Snooze Control: Tackling ADHD Sleep Challenges with Dr. Roberto Olivardia

ADHD HealthGuests

May 16

Struggling to fall asleep or stay asleep is a common challenge for those with ADHD. In this episode, Pete and Nikki dive deep into the complex relationship between ADHD and sleep with special guest Dr. Roberto Olivardia.

As a clinical psychologist specializing in ADHD treatment, Dr. Olivardia shares his professional and personal insights on this critical topic. He explains how people with ADHD are at higher risk for an array of sleep disorders, from sleep apnea to restless leg syndrome. But beyond diagnosable conditions, those with ADHD often find it difficult to wind down at night due to the constant search for stimulation.

Pete, Nikki and Dr. Olivardia discuss practical strategies for improving sleep, some of which may seem counterintuitive. For example, listening to an audiobook or familiar TV show can actually help an ADHD brain relax by providing just the right amount of stimulation. They also bust some common myths, like the idea that you can "catch up" on lost sleep over the weekend.

Getting proper sleep is crucial for memory, brain function, and overall health. While it can feel like an uphill battle, this conversation provides both the "why" and the "how" of prioritizing sleep with an ADHD brain.

Pete Wright:
Hello everybody and welcome to Taking Control: The ADHD Podcast on TruStory FM. I'm Pete Wright and I'm here with Nikki Kinzer.
Nikki Kinzer:
Hello, everyone. Hello, Pete.
Pete Wright:
Nikki, is this an important one for you today, this topic?
Nikki Kinzer:
Yes, and it's very important I think to a lot of our listeners too.
Pete Wright:
Yeah, I think so too. As I was preparing my tea, I was yawning in the kitchen wondering why do I feel so tired right now. I am so glad we're talking about ADHD and sleep, and I will say, because I know she is particularly proud of this line, I'm going to read verbatim what Discord Mom wrote in our show notes. "Before we put our co-morbidity series to bed, we invited Dr. Olivardia back to talk with us about ADHD and sleep. I'm very excited to have this conversation," and thank you, Melissa. Before we do that, you know the drill, head over to takecontroladhd.com and get to know us a little bit better. You can listen to the show right there on the website or subscribe to our mailing list, and we'll send you an email each time a new episode is released.
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Nikki Kinzer:
Platinum.
Pete Wright:
You can watch along live. What?
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Platinum level.
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Platinum. [inaudible 00:02:10]. There's so many levels and they're all named after pizzas in my life.
Nikki Kinzer:
That's right.
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I forget my favorite pizzas. There's a deluxe pizza, there's a supreme pizza, there's a platinum pizza, but you also get direct time with me and Nikki and you get all of the happy hours and the ADHD accountability sessions. It's like thousands of dollars in time if you were to pay for these things individually and you get them for 25 bucks a month. I mean, it's crazy. It's crazy. It's the best deal in ADHD. How about that? The best deal in ADHD, you heard it right here. So check it out, patreon.com/theadhdpodcast, and then you'll be in the live stream and you can come join us when we talk to our fantastic guests, like today.
Dr. Roberto Olivardia is a clinical psychologist, lecturer in psychology in the Department of Psychiatry at Harvard Medical School and Clinical Associate at McLean Hospital. He maintains a private psychotherapy practice in Lexington, Mass where he specializes in the treatment of ADHD, and he's back today to talk to us about ADHD and sleep. Roberto, welcome back.
Dr. Roberto Olivardia:
Oh, it's great being here and a very, very important topic, absolutely, and one that I personally can speak to as well as all the clinical experience with patients that I would say top three issues that I hear about with ADHD and parents who have children with ADHD is up there is always the issue of sleep.
Pete Wright:
Let's start then with your experience working with patients and your personal experience with ADHD and sleep. Where does troubled sleep come from?
Dr. Roberto Olivardia:
So I personally don't know anyone with ADHD that doesn't have an issue with sleep. I mean, I honestly think at some point it's going to be part of the diagnostic criteria, and empirical studies show this to be the case, that people with ADHD are more likely to have sleep disorders like sleep apnea, sleepwalking, sleeptalking, bedwetting, restless leg syndrome, sleep paralysis episodes. I can check the box on most of those in my own life. Also have issues with getting to sleep and sort of shutting their brain down, sometimes staying asleep, waking up multiple times, having difficulty waking up in the morning even with ample amounts of sleep. I mean, certainly if you're sleep-deprived, it's hard to get up in the morning, but studies show for people with ADHD, even when they're getting ample amounts of sleep, it's like waking up the dead in the morning, really, really difficult.
