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Note on links: I attempted to ensure most of the articles linked are from scholarly or at least peer reviewed sources. They will open in a new window for you to read at your leisure. Most will simply discuss the referenced illness and its relation to adult ADHD.

Mental illness is something I've learned to feel very strongly about. It's also something I'm learning to live with.

It (mental illness) feels like such a "strong" word to describe ADHD with. Except, it's hard to even say if I have ADHD. It describes a host of symptoms that are also present in other illnesses, including but not limited to narcolepsy, hypersomnia, and insomnia. Recent research (AWESOME article, opens in a new tab/window that links to the abstract. You have to have a username/password for it, but the abstract basically explains what I mean) has also shown that many adults with ADHD show many symptoms of a general sleep disorder (typically referred to as narcolepsy for simplicity's sake, though note that it is NOT always true narcolepsy).

Sleeping
Fun fact: sleep disorders are often treated with the same drugs as ADHD, i.e., stimulants. That is, the version my psychiatrist thinks (thought? I'm seeing a new doctor due to insurance change right now) I have. Sometimes it can be treated with sleep medications (which are supposed to be much cheaper than stimulants), but I'm personally of the thought that if something works for me, there's no reason to want to fix it.

I have issues sleeping. Falling asleep is one of the hardest activities for me. You probably know this as insomnia. However, the need to sleep greater than 8 hours is also something I have to live with. This is often referred to as hypersomnia, and (at least for me) occurs due to not being able to sleep restfully. I appear to have a shorter sleep cycle (allowing me to have very vivid dreams when taking a short nap), thus I am more likely to awaken at night (which could be due to other factors).

Understanding the Beast Itself
My sleep issues lead to symptoms similar to ADHD, or basic sleep deprivation. I'm moody, anti-social, and trying to get me to pay attention is like trying to make a zombie act human - in most universes, it's not going to happen. Asking me to get up to do a simple task, such as just cleaning up after myself, can be like asking me to run a marathon - it takes serious effort on my part. Obviously, I have self-discipline, otherwise I probably wouldn't be gainfully employed. But that doesn't mean that things as simple as my homelife don't suffer.

For those who only know of ADHD as the stereotypicaly, can't-sit-still issue, here's a general breakdown of its symptoms (or, at least, the ones I live with):

  • Lack of attentiveness
  • Impulsiveness
  • Absent-minded-ness
  • Disorganization (to put it lightly)
  • Failure to pay attention to detail; often makes careless mistakes
  • Appears to be unable to actively listen
  • Often fails to complete or follow-through with projects
  • Avoids/dislikes anything which might require mental effort
  • Interrupts or intrudes others
  • Blurts out answers
  • Impatience
So, you can see from this list (and, if you go to the article in the link, the different sets) that new research has found that ADHD is actually a pretty intense puzzle. It's not just "one thing".  What's not mentioned in this list is also the ability to hyperfocus on a certain subject - this is what leads many people with ADHD to be incorrectly diagnosed with Asperger's Syndrome.

So, What's Your Point?
Have you ever had a night where you just couldn't sleep for some reason?  Maybe you had a huge test the next day and spent the entire night cramming, or the neighbor's dog was having an offnight.  The next day, all you can think about is when you get to go back to bed and sleep.  It's almost an obsession.  Your school work is lacking, you probably snap at anyone who talks to you, and you just want to be left alone.

Think about that for a moment, and then look at my list of ADHD symptoms.  You probably see where my point is leading, especially since I practically laid it out in my earlier paragraphs about narcolepsy and general sleep disorders.  ADHD shares common symptoms with sleeping disorders (or, to be less of a generalist and more scientific about this claim, ADHD-Inattentive and ADHD-Impulsive do - I am not afflicted with ADHD-Hyperactive, so I can't comment on that).

That's why the recent studies on ADHD in adults are so very important.  Sure, we can write the disorder off as "mental illness" or acting like a child, but can you imagine trying to get any work done when every day of your life feels like you spent the whole night trying to get the neighbor's dog to shut up?

Now, Sleeping Disorders
I mentioned earlier something about narcolepsy, and linked to an article talking about it.  Now, you probably had a flashback of Mr Bean from Rat Race (if you've ever seen the movie) where he'll randomly fall asleep.  That's not always the case.

