Monday, April 29, 2013

ADHD or Just Plain Tired?

In Diagnosing the Wrong Deficit,  Dr. Vatsal G. Thakkar talks about the concept that the incidence of Attention Deficit Disorder has coincided with people getting less sleep as their days have gotten busier and longer.  He wonders if the symptoms that get attributed to ADD might be a result of too little sleep.  And if not too little, then maybe the wrong kind of sleep.  Dr. Thakkar goes on to talk about his own difficulties with focus and concentration and how he believes these symptoms were because his sleep architecture was disordered: too much dreaming, too little deep sleep -- a problem that was solved with a stimulant by day and a selective serotonin-norepinephrine uptake inhibitor (an SNRI such as Cymbalta or Effexor) by night.  He also mentions that clonidine, a alpha-2 adrenergic anti-hypertensive agent that is used by psychiatrists for -?- (sleep/ptsd/restless legs/whatever ails you)  might be useful to change sleep architecture and quality.

Thakkar writes:

We all get less sleep than we used to. The number of adults who reported sleeping fewer than seven hours each night went from some 2 percent in 1960 to more than 35 percent in 2011. Sleep is even more crucial for children, who need delta sleep — the deep, rejuvenating, slow-wave kind — for proper growth and development. Yet today’s youngsters sleep more than an hour less than they did a hundred years ago. And for all ages, contemporary daytime activities — marked by nonstop 14-hour schedules and inescapable melatonin-inhibiting iDevices — often impair sleep. It might just be a coincidence, but this sleep-restricting lifestyle began getting more extreme in the 1990s, the decade with the explosion in A.D.H.D. diagnoses. 

Interesting ideas and I'm wondering what others think of them.

Does more sleep get rid of the symptoms of ADD?  Since I'm not a big 'fan' of the controversial adult ADD diagnosis, it sounds good to me.   Is more sleep enough, or is changing how a patient sleeps with medications helpful?  And what about the use of clonidine?  I know child psychiatrists sometimes use it, and that it is used for the treatment of drug withdrawal, but I have never prescribed it.  Tell me what your experience with clonidine is.