" and yeah.

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that would make sense.

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if, I, if you have kids that, that don't
wanna sleep alone, and you're making

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them sleep alone for whatever reason,
they're probably not gonna get good sleep.

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Yeah.

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But yeah,

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back to the study itself.

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so yeah.

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So they did find that daytime
sleepiness was the most common issue,

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but, it was still, fair- fairly low,
in that it was just, like 37% of parent

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report or 42% from the adolescent report.

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And whereas the nighttime sleep problems
were like, the 1% to 5% problems.

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So it was really daytime sleepiness
was the biggest issue, but not highly

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correlated with other sleep issues.

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yeah.

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It was really interesting.

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And then they sort of
just didn't know why.

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this is kind of an interesting example.

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Uh, studies usually have some theory.

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I feel like this was the, this was
a study that it felt to me was very

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much like, "Does anybody know? Like,
why is this happening?" because

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it wasn't necessarily correlated.

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They f- I feel like they came in so
certain that daytime sleepiness was

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correlated with struggles with sleep.

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and when they found that that wasn't
100% the case, there was conversations

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about, about what was going on.

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And one of the conversations that
really stood out to me, 'cause

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I was thinking about it, was the
idea of your dopamine, uh, or your

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stimulation levels during the day.

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'Cause remember, these
kids are going to school.

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Since this is not a, in-lab study, they're
just measuring time in bed, which is

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a great measurement for getting sleep.

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That is per- But, and so
they're, like, getting yeah,

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Nine hours they were

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nine hours and on weeknights
or, yeah, during school days,

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and, 10 hours on weekends.

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That's great.

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Yeah, I know.

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say.

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love that.

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And my, I'm like, "Were they really
getting that?" Is what my, was

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like with these re- 'cause I, I've,
woken up and been like, "Oh, why is

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there lights on in my house?" And
found children awake at 5:00 AM and

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Yeah.

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Yeah.

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It can feel like you're
being haunted slightly.

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Yeah.

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but yeah, so I don't want to completely
cast, be like, we can't trust results

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from surveys, but it's also just,

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Yeah.

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it seemed it was higher than I
expected, and so then I'm like,

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There was, yeah, there's levels of
research quality, and a survey is

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obviously not gonna be as good as,
like, having them in the space.

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But then again, if you have them in a
room and you measure their sleep, then

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it's not an environment study, and this
is, this is kind of how studies go.

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I did wanna say, though, just as a
personal experience, like, if you put

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me in school and I am not enjoying
the subject that I'm learning, you

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know, it's like a really complicated
chemistry class that I, was just

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not my subject, you will see me
experience daytime sleepiness for sure.

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I mentioned, the, circadian
rhythm issues earlier.

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That is a huge issue with when
school happens, it's too early.

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that is- Straight up there is
data that says school happens

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before most kids should be awake.

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And so yeah, they are going to be
sleepy in the morning at school

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because their body is telling them,
"You should be asleep right now."

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Yeah.

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So I think really what this paper
is telling us is we should probably

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find, more, read more, sleep papers,
'cause I know this is a big thing.

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Yep.

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Absolutely.

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It'd be great to be like, "Okay, so we
have 40% of these kids saying they have

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daytime sleepiness, but they're getting
nine to 10 hours of sleep." That is

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yeah, we need to know more about that.

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Is that, just a data problem
or is there more to it?