So we see this whole sort of area with sleep, and what we know is that the ADHD brain and sleep centers in the brain that really rely on arousal and all those centers in the brain that are implicated with arousal and motivation, we see are hypo-activated, which means they're not activated enough, with ADHD as well as with sleep. And then you put on top of that all the behavioral aspects that people with ADHD often will procrastinate things until the nighttime or might get themselves involved in very high stimulating activities in the nighttime that make it difficult to go to sleep, and also the willingness to want to go to sleep.
I mean, I can certainly relate. I mean, it's changed for me. I would say in the last four years I've become more of a morning person which is very odd for me to even utter those words, but I love the night. I mean, there's something about no one is going to bother me. At 1:00 in the morning, I'm not expected to do anything, and sometimes in college my greatest thinking in writing papers was at 1:00, 2:00 in the morning because there was no distraction.
Pete Wright:
Yes, a hundred percent.
Dr. Roberto Olivardia:
So there's an element to it there where it's not just a... it feels almost like not just like a choice, and at the same time to know that there are these biological underpinnings. When I got a sleep study, and I can tell you my experience with sleep apnea in a moment, but one of the things that was revealed in the sleep study I got was I have something called the delayed sleep phase syndrome or DSPS which is quite common in people with ADHD. What it is is basically a circadian rhythm abnormality which is almost like at 10, 11 o'clock when a lot of people are winding down, a lot of folks with ADHD are winding up, and it's not even due to stimulation, it's just internal. I could definitely relate to that where I just felt like this rush of energy and it wasn't until 1:00 or 2:00 in the morning that my body was finally getting tired.
Pete Wright:
Sure.
Dr. Roberto Olivardia:
And when I-
Pete Wright:
Can I interrupt you?
Dr. Roberto Olivardia:
Sure.
Pete Wright:
I mean, I got this question. Everything you're talking about, and plus you just mentioned a sleep disorder, what is the difference between ADHD-related difficulty sleeping and a diagnosed or diagnosable sleep disorder, right? We're talking somewhere about the Venn diagram of where they meet, but since this is a comorbidity series, let's talk about how do we separate the two things.
Dr. Roberto Olivardia:
Yeah. So it's important to know that people with ADHD, and multiple studies have shown this, are at higher risk for all of those sleep disorders and then sleep difficulties. So we know though that even aside from diagnosable sleep disorders that the difficulty of winding down, getting to sleep at a certain time. I mean, I remember when I got a sleep study and you fill out this long survey and my doctor said, "How long does it take for you to fall asleep from the time your head hits the pillow?" And I said, "Oh, I fall asleep instantly when my head hits the pillow." And she's like, "That's not..." And she goes, "What time are you going to bed?" And at that time, I think it was like 3:00 am.
Pete Wright:
3:00.
Dr. Roberto Olivardia:
She goes, "Well..."
Nikki Kinzer:
Of course you're tired.
Dr. Roberto Olivardia:
You're exhausted. You should have been asleep five hours ago. She said, "Typically people are awake like 10 to even 20 minutes before they fall asleep." I'm like, "Are you kidding me?" I said, "In that moment of time, my head is going to be in the..." I'm going to be so activated because either I'm going to start thinking about something I'm anxious about, I'm going to be thinking about something I'm excited about, I'm going to be thinking about, ooh, what's my next day. I have many mantras of trying to just ease my mind, and one of them is you're not going to solve any of the world's problems right now in this dark room at 1:00 in the morning, Roberto. Go to sleep. Because I get creative ideas when I'm... So for folks who maybe-
Pete Wright:
I have to shut it down with, I have to put AirPods in. When I go to sleep, I listen to a book that I've heard before. I have to bore myself to sleep at this point.
Dr. Roberto Olivardia:
Yes.
Pete Wright:
And it still takes that time, but at least I don't feel like that excruciating anxiety of I'm never going to sleep again, right?
Dr. Roberto Olivardia:
Yeah.
