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- [00:00]
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- [00:36]
William Curb
Welcome to Hacking youg adhd. I'm your host, William Curb, and I have adhd. On this podcast, I dig into the tools, tactics and best practices to help you work with your ADHD brain. Today I'm joined by Sky Waterson for our Research Recap series. In this series, we take a look at a single research paper, dive into what the paper says, how it was conducted, and try and find any practical takeaways. In this episode, we're going to be discussing a paper called Prevalence Patterns and Predictors of Sleep Problems and Daytime Sleepiness in Young Adolescents with adhd. And so this is a study that's investigating the high prevalence of sleep related issues in adolescents with adhd. And this paper is also trying to distinguish between like, nighttime sleepiness disorders and daytime sleepiness. So the story here being that, you know, hey, maybe ADHD might not be caused by poor sleep quality alone, but there are like strong links to other things like sluggish cognitive tempto, which we'll all get into. So how about that? Let's dive in.
- [01:32]
Sky Waterson
Yeah, this was a, this was a very, very interesting study. And they were basically going in and saying, okay, like you said, ADHD has been considered to be related to sleep problems. I think in some cases, especially with young people, they will literally check for sleep conditions as part of the diagnostic process. But let's figure out what is going on. So they describe daytime sleepiness as something that, you know, affects upwards of 50% of adolescents with ADHD. And this is specifically about adolescents. Can you give us a sense of what daytime sleepiness looks like? Because I feel like this was something that they didn't necessarily go into enough because it just sounds like what it is, right? It's just being sleepy in the daytime.
- [02:21]
William Curb
Yeah, well, it, yes, yes and no. Because it is like basically, yeah, it's just being sleepy in the daytime and you know, and it is like, you know, but it's also like when be it's being diagnosed, it's like, you know, more of a chronic thing it is more of, you know, you're being slow, foggy. And, you know, it's. Something where I feel like. It really feels a lot like the inattentive side of adhd where people are just like, oh, yeah, you're not quite there sometimes.
- [02:59]
Sky Waterson
Yeah.
- [02:59]
William Curb
Where people are like, you know, the. I will have things with my ADHD where someone is talking to me and I am not hearing them at all. And, you know, they're like. They say something and just like, I'm like, right back into reality and I'm just like, I don't know where I was. And that's a lot. Kind of like where I feel like daytime sleepiness kind of feels like where you're just like, oh, I'm. I'm in a fog during the day and occasionally I break out, but it's weird.
- [03:23]
Sky Waterson
Yeah. Have you ever experienced, like, daytime sleepiness, what you consider versus just not getting enough sleep?
- [03:30]
William Curb
That would imply I had times where I got enough sleep. So that's hard. I was like, times that I got enough sleep. And then also, like, I mean, there are certainly, like, you know, you are wake up and you're like, man, I got enough. Felt like I got enough sleep. But it is, I think, would be very hard to tease out from not getting enough sleep. You know, maybe not eating enough, maybe all the other things that you need to do, you know, maybe like, oh, my, daytime sleepy because I'm sick. Or is this something indicative of something else?
- [04:01]
Sky Waterson
Yeah, I will say, you know, as we kind of go into this, I feel like it is worth me talking about our own sleep experiences a little bit before we go into what they found. Like, I. I get pretty good sleep. I've done. I've done pretty well. I crash in the afternoon. Like everyone. Like a lot of people, I try and like, work or move to. To solve that. When I was in university, I did experiment for a while with that system where you slept for a couple of hours and then you got up and you did something and you slept again for polyphasic sleep. Yeah, yeah, I got into that. I don't think I did it for very long. It was the year before I burned out really hard. So I don't know what that says, but yeah, yeah, the.
- [04:45]
William Curb
They pres. It was. Polyphasic sleep was definitely presented as something with like, a lot of, like, oh, this is how, you know, early humans lived because of what. And it's like, this is really not supported by anything other than some weak anthropology.
- [04:58]
Sky Waterson
I know. I think my, My, my. Like, I was just Trying to figure out how to get everything done. And you know, and, and also the reason I bring that up is because I wonder if that was my way of trying to combat daytime, you know, sleepiness was essentially to sleep.
- [05:13]
William Curb
Yeah, yeah. And there are, I mean as we mentioned earlier, there are a ton of sleep related issues with adhd. I want us to look at a paper that I kind of saw a couple days ago that was about linking delayed security and rhythm to adhd. And it's just one of those things where there's a lot that can be going on. And so a lot of people with ADHD are dealing with all sorts of sleep problems and being tired in the day. And so yeah, they're trying things like polyphasic sleep or you know, just, I know people that are like, I'm going to be sleepy anyway, so I'm, I'm not even going to try and get to.
