As a therapist I’m usually a good sleeper.
In fact, sleep and I have a bit of a thing going on. But last night? We weren’t friends at all. I was tossing and turning, my body ached, and my mind raced. I tried all my tricks, but it just wasn’t happening. And my alarm went off after I managed maybe a total of 4 hours. So today?
I’m a bit of a mess.
Marcy M. Caldwell, Psy.D. is a licensed clinical psychologist who specializes in the treatment and assessment of adult ADHD Psychologist Philadelphia.
My therapy brain is foggy, each word I type seems to take a century, and oh how annoying everything and everyone around me is!
But, it’s been worse. Much worse.
In fact, I have a bright and vivid memory emblazoned on my brain from when my youngest was an infant.
Is it his sweet, toothless grin as he gazed up at me? No. Is it his delicious little thigh rolls? Nope. Not that either—unfortunately, those memories need the aid of photos to call up.
You know what doesn’t need any aid? The memory of me dissolving in a puddle of tears in the middle of the kitchen floor, crying, “I’m just so f**king tired!” then continuing this cry all the way up the stairs as my husband directed me to bed. Once on that bed- did I lay down and go to sleep? No! I just sat on the edge, my shoulders heaving as I cried hot, angry tears and my husband tried, fruitlessly, to convince me to lay down and sleep.
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Why do we resist sleep?
Why was I resisting the one thing that would actually help? The truth is that therapy science doesn’t really know why we resist sleep but they do know we are the only mammals that do it. They are also very clear on what happens when we deprive our oh-so-tired brains of the thing they crave the most.
One of the interesting findings when looking at sleep-deprived brains is that ADHD and sleep-deprived neurotypical brains look remarkably similar.
Sleep deprived Neurotypical and ADHD brain comparison
In fact, when scientists look at fMRI scans of ADHD and neurotypical brains deprived of sleep, they see that the two look virtually identical EXCEPT that the sleep-deprived brain actually has a little extra assist in the thalamus (our brains relay station) ADHD brain does not.
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This extra therapy assist that the sleep-deprived brain gives may be why some people with ADHD say they feel better when they don’t get enough sleep- they may be benefitting from this extra sleep deprivation boost that they don’t normally get.
The problem is, that extra help?
It doesn’t last. And then the sleep-deprived ADHD brain is left with even less fuel in its executive functioning stores and struggles even more.
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What does sleep deprivation do to ADHD brains?
If your ADHD brain could talk after several nights of, even just a little, less sleep it would sound a lot like this.
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Sleep deprivation and ADHD
AHHH, it’s like my ADHD symptoms are on steroids!
Sleep deprivation amplifies ADHD symptoms. The exact same areas of the brain are impacted. That means that when you don’t sleep- your brain has even less fuel in its executive function stores causing you to reach that “I’ve got absolutely nothing” point before you even get started.
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Why won’t my brain work!!
(AKA “slowed cognitive therapy speed”) It’s that feeling of your brain slogging through the swamp wearing oversized galoshes filled with heavy mud—you know the one— Is, what makes it hard to follow a conversation, put 2 concepts together, or respond quickly. The ADHD brain is often trying to follow so many tracks at the same time that it can struggle to feel quick on a well-rested day. Following all those tracks while also moving at a snail’s pace? That can feel impossible.
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Oh, that was important? Whoops!
Already having a hard time staying on top of the essential things, picking out details, and attending to the top priorities? Add some sleep deprivation in and you might as well just watch it all sail on by! Your brain doesn’t have enough energy to see all the things it needs to and pick the most important ones so it just lets everything pass by.
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Sometimes people with ADHD actually appreciate this feeling- because it can ease some anxiety and struggle. And if it only happens here and there, it’s not too bad because the important things will likely circle back to you. But when this happens repeatedly (or in certain jobs or roles), missing the important things can have a lasting and even devastating impact.
You know how that scratchy sweater is completely intolerable when you are tired? Or how the chances of you not checking that pop-up after pulling an all-nighter are virtually non-existent? That’s because your executive attention stores are basically wiped out by lack of sleep. Executive attention is your ability to filter out distracting or extraneous material from your awareness. ADHD brains don’t love this to begin with- it takes a lot of its energy- lack of sleep depletes the resource so significantly it can feel like the filter never even existed.
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Wait, what? You asked me to get milk?
Lack of sleep diminishes your working memory stores, which I like to describe as the table on which you put all the things you need to think about. When something is on the table, you can play with it, use it, or find a place to store it. But the table can get too full, and then things start falling off. The ADHD brain loves to collect things on the table- it likes to have things out and visible. But lack of sleep? That makes your table smaller, so now you don’t have room for your grocery list, your to-do list, and what the person in front of you is saying- things start plummeting off the edge of the table- often never to be seen again- sorry grocery list!
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Problem Solving? Forget about it!
This is part of what was going on as I sat on the edge of my bed, crying about being tired. I had lost all of my higher therapy thinking power. My problem-solving capacity was virtually non-existent. There I was literally sitting on the solution, and I couldn’t put 2 and 2 together. Problem-solving requires a lot of executive functioning (something the ADHD brain has a limited supply of), so making it harder by lack of sleep? That feels unfair.
ALL the feelings
We are angrier and more easily frustrated when we are tired. Scientists have discovered that a lack of sleep cuts the connection between the emotional part of our brain (the amygdala) and the part of our brain that makes sense of emotion (the prefrontal cortex). So we aren’t able to reason through our feelings- we feel them full force.
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Sound familiar? The same thing happens with ADHD. When you are well-rested, your ADHD brain may struggle but still can get some of that communication through, provided it doesn’t get too flooded. Sleep-deprived, though? Now all channels are down and out of order and the feelings just come flooding in full force.
Sugar. Fat. Salt. Yes, Please!
When my youngest was an infant, I got into the habit of eating several candy bars a day (and I’m not talking about the fun-size version). I told myself I was nursing and needed the extra calories, but, really? My oh-so-tired brain just wanted that sugar rush. Our sleep-deprived brains overuse and overvalue its “drive” parts and underuse “higher thinking” parts. So high-fat, high-salt, high-sugar foods are extra rewarding to a tired brain, AND a tired brain doesn’t have the willpower in reserves to resist the reward.
This is a pattern already seen in ADHD. At the beginning of the day- it’s easy to resist that candy bowl on your coworker’s desk by 3 pm, though? The will-power supplies are low, and it gets so much harder. If you start the day already depleted then, it can feel next to impossible to resist that powerful therapy drive for pleasure all day long.
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