Pete Wright:
I can't sleep so I'm broken and I'll never go to sleep. But I can sort of exhaust my system a little bit.
Dr. Roberto Olivardia:
Well, yeah, I mean if you think about even the process of sleeping, I mean, one of the best quotes from an ADHD conference, I think one of the first ones I went to, someone said, "For someone with ADHD, sleep is lying in a dark room waiting for nothing to happen."
Pete Wright:
Yeah.
Nikki Kinzer:
Right.
Pete Wright:
That's so good.
Dr. Roberto Olivardia:
You're just like, "What am I doing? Let's get this on the road. Come on, let's get to sleep."
Nikki Kinzer:
This is not okay.
Dr. Roberto Olivardia:
"We need to move along." And if you think about what it requires, we are lying in a dark room, there's no stimulation, and we're supposed to just kind of ground ourselves, and we know with an ADHD brain we're constantly looking for stimulation which makes that bridge very difficult of getting to sleep.
Now, what you describe, Pete, is one of the strategies, and this is where understanding the ADHD component is super important because it can feel paradoxical, as a lot of things with ADHD may be, whereas you're introducing a stimulus, aka the book, which to a lot of non-ADHD people would keep them up. They're like, "I'm listening to this book, I'm not going to be able to fall asleep." But now your brain is getting a stimulus, but it's not stimulating because it's a book, like you said, you've heard multiple times, and this is with patients of mine, if we were playing Family Feud, the number one answer is the Harry Potter books. For some reason, a lot of my ADHD of all ages will say-
Pete Wright:
Listen to the Harry Potter books.
Dr. Roberto Olivardia:
... the Harry Potter book. I've never read any of the Harry Potter books, but apparently the narrator who does the Audible version is fantastic. Or people will say they put on a TV show of a show they've seen a million times, or what I do is sometimes I'll play like Enya or a very sort of soft artist and I'll play-
Pete Wright:
Classic.
Dr. Roberto Olivardia:
Classic.
Pete Wright:
Classic, yeah.
Dr. Roberto Olivardia:
I'll put the same song though on repeat. It has to be the same song because even if it's a different song, there's novelty there, and it has to be-
Pete Wright:
It's Orinoco Flow, right? I mean...
Dr. Roberto Olivardia:
Oh yeah. I mean, anything of Enya.
Pete Wright:
I mean, always, but I just want to make sure.
Dr. Roberto Olivardia:
I can sing her praises, she's a brilliant, brilliant artist, but it has to be of low enough volume that I'm not overstimulated but I have to hear it so that I'm getting enough of it. So now my mind focused on one thing as opposed to 50 things. And so that's one of those things for parents when I'm working with parents around this that they're like... I could give you an example because I have two kids, they have both have ADHD and dyslexia, and my son who's now 19, who literally in a week is finishing his freshman year of college which I can't believe, but when he was a kid, you have those baby swings that you put the baby in and they have little lullabies and you put on slow, and he just would not fall... He's his father's son.
This is also to talk about how neurologically wired, this is since infancy. My mom would tell me stories that, as an infant I was nocturnal, and I'm the youngest of three, and she told me the story once where I was not going to sleep and I didn't have colic. She goes, "I was looking for a party in the crib."
Pete Wright:
Sure. Sure.
Dr. Roberto Olivardia:
And she called the doctor. She's like, "I keep..." I have two other, my brother and sister are six and five years older than me. The doctor said, "Have your other kids just stimulate him, keep him up all day and he'll just conk out in the night." So that's what my mom said. My brother and sister played with me all day and I was up all day and I was up all night. I still didn't fall asleep.
Nikki Kinzer:
Oh no.
Dr. Roberto Olivardia:
And my mom was like, "Oh my god." Now my mom, she had ADHD, I mean, very clear, and she had sleep issues throughout her life. So this is sort of a genetic component as well. But going back to my son, we put him in the swing, he wouldn't fall asleep. You'd turn the knob, and I'm not kidding, for people who can't see the video, just imagine a swing going like... like really fast. I mean, it almost looked abusive, like he's going to fly off this thing, and lo and behold, his eyes would get heavy and he would fall asleep.
Pete Wright:
Stimulated, yeah.
