Does your brain check out when you get bored
to the point where you just go unconscious just like that?
It can happen when you're sleep deprived
or have narcolepsy, but guess what?
It can happen when you have ADHD too.
That's what I'm talking about today.
I'm Dr. Tracey Marks, a psychiatrist
and I make mental health education videos.
I talked on a previous video
about sleep problems with ADHD
and how the disorder can alter
your normal biological sleep patterns.
These altered patterns create insufficient sleep.
The problem that I'm talking about today of sleep intruding
into your wakeful state happens independent
of how much sleep you've gotten.
Not getting enough sleep the night before
because you were up late on your phone
and then you needed to get up early
for work or school can make this problem worse,
but this still happens even
if you slept well the night before.
This problem is called sleep intrusion,
or theta wave intrusion,
and can be subtle or pretty dramatic.
The scientific literature supporting it
and explaining it is pretty scant,
but the problem does exist nevertheless
and here's our current understanding of it.
It is thought that people
with ADHD have increased theta wave activity while awake.
Let me explain the brainwaves.
The brain produces electrical activity that can be
measured using a device called an electroencephalogram.
The brainwave frequencies are classified by speed
and they're associated with different mental states.
The fastest to slowest are gamma, beta, alpha, theta,
and then delta.
Gamma waves are the fastest brain waves
and can be seen with high level cognitive processing.
It's also present when you're being very creative.
We get beta waves when we're alert and active.
We may be thinking about something or problem solving,
but it's still not as intense as with the gamma waves.
We also see beta waves during dream sleep.
We get alpha waves when we're relaxed and awake,
and you can be peacefully listening to music or meditating,
but they're also present in the first stage of light sleep.
Next, there's theta waves.
They're slow waves that you get when you're deeply relaxed,
or meditating or dreaming,
and then in also a fairly
light stage of sleep.
Then delta waves are the slowest waves
and they're present during deep sleep.
Some studies have shown that people with ADHD
have slower theta waves than people without ADHD,
and these slower waves happen more during the day
at times when you don't expect the brain to be slowed,
and the slower brain activity makes you tired and sluggish.
Then it's hypothesized that when you become
bored with something,
your mind disengages and instead of shifting
your attention to something else,
you have an intrusion
of these theta waves that makes you feel sleepy.
It's like driving a car with a manual transmission
and then having the gear downshift too low
for the speed of the car.
If this happens, your car can choke and stop.
This mental downshifting or disengagement
from your environment can be a subtle thing
like you feel the sleepiness coming
and you have a chance to do something about it,
or it can be pretty dramatic
like the lights just turn off.
I've seen this in action.
My son gave me permission to use him as an example.
He's in high school and has this energy pattern
of feeling sleepy whenever he gets home from school.
If he does nothing to stop the process,
he'll fall asleep for several hours,
but we've been working
with him to stay awake
and active when he comes home.
If he can stay awake for those first couple of hours,
he's home free and then he can make it
all the way to bedtime.
So that's the backdrop.
One day he came home
and drifted off to sleep for about an hour.
I got him up and helped him shake it off.
He was standing and talking, and walking around.
I think he even took the dog for a walk.
Then he came home, came downstairs for dinner
and he looked a little tired,
but he was having conversation
with people at the dinner table.
After about 10 minutes of not speaking,
he suddenly slumped
over in his chair and almost hit the floor.
My first thought was, "Is he on drugs?"
Now? I didn't think he was,
but in the absence of a brain injury
or some other medical problem
that I know he doesn't have,
it didn't make sense
to me how he could be walking around and talking,
and then after only 10 minutes of not talking,
just fall asleep sitting up in a chair.
And it was seven o'clock in the evening,
it was still light outside.
Now, his situation is probably more influenced
by the circadian rhythm sleep disturbance of ADHD
that makes him get locked into these foggy sleepy states
at random times.
But this was still a dramatic example of
how he was up and alert,
and then just like that,
his brain powered down.
This is a bigger problem than it may seem.
It's not something that's easy to understand.
I'm a psychiatrist and I was still questioning
if he took something to make him
just check out like that.
In a public setting, people don't take well
to you falling asleep
while they're talking during a meeting
or in class.
And even if you say you have ADHD,
people don't think of ADHD as causing this level
of dysfunction.
They're likely to blame you believing
that it's self-imposed by not letting yourself
get proper sleep.
It's insulting to people to think that you fall asleep
because you lose interest.
They don't understand that boredom isn't a choice.
It's not like you say,
"You can't keep me interested,
"so I'm going to fall asleep on you,"
but that's how it can feel to the person on the other end.
There's not a lot of scientific articles
on this because it's hard to produce the effect.
You can't just make this happen on command.
Nevertheless, studies on sleep disorders
and excessive daytime sleepiness in ADHD is ramping up.
Hopefully, sometime in the near future,
we'll have a clearer understanding of how this happens.
My hope is that
if we can understand it and define it better,
we can incorporate it as a clinical feature of the illness,
develop therapeutics to target this feature
and develop workplace or school accommodations for it.
Entities that hold you accountable need to understand
that this is something that's involuntary
and not just a byproduct of bad habits.
In the meantime, what can you do about this?
Well, yes, tightening your sleep hygiene helps,
but it's not the entire solution.
Some people are helped
by taking their ADHD medications regularly,
but this can happen later in the evening
or in the late afternoon when your medication is worn off.
What works for you will be an individual thing,
but the most likely thing to be helpful is
doing things that increase your movement.
You can get some fresh air.
Warm rooms with stale air can set you
up to get drowsy,
stand up and stretch.
If that generates too much attention,
pretend like you've got a back cramp
or need to shake off a leg that fell asleep.
Use a fidget spinner if you can.
Some settings don't allow them
because they can be distracting to other people,
but if you're alone, reading text,
or in a Zoom meeting, spin away.
If you're listening to a talk, take notes.
Some people doodle while they listen.
It's the same concept
as using a fidget spinner to stay focused,
but doodling is less distracting
to other people
and can look like you're taking notes.
Chewing gum with your mouth closed
is another tactic people use.
If you do this a lot,
you should opt for teeth friendly sugarless gum.
If you didn't already see it,
watch this video I did on sleep issues with ADHD.
Thanks for watching.
See you next time.