I'm going to link to this article because I feel that it better explains the symptoms of narcolepsy than the original link in the beginning of this essay.  And here's a summary with my own commentary of what I understand from my own research:
  • Excessive daytime tiredness.  I mean excessive.  Like you didn't sleep at ALL last night, because of the test you were cramming for.  Except this is every day, and you weren't cramming for a test.  Specifically, let me draw attention to this (from the earlier article): People with EDS describe it as a persistent sense of mental cloudiness, a lack of energy, a depressed mood, or extreme exhaustion. Many find that they have great difficulty maintaining their concentration while at school or work. Some experience memory lapses. Many find it nearly impossible to stay alert in passive situations that include sitting and listening to lectures or watching television.
  • Involuntarily falling asleep.  This pops up pretty often, but most of my research has shown that it's actually pretty rare, even in people diagnosed with narcolepsy.  But, I'm not a doctor, so I may well be wrong.  Again, quoting from the article, here's something interesting about that: During these episodes, people are usually engaged in habitual, essentially "second nature" activities such as taking notes in class, typing, or driving.  This makes it sound like (to me) that the afflicted person can fall asleep for a few seconds and not even realize it.  Now, think about how often you yourself might've.  What happened on the drive home from work - you remember leaving work, but nothing about the actual drive home.  Or the repetitive task you were working on.  It kind of makes me wonder if this can be considered actual sleep, or "zoning out".  I suppose, scientifically, it can be considered actual sleep.
  • Loss of muscle tone.  I admit that this portion of the article kind of confused me.  Muscle tone, to me, has always meant actual... well, muscle tone - not the loss of control of muscles.  This is the first article on narcolepsy that I have read that mentions it, so I'm not entirely sure how common this is.  I did speak with a psychiatrist about this, though - apparently this symptom can occur in different ways.  Note that this is me paraphrasing a psychiatrist.  Apparently, this can happen to you while you are asleep (whether napping, or actually night-sleeping, and despite what the linked article says - that's why I have to put the disclaimer since I'm still a little bit fuzzy on this logic).  Apparently this is related to the below symptom (sleep paralysis) in which the person twitches and moves involuntarily while asleep rather than being fully paralyzed.  An example of this is that I apparently kick people while I am asleep (explains why my cat always vacates the room by morning).  Now my thoughts on the linked article and what it has to say.  It seems to me that cataplexy (loss of muscle tone) is the most specialized symptom of narcolepsy, but is a bit more rare.
  • Sleep paralysis.  I can tel you from experience that this is one of the scariest things that can happen to you.  When I wake up without an alarm, sometimes I'm still in a mostly-asleep state.  I have absolute nightmares.  You dream that the ceiling fan is actually an alien attempting to kill you, but you can't get up and move - you can't even scream.  Or you wake up in the middle of the night, and the shadows around you are actually Endermen attempting to strangle you.  Not fun at all.
  • Hallucinations.  According to my doctor, this isn't what you think it is.  I'm not going to have pink rabbits all over my desk - that's schizophrenia.  Apparently, the dreams I have when I daydream or fall asleep at work fall into the category of hallucinations and are what caused this doctor to think that perhaps a battery of tests specific to narcolepsy might show something for me.  I haven't followed through with that advice.  Here's something fun from the article:  These hallucinations represent another intrusion of an element of REM sleep—dreaming into the wakeful state.
  • Disrupted nocturnal sleep.  Oh boy.  So basically - you wake up at night.  A lot.  Sound familiar?  Sleep may be disrupted by insomnia, vivid dreaming, sleep talking, acting out while dreaming, and periodic leg movements. That one sentence encapsulates every other symptom in this list.
  • Obesity.  I think that's an understandable occurrence, given the rest of the symptoms.  I doubt that you're going to be attending the gym when you feel this tired - in addition to studies that have shown sleep deprivation's effect on weight gain/loss.
So, you probably think that I think I have narcolepsy.  If that's the case, I probably haven't made my point yet.  I'd love to also go into hypersomnia and insomnia, but here's the bottom line:  I think that most of the issues described in ADHD trail right back to sleep disorders.  Perhaps in my case it is insomnia or narcolepsy or even a combination of the two - I don't know.  But the fact that the symptoms are similar tells me that there's something there.

So What?
I want to see more research on the similarities between sleeping disorders and ADHD.  New York Times recently had an article that did mention some research on this, which is actually what got me thinking about it.  It gives me hope that this horrible horribleness (for lack of a better term) will actually receive the scientific examination that it needs.

I honestly feel that ADHD exists, but I also feel that there's more to the symptoms than one disorder.  I almost feel like ADHD-Inattentive (previously ADD) really is its own disorder, but may be more related to sleep than ADHD-Hyperactive.  In other words, I don't think that my ADHD-Inattentive is a mental illness: I think it's a sleep disorder, and I think understanding it as a sleep disorder may unlock the help I need.

I also think that current knowledge on ADHD suffers from a lack of previous care.  Hard to handle children were often labeled (usually incorrectly) as ADHD when they simply didn't receive the attention they need (my nephew is a prime example of this).  In addition, people like to say things like "ADHD doesn't exist" (I've heard this ONE too many times), which hurts people who actually suffer from it or similar disorders.  This resulted in a lack of early research - it's only recently that scientist and doctors are accepting that adults can have ADHD, for pete's sake.

I'm not ashamed to say that I have ADHD, and then to gently correct people when they make the stereotypical jokes.  I'm also not ashamed to take my Concerta every day at my desk at almost exactly 9:30 in the morning.  And I'm not ashamed to tell my (rather understanding) supervisor that I have to see a doctor once a month in order to fill said prescription.  I think with the help I'm now able to receive, things are going to improve for me.  I'm not currently in school, but I know from experience that when I return - I'll actually be able to perform at my fullest.

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September 2013

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