Dr. Roberto Olivardia:
It was almost like the equivalent to being on a roller coaster. I mean, I couldn't even believe that it went this fast, this swing.
Nikki Kinzer:
Wow.
Dr. Roberto Olivardia:
And we would watch it and he would... When I would sing to him, because we're big music lovers in our house, I never sing like << lullaby >> I would sing like Nirvana and Green Day songs, I'm not kidding, in loud octaves.
Nikki Kinzer:
Wow.
Dr. Roberto Olivardia:
And he would fall asleep and ground himself. So yeah, and I would tell my friends as they're like, "What are you talking about?" I mean, anytime people would buy those lullaby CDs, that never worked for [inaudible 00:14:18]. It had to be something more stimulating.
Pete Wright:
You said something interesting that I want to go back to because when the sleep study person asks you, "What time are you going to sleep?" and you say, "Three o'clock," my understanding is there is benefit, like physiological benefit to going to sleep some hours before midnight, right? If you can kind of safely target that zone, you're getting better sleep. That seems like a massive mountain if you have been struggling with getting to sleep because of ADHD or something else.
Dr. Roberto Olivardia:
Definitely.
Pete Wright:
Can you talk about what the benefits are, and maybe make the case for people who are struggling and have just let go? Why should you maybe try to focus your sleep in these different hours?
Dr. Roberto Olivardia:
It's a great question because I remember when I heard studies that show that it's not... I mean, the number of hours you sleep is one factor, but when those hours are are very, very important, and I have to tell you, I was mildly depressed the day that I heard that going to bed at 3:00 and waking up at 9:00 am which is typically-
Pete Wright:
Not the same.
Dr. Roberto Olivardia:
... is not the same as going to bed at 11:00, waking up at 6:00 or 7:00. We are meant to sleep when the sun is down and to wake up when the sun is up, and there are studies looking at even of night workers, and not just people who one might argue would gravitate to doing night work, but even control studies where they've sampled randomly selected people and had said, "You're working the night shift and we're going to put you in the day shift," and controlling for other variables, the people who work night were more likely to have depression, we're more likely to gain weight, we're more likely to have a lot of emotional dysregulation. We're really meant to sleep when the sun is down. And I was like, "Ugh, are you kidding me? Here I thought I was hustling and getting away with it."
But I think let's go to why is sleep important because it's one of those things that... And as an ADHD person, we know we hear these things, it's like blah, blah, blah, blah, blah. I need to know really what makes it very relevant. So sleep we think of as a very passive process. It's actually not. It's a very active process. There's a lot happening, and what I tell people is imagining when you're going to sleep there are all these elves, in particularly your brain but in all your body, and they're shining up all these parts, particularly of your brain.
We have our neurons in our brain and there's something called myelin which is basically thinking of it as like a jelly-like insulator on a neuron, and the more myelin we have, the quicker those messages get communicated from one neuron to another to another to another. So our ability to process things, our executive functions, and all that sleep promotes myelin growth and sleep deprivation erodes myelin growth. This is not a scare tactic. I mean, this is just science that there is a lot of studies looking at. You are really increasing your risk of dementia in later life and Alzheimer's disease, and one of the contributing factors is sleep deprivation which kind of scares me honestly a little bit.
Pete Wright:
Wow.
Dr. Roberto Olivardia:
My mom was in the early stages of dementia before she passed. So now when I heard that research, that's what it takes for me to be like, "Oh, yeah, yeah, yeah, we're working on this," because I care very much about my health and I can get obsessive actually about my health. So when I heard that and I could see directly sleep deprivation is eroding this kind of growth which is protecting the brain, especially as you get older... The other thing that happens in our sleep is our immune system is being like shiny-ed up again, so to speak. I have definitely had that where I push it and I push it and I don't sleep enough, and then boom, I have shingles and I'm like, "Why do I have shingles at 32? Who gets shingles at 32? Oh, I was sleeping three hours a night for two weeks straight. That's not healthy."
Pete Wright:
What's the relationship to memory too?
Dr. Roberto Olivardia:
Memory, absolutely. If people know what a defragmentation process is on a computer.
Pete Wright:
That's old school comparative, that's old school.
