Have You Ever Been So Tired You Can't Sleep?

Truck driver Joe Diemand (76) feels that way all the time. Working long and late hours like Joe or working the night shift have even been called carcinogenic by the World Health Organization. U.S. Center for Disease Control recommends at least 7 hours of sleep a night and reports show that more than 80 million Americans are sleep deprived. Just look at the spike in fatal car accidents and heart attacks (increases 24%) the Monday after day light saving time!

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We have an internal molecular clock that is set to mirror and stay in sync with the sun. Because of technology and brain imaging, these three Nobel Prize (2017) winning scientists discovered this so called circadian cycle and it is now known that disruption to this cycle can lead to things like diabetes, heart disease, and dementia. 

Disruption to this sleep cycle is due to our eyes and their exposure to certain light at certain times. I can't help but feel guilty as I stare at my computer screen late at night while reading about the negative affects of reawakening my wake cycle through exposure to this type of light. According to the most recent National Geographic, Michael Finkel states light at night inhibits the production of melatonin, the hormone that helps regulate our daily biological rhythms.

Insomnia is the main reason 4% U.S. adults take sleeping pills each month. But there is research to show that people who generally take longer to fall asleep, wake up for prolonged periods during the night, or both do not need medicine. Neurofeedback has been shown to improve sleep . 

The engine of our brain, the prefrontal cortex, is the first to begin to deteriorate when we do not get enough sleep. Finkel reminds us that this is the home for our decision-making power and problem solving abilities. It's no wonder why we are cranky when we are tired. Chiara Cirelli (a neuroscientist at the Wisconsin Institute for Sleep and Consciousness) tells us, “Every cognitive function to some extent seems to be affected by sleep loss.” So, what better way to improve symptoms of sleepiness than by training your brain with Nuerofeedback which directly  addresses symptoms for each individual client by focusing on certain parts of the brain that need strengthening. Using certain electrode site placement on the head and frequency levels, people report improvements in falling asleep, staying asleep and quality of sleep after the recommended 20 sessions of Neurofeedback.  These sessions in turn improve a healthy lifestyle as lack of sleep can induce overproduction of ghrelin, the hunger hormone, and can lead to obesity. Even those who get 6 or less hours of sleep per night are at higher risk for depression, psychosis, and stroke. Neurofeedback has not only been reported to help with sleeplessness but also these exact diagnoses. 

A common symptom of ADHD is daytime sleepiness (Timimi & Leo, 2009). This symptom served as a predictor for homework problems and academic impairment in adolescents with ADHD (Langberg, Dvorsky, Marshall, & Evans, 2013). Those with Autism have also having difficulty falling asleep and experience disturbed sleep once they do. ASD has also been linked to anxiety and depression. Neurofeedback addresses any dysregulated state of the brain and research has shown it improves many symptoms of these disorders. 

In this case, if you snooze, you don't lose! Biofeedback is now a "Level 1 - Best Support" for Attention and Hyperactivity behaviors or ADD/ADHD interventions based on The American Academy of Pediatrics (AAP). Other treatments such as Behavioral Therapy and medications are considered "Level 1- Best Support" treatments as well. Based on the dysregulation model, neurofeedback addresses common symptoms of ADHD like inattentiveness and impulsiveness by "brain training" and helping to regulate brain activity. Not only can neurofeedback address behavioral, academic and emotional symptoms, it can help regulate our sleep to allow for the full potential of " playtime of the brain" (Finkel, 2018). Sleep Help guides and tips are a great place to start, and if you'd like more information on how neurofeedback can improve quality of sleep, contact us today. 

~ Written by Hannah Berry, M.Ed.

References: Finkel, Michael. (2018). "While we sleep, our mind goes on an amazing journey." National Geographic, Aug. 2018.

Langberg, J. M., Dvorsky, M. R., Marshall, S. and Evans, S. W. (2013). Clinical implications of daytime sleepiness for the academic performance of middle school‐aged adolescents with attention deficit hyperactivity disorder. J Sleep Res, 22: 542-548. doi:10.1111/jsr.12049

Timimi, S., & Leo, J. (2009). Rethinking ADHD: From brain to culture. Palgrave Macmillan.

Consistent Use of ADHD Medication May Stunt Growth by 2 Inches

As previously seen on Hilber Psychological Services, there may be a relationship between consistent use of SDHD medication and height growth. According to the article, "Consistent Use of ADHD Medication May Stunt Growth by 2 Inches, Large Study Finds", written by Dr. David Rabiner, "although the benefits of medication treatment on ADHD symptoms dissipate, the impact on adult stature persists". The Multimodal Treatment Study of ADHD (MTA Study) tested 600 7–9-year-old children with ADHD. These children were randomly assigned into one of these four groups: 
1. Carefully monitored medication treatment
2. Intensive behavior therapy
3. Medication treatment combined with behavior therapy
4. Community care (parents obtained whatever treatment they want)

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After 14 months, the study showed that those children who received carefully monitored medication treatment or medication treatment combined with behavior therapy had lower levels of overall ADHD symptoms and better overall adjustment compared to those children who received intensive behavior therapy or community care. The results stayed the same after an evaluation 10 months later. However, evaluation after 1 year and again after several groups showed no group differences based on the initial group treatment assignments. Therefore, the initial benefits of the medication had disappeared. The study continued annually through age 18 and then reduced visits to age 25. Within this group, individuals were categorized based on their medication usage:
a. Consistent, i.e,. those who had met the minimum threshold during each year;
b. Inconsistent, i.e., those meeting the minimum threshold in some but not all years; and
c. Negligible, i.e., below the minimum threshold in all years. 