- [05:50]
Sky Waterson
That's really interesting because we'll come to a second in a minute. Like what they found, that's very relevant. So basically they, they had 262 young adults in sixth through to eighth grade. Eighth grade, 73% male. So back on, more males than women comprehensively diagnosed with adhd. Which is, which is interesting. Yeah, we'll talk about that. And, and in terms of the procedure, it was a lot of, a lot of surveys basically. So they were going through the child interview for Psychiatric Syndrome. They were looking and just says, so again, no diagnosis in my notes. They were doing the Vanderbilt ADHD Diagnostic Grading Scale, Behavioral Assessment System, Child Sleep Habits Questionnaire and Sleep Self Report and then the Pediatric Daytime Sleepiness Scale and a bunch of other ones. They did a lot of, a lot of surveys.
- [06:54]
William Curb
Yeah, but mostly filled out by the parents. Sometimes filled out by.
- [06:59]
Sky Waterson
Yep, yep.
- [07:01]
William Curb
Adolescents.
- [07:04]
Sky Waterson
So let's talk about the diagnosis piece because I think it's always important to note if like how people are being diagnosed.
- [07:13]
William Curb
Yeah, well, because in this one they were doing the Vanderbilt, which is a great assessment, but reminders, it was just being done by parents, which is not a full assessment.
- [07:23]
Sky Waterson
Yeah, parents, caregivers rated how frequently each system occurred on a four point scale and yeah, then they used the system. So it wasn't being done by an expert in any kind of expert way. And if you have kids, you'll know that like, you know, some of the answers, they don't necessarily lead to an ADHD diagnosis. They may just be. Yeah, like kids run around a lot.
- [07:52]
William Curb
So this is an interesting conversation in itself because the, it is I. One of the components of ADHD diagnosis is that it is happening both at home and, or at. Both at home and then and at school or work, where it's just like, this is not just a single place issue. And usually people are more concerned about it happening at schools than they are at having at home. But specifically, often because of the masking that often happens at school, you might see people having more ADHD symptoms at home than they do at school. Nonetheless, it is kind of being like, oh, if you only are only looking at one side of the picture, it is hard to really give that diagnosis.
- [08:39]
Sky Waterson
Yeah. I thought this was really interesting. I mean, I, I, I, I know we probably talk about this a lot, but I think it's so crucial because, I mean, I had a conversation yesterday on a podcast and someone was like, do you have to be diagnosed? How do you get diagnosed? What is that process? And I still continue to find it interesting that the papers that are published in academic journals that are for the purposes of building a body of work about how ADHD works for the purposes of prescribing medication or sleep support or, you know, diagnosis in itself are based on such ephemeral ground compared to that.
- [09:22]
William Curb
Yeah, it's, if we're trying to have, like, empirical data, it needs to have a solid base of where it's coming from. Otherwise we're, you know, we don't know if we're actually comparing. All the same.
- [09:35]
Sky Waterson
Yeah. And I do feel like most people who are not listening to this wonderful episode, you guys are in the know, but most people don't know that. Most people have no idea.
- [09:48]
William Curb
Yeah. And it's, I think it's important. Yeah. If you are not in a science study, I don't really care how you got your diagnosis. Like, if.
- [09:56]
Sky Waterson
Absolutely. I say it all the time.
- [09:58]
William Curb
Yeah. I'm like, self diagnosis is fine. In this case. I don't like being, you're not going to get medication with self diagnosis because you need a doctor to do that and they're not gonna do that. And that makes sense to me. But if you're just like, I have ADHD and I need to do these things to help me get through the day, that's fine.
- [10:15]
Sky Waterson
That's welcome to the family. That's awesome.
- [10:18]
William Curb
Do what works for your brain. But if you're doing a study, you need to know what's really going on. Because the way that lack of sleep can mimic ADHD and then not having a super comprehensive, like, this person has ADHD and not just sleep issues makes it so I'm like, that's that's hard. Yeah, Hard to get my bread around here.
- [10:42]
Sky Waterson
And I think it's. It's like the study itself is. Makes sense. It's all written out there. It's all easy to see what I get. And I promise we'll talk about what they found in a second. But what I. What I feel like, a little bit frustrated about is I know how these sort of academic things go. And so this paper will be read at a conference by a certain person, and then it will be meta analysis into a variety of papers, and then eventually it will become something that gets given as just like a line or two to a person who is helping with really important diagnoses.
- [11:21]
William Curb
Yeah. Or, you know, someone will see this as a, you know, like it'll be posted on a science forum and it's just the headline that people are reading.
- [11:29]
Sky Waterson
Yes. Or that. A hundred percent. So in both cases, no one will know. Okay, so now that we've talked about that, let's go into what they. What they found. So it was. It was interesting. They found. They talked about, like, time spent in bed, sleep scores, bedtime resistance, sleep duration, sleep anxiety, night waking, parasomnias, sleep disordered breathing, and daytime sleepiness. So they had a whole regime of different things that you could be struggling with. But what they found was that, yeah, daytime sleepiness was not related, like ADHD symptoms was not related to a lot of them, which was. Which was not what they expected.
- [12:11]
William Curb
Yeah. Although there are some interesting ways that. So, like, the bedtime resistance. Not what I would have labeled as bedtime resistance, because it doesn't. They're like, this was you. No, it was not from resisting going to bed. It was more this focused on sleep habits. And I'm like, that's. Oh, why don't you just call it sleep habits then?
