SLEEP DEPRIVATION AND ADHD

Sleep Deprivation and ADHD



Sleep Deprivation and ADHD

CHAPTER I

Background of the Problem

The confusion surrounding the ADHD starts with its definition, it's criteria for diagnosis, its clinical symptoms that overlapping many of other psychological disorders, and ends with the different modalities of pharmacological treatment. If diagnosis of the inattention impairment of the ADD can be separated from the hyperactivity-impulsivity symptoms of ADHD, the clinicians would be alerted to the wide range of cognitive impairment associated with ADD, and the fact that they could be treating two separate disorders. The DSM-IV did not effectively address or discuss the components of the ADHD such as inattention, cognitive impairment, and hyperactivity.

The lack of clarity in the diagnostic criteria left the door open for personal interpretations of the symptoms presented, particularly when they were accompanied with disruptive aggressive behaviors. Disorders such as Oppositional defiant disorder(ODD), and conduct disorder often present symptoms (impulsivity, risk taking and aggressive behaviors) that overlap and are similar in many ways to those of ADHD, makes clinicians often wonder, if it is a coincident or most of these symptoms could be due to inhibition of the same brain regions.

In the1940s and the1950s the use of stimulants such as methylphenidate and different forms of methamphetamines was a common practice to improve and prolong wakefulness, concentration and enable people to work longer hours, most users were adults who, willingly tolerated and dealt with the side effects of the stimulants for short periods of time, they considered the side effects a price they had to pay in order to achieve and meet certain scheduled deadlines. During WWII Japanese and German pilots used the same stimulants to enhance wakefulness and vigilance in transpacific flights.

These powerful stimulants produce their pharmacologic effects by increasing the release of dopamine from its vesicles and inhibit the reuptake into the producing neurons, thus elevating levels of dopamine in the mesocortical pathways promote and enhance wakefulness. Norepinephrine levels will also elevate, producing stimulating effects along the ascending reticular activating system, midbrain and the thalamus, thus stimulating the parietal, temporal and occipital cortices with an end result of strong wakefulness accompanied with many desirable properties such as increased productivity, concentration and elevated mood, spirit and cognition.

Side effects of stimulant medications are basically similar to that of elevated tone of the sympathetic nervous system (sympathomimetic).

Insomnia; due to increase levels of dopamine and norepinephrine in the brain.

Hypertension; due to increase heart rate and cardiac output in presence of mild vasoconstriction.

Anorexia; mostly due to elevated levels of norepinephrine systemically.

Dysphoria and mild anxiety; due to sympathomimitic effect.

Addiction is always a concern since it is a possibility.

Stimulants are currently being prescribed to children, adolescents and adults for treatment of attention deficit disorder with or without restlessness; the diagnostic visit by a psychiatrist is mostly brief and includes self reported history from the patient (if adult) or parents if minor. History of sleep disturbances, if included in the diagnostic questions is usually attributed to the ADHD ...