Dr. Roberto Olivardia:
Yeah. So I'll put it in this way. So imagine that you are in a library and people take out books off the shelf, but instead of putting the books back in the right spot, they put it on a cart and then the librarian at the end of the day puts them back. Now at the end of the day, there are lots of books that are out of order. So now if I'm looking for a book and I look on the shelf, it might not be there. I might have to go through the piles of books on the cart, and it's not until the librarian puts them all back. So a defragmentation, old school term, with computers, and I'm not even a computer person, but it's basically grouping like items together in data points, and our brain does that when we sleep. And so think of it as the librarian is putting all the books back according to the Dewey Decimal system so that tomorrow you have quicker access to getting that book instead of inefficiently going through piles and piles of books.
Nikki Kinzer:
Trying to find it.
Dr. Roberto Olivardia:
Trying to find it, and sleep really helps with that. That's a big part with memory consolidation. So with college students, and thankfully my son, one is because I was so strict about sleeping because of my own issues growing up, my son's like, he's a dad. I don't think I could pull an all-nighter even if I wanted to. I'm done like at eleven o'clock. I'm like, "I have done my job."
Nikki Kinzer:
Right. Mic drop.
Dr. Roberto Olivardia:
Because I was just beginning at that time. But with students is the idea of cramming and pulling all-nighters, which I did all the time, is baring and taxing that system. The best thing you could do actually to prepare for an exam is to get a good night's sleep-
Nikki Kinzer:
Sleep.
Dr. Roberto Olivardia:
... because the librarian is putting all those books that makes it easier for you to access during the process of an exam. So it's doing a lot.
Pete Wright:
That's the thing that I think is so powerful. The things that you've just talked about, we're talking about memory, we're talking about myelination, we're talking about your immune system, all of these things that ADHDers struggle with are directly related and essentially improved by just figuring out your sleep issues, just trying to put some attention to sleep.
Dr. Roberto Olivardia:
Definitely.
Pete Wright:
That's incredibly powerful.
Dr. Roberto Olivardia:
Because poor sleep exacerbates all of those ADHD symptoms. But what is important though, and to validate though for people with ADHD, and again, my own experience, I did not have the negative impact of sleep deprivation in an obvious way. I'm not one of those people that is irritable the next day. Now some people may be, but that kind of worked against me because I'm like, "I feel fine." In fact, I had more energy, and so there's almost this like high sometimes that you're sort of getting.
Pete Wright:
Sure.
Dr. Roberto Olivardia:
Not in a clinically manic way, but in somewhat of a hypomanic kind of sense, and a lot of my patients will say that. They're like, "When I get three hours, that next day I'm like, I don't know, I almost feel like I'm riding higher." But then eventually-
Pete Wright:
But how are you the next day after that?
Dr. Roberto Olivardia:
Exactly.
Nikki Kinzer:
Yeah. Or the weekend
Dr. Roberto Olivardia:
Or the weekend. It'll crash. This is something that has been, I mean, really again, probably in the last decade that I feel like I finally got in order because I would say there's this almost sense of, oh, I can push it a little further, I can push it a little further. And then certain then I'm getting laryngitis, I got mono, I get shingles. It's just the body is not getting those cues on the short term which means now you're really pushing it on the long term. So now I'm actually grateful that my body finally responds if I don't get a good night's sleep, I feel it now the next day.
Pete Wright:
So you have a message, you have a [inaudible 00:22:47], yeah.
Dr. Roberto Olivardia:
And I have a message, and I'm actually like, "Oh, thank goodness, I'm irritable. Yes."
Nikki Kinzer:
Mm-hmm. Mm-hmm. I'll purposely make sure I don't nap because I want to get to bed early that night, and then I usually will have a good night's sleep because I'm not napping. I don't know what your thought is on that, but I am curious, well, curious about napping, and I'm also curious about this thought of, oh, I can catch up on the weekend because I hear that a lot too.
Dr. Roberto Olivardia:
So this is another, I'm going to bust this myth and it's going to sound depressing. Once you lose sleep, it's gone.
Nikki Kinzer:
Gone.
Dr. Roberto Olivardia:
You are never making up for it. It's just gone. And so what's happening is that on the weekends we're just sleeping more because we're just exhausted. But when we use that term, and I'm very specific with language and it's so important, when we say I'm making up for it, meaning that whatever impairment that we've done to our body that that's going to be repaired in the week, that's not happening. The damage is done. And so now we're just maybe getting extra sleep in the weekend to maybe prevent further damage, but it's happened. It's like if somebody punches you really hard, it's done.