- [12:33]
Sky Waterson
The bedtime resistance one was interesting because I was like, oh, we're talking about, like, you know, I think it's a colloquial thing we say revenge bedtime procrastination. But it didn't necessarily. They weren't necessarily correlated those two things.
- [12:49]
William Curb
Yeah. Also for adolescents, it was weird too, because it also included separation anxiety, which I was like, I. These are not young kids.
- [13:02]
Sky Waterson
That was really. That was really interesting. So they were really. Because I was like, oh, we took. This is gonna sound so funny for a second. I was like, are we talking about separation from sleep or from your phone?
- [13:14]
William Curb
It's specifically they have afraid of sleeping alone or needs parents to sleep in the room. And I'm like, these aren't Like, I understand young kids, but that is not something. I mean, maybe I, maybe that's just how my cultural being is. But that is.
- [13:36]
Sky Waterson
That made me wonder. I was, I was like, is there some different cultural conversation that we are missing here where like for some reason that would be a thing that would happen and. Yeah, I mean that would make sense. Like if, if I, if you have kids that, that don't want to sleep alone and you're making them sleep alone for whatever reason, they're probably not going to get good sleep.
- [14:01]
William Curb
Yeah. But. Yeah, so back to the study itself. So, yeah, so they did find that daytime sleepiness was the most common issue, but it was still, you know, fairly low in that it was just like 37% of parent report or 42% from the adolescent report. And whereas like the nighttime sleep problems were like, you know, in the 1 to 5% problem. So it was really. Daytime sleepiness was the biggest issue but not highly correlated with other sleep issues.
- [14:46]
Sky Waterson
Yeah, yeah, it was really interesting. And then they sort of just didn't know why. Like this is kind of an interesting example. Studies usually have some theory. I feel like this was the, this was a study that it felt to me was very much like, does anybody know, like, why is this happening? Because it wasn't necessarily correlated. They, I feel like they came in so certain that daytime sleepiness was correlated with struggles with sleep. And when they found that that wasn't 100% the case, there was conversations about. About what was going on. And one of the conversations that really stood out to me because I was thinking about it was the idea of your dopamine or your stimulation levels during the day. Because remember, these kids are going to school.
- [15:35]
William Curb
Since this is not a like in lab study, they're just measuring time in bed, which is a great measurement for getting sleep. That is. But you know, and so they're like getting like.
- [15:46]
Sky Waterson
Yeah, nine hours.
- [15:47]
William Curb
They were saying nine hours and on weeknights or. Yeah. During school days and 10 hours on weekends.
- [15:53]
Sky Waterson
It made me jealous.
- [15:55]
William Curb
Right. Yeah, I know. I love that. And my, I'm like, were they really getting that just kind of what my, like with these. Because I, you know, I've woken up and been like, oh, why is there lights on in my house and found children awake at 5am and stuff.
- [16:14]
Sky Waterson
Yeah. Yeah. I could feel like you're being haunted slightly.
- [16:17]
William Curb
Yeah. But yeah, so I mean, I don't want to completely cast. Be like we can't trust results from surveys. But is also just. Yeah, it seemed it was higher than I expected. And so then I'm like, there was.
- [16:30]
Sky Waterson
Yeah, there's levels of research quality and a survey is obviously not going to be as good as like having them in the space. But then again, if you have them in a room and you measure their sleep, then it's not an environment study. And this is, this is kind of how studies go. I did want to say though, just as a personal experience, like if you put me in school and I am not enjoying the subject that I'm, that I'm learning, you know, it's like a really complicated chemistry class that I was just not my subject. You will see me experience daytime sleepiness for sure.
- [17:05]
William Curb
I mentioned the like circadian rhythm issues earlier. That is a huge issue with when school happens. It's too early. Like that is straight up. There is data that says school happens before most kids should be awake. And so yeah, they are going to be sleepy in the morning at school because their body is telling them you should be asleep right now.
- [17:26]
Sky Waterson
Yeah. So I think really what this paper is telling us is we should probably find and more read more sleep papers because I know this is a big, a big thing.
- [17:36]
William Curb
Absolutely. It'd be great to be like, okay, so we have 40% of these kids saying they have daytime sleepiness, but they're getting nine to ten hours of sleep. That is like, yeah, we need to know more about that. Is that, is that just a data problem or is there more to it?
- [17:55]
Sky Waterson
Hello everyone. If you have enjoyed listening to this episode, then you might like to listen to my podcast, the ADHD Skills Lab, where we go and deep dive into more of the research. And also we focus on ADHD support for business owners. Whether you're aspiring or you have your own company. And if you have your own company and you wish that you had somebody who would just build these systems for you so you could stop figuring out what to do all the time. Well, that's what we do. We are mentor and operator together. So if you want to learn a little bit more about that, you can find me at Unconventional organization. Thanks for listening.
- [18:46]
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