At the last evaluation, age 25, participants self- and parent-reported, and doctors measured the patient's height compared to other individuals around the area that had not been diagnosed with ADHD in their childhood. Based off of the medication categorized above, only 14.3% of participants consistently used medication through age 18. After comparing the other participants, participants with ADHD maintained substantially higher ADHD symptoms over time regardless of their initial treatment. It was clear that ADHD symptoms in young adulthood are not related to patterns of medication use through adolescence. 

There was thus no indication that consistent medication treatment over a number of years had any persistent impact. However, there was a relationship found between persistent medication use and adult height. According to Dr. Rabiner, "Students in the Consistent and Inconsistent medication treatment groups had average heights — combined across these groups — that were about an inch shorter than those in the Negligible treatment group. And, participants in the Consistent Group were nearly an inch shorter on average than those in the Inconsistent group, i.e., nearly 2 inches shorter than those in the Negligible group". 

Overall, the study concluded there was substantial persistence of ADHD symptoms into adulthood and although the benefits of medication treatment on ADHD symptoms dissipate, the impact on adult stature persists. However, it is possible that some other factor that contributed to some participants taking medication more consistently, e.g., more severe symptoms, also explains the reduced height attainment in this group.

There are many take home messages:
1. Relatively few youth with ADHD use medication consistently over their development.
2. Many individuals with ADHD will continue to struggle with ADHD symptoms into adulthood. 
3. Although medication helps control symptoms in the short-term, it is not a cure.
4. It is unknown whether optimal medication treatment maintained over many years would have a greater impact.
5. Parents and clinicians need to balance the need for persistent treatment in some children with the likely consequences of reduced adult height. 

Due to the symptoms that may occur from using persistent medication, an optimal solution would be to find the lowest effective dose of medication, or combine medication treatment with other behavior therapy and/or other approaches.

If your focus still has not improved enough to meet your goals, your brain may need some training. Neurofeedback can train your brain to regulate, stabilize and focus itself so you're able to concentrate better on your tasks or follow directions that are given to you.

 Contact us for more information on how Neurofeedback can help you and your family find the focus you need to function at your best.

~Written by Allison Parker and Tanya L. Hilber, PsyD

Reference: Rabiner, David. “Consistent Use of ADHD Medication May Stunt Growth by 2 Inches, Large Study Finds.” SharpBrains, SharpBrains, 28 Mar. 2018

Neurofeedback and ADHD

For those who have been diagnosed with ADD or ADHD or who have a child diagnosed with ADHD, you are familiar with the unpleasant symptoms that stem from the disorder. ADD and ADHD affect an individual's prefrontal cortex, located in the front of the brain. If you recall a previous blog entry on The Adolescent Brain, the prefrontal cortex is one of the last areas of the brain to develop. Within the prefrontal cortex, it affects one’s ability to perform executive functions. These functions primarily include the ability to plan and/or the ability to make decisions. This makes tasks asked of individuals in both work and school environments more challenging than for those who do not have a diagnosis of ADD or ADHD. For students, planning ahead to complete a research project or trying to study in advance for a test can be extremely difficult and frustrating. Similarly for adults, trying to make a work deadline or attempting to finish a project can be overwhelming and feel nearly impossible. Individuals who have been diagnosed with ADD or ADHD often experience difficulties when tasks are too boring or too demanding. As such, these individuals may have difficulty working when a task feels mundane or working when under pressure. There are many other symptoms associated with ADD and ADHD, such as inattention or hyperactive-impulsive behavior, that an individual may experience. However, let’s move to look at possible treatment options for individuals affected by this disorder.

For those diagnosed with ADD or ADHD, there are lots of treatment options. Should you seek a therapist? Should you seek a psychiatrist? Should you try neurofeedback? This is a personal decision and should be decided on an individual basis. However, let’s take the time to examine how neurofeedback can help alleviate problematic symptoms and help you achieve optimal brain health.

According to several studies as cited by Dr. Clare Albright (2010), approximately 80% of individuals’ problematic symptoms are alleviated within 30-40 neurofeedback sessions. That may seem like a long time, but there is a benefit: the symptoms do not come back. Unlike other treatment alternatives, neurofeedback does not mask the symptoms but works to minimize and possibly eliminate the symptoms, permanently. How does it do this? Neurofeedback looks to treat the problems that are responsible for the symptoms-- it targets the source itself. Medication may help with symptoms, but unlike with neurofeedback, once an individual stops taking medications the symptoms are likely to reappear. If you decide that medication is an option for you or your loved one, know that it can be taken in conjunction with neurofeedback. However, before making any decisions regarding medication, please consult with your psychiatrist or doctor.

Luckily, neurofeedback treatment for ADHD is considered a “Level 1- Best Support” by the American Academy of Pediatrics for children and adolescents. Out of 5 levels, this is the most empirically supported treatment level an intervention could acquire. As such, this is a wonderful empirically-based treatment option for you or your loved ones.

If you are interested in the services that neurofeedback has to offer, please feel free to contact us to learn more about whether neurofeedback is a good fit for you.

 

References:

Albright, C. (2010). Neurofeedback: Transforming your life with brain biofeedback. Trenton, MO:Beckworth Publications.