Nikki Kinzer:
Yeah, it's still there. It still hurts, yeah.
Dr. Roberto Olivardia:
Yeah. It's just still there. The bruise is still there, and you can put an ice pack on it and that'll help and a heating pad, and we want you to move away so the person isn't continually punching you, but that punch has happened. So that's so important, and again, when I heard and read the research on that, I was like, "Oh." It's just like, because I do care about my health, and a lot of people with ADHD do. As we know, having ADHD is that disconnect from our values and our behavior, and so we do have to sort of make it that concrete for people to be like, "This is why it's really, really important." So your question on napping, so it really varies. Now I am not a napper. If I nap, I am going to wake up feeling more groggy and more irritated than I did before.
Pete Wright:
Hallelujah. Me too.
Nikki Kinzer:
Yeah.
Dr. Roberto Olivardia:
Never worked for me. Again, back in infancy, my mom said I gave up naps earlier than the typical age. Both of my kids gave up naps at early ages. Now I have an older brother who, we all have ADHD, he is like a power napper. He could take like a 20-minute nap and feel refreshed, and it works for him.
Pete Wright:
So weird.
Dr. Roberto Olivardia:
It's so weird to me, exactly. So it really varies as long as the nap though. But a nap is really anything less than an hour typically, because if we're sleeping, if we're napping more than, and I'm using air quotes, more than an hour, we're sleeping but now we're just sleeping for a little bit of time which actually is more frustrating to the brain because now it's like sleep deprivation. If we're napping for two hours, our brain is like, "Ooh, we're sleeping. We're going to go through the four stages of sleep [inaudible 00:25:51]-"
Pete Wright:
Of course, yeah.
Dr. Roberto Olivardia:
"...and now we're awake, oh," and then it's like it's sleep deprivation. So some people are refreshed and as long as it's not impacting their ability to go to bed that night, and the same way with caffeine. I could drink a cup of coffee a half hour before bed and I'll be fine. In fact, sometimes I honestly think it helps me fall asleep because I'm focused on falling asleep. It's like stimulating.
Pete Wright:
Stimulate. Yeah, right, right.
Dr. Roberto Olivardia:
There are a lot of other people with ADHD, if they drink caffeine after 1:00 PM they can't go to sleep that night. So it's just being aware and taking data individually.
Nikki Kinzer:
For you, yeah, yourself, yeah.
Dr. Roberto Olivardia:
Yeah.
Pete Wright:
So we've dropped a number of numbers, right? There's three hours that's been kind of our colloquial, we're sleep-deprived. We've heard eight hours is about what you should get, but I want to make sure we understand because we hear a lot of people talk about I can function on say six hours of sleep, I can function on four or five hours and be fine. When technically are you depriving yourself of sleep, and is there any truth to you sleep as much as you need to sleep, that it's somehow unique to you?
Dr. Roberto Olivardia:
Yeah. So there is a range. I mean, the Sleep Foundation, sleep medicine doctors have general rules, or guidelines I should say, of that in adult we typically get anywhere from seven to nine hours of sleep is healthy. When we're teenagers, like 10 hours of sleep actually and now how many teenagers are getting 10 hours of sleep. I mean, as a whole, we are more sleep-deprived in our culture than we ever have been, and there are ramifications that we're seeing not only mentally but as I mentioned physically, like proper sleep also regulates our metabolism. And so guess what happens, I mean, when we're not sleeping well is we tend to hold onto body fat more, we tend to crave more high fat, high caloric food. And so one of the contributing causes actually, one of the many multimodal causes of obesity is sleep deprivation.
Pete Wright:
Sleep deprivation, yeah. Wow.
Dr. Roberto Olivardia:
That can motivate people too is you not only are going to make better choices in what you eat because your executive functioning is better when you sleep more, but when we're sleep-deprived, and this is our evolution at play, there are hormones in the body that literally say, "Oop, okay, if this person is up during the night, they're burning calories. We have to conserve those calories, so we're going to hold onto that body fat as much as possible." So even if you're working out, I've had patients who maybe sleep four hours a night and they're like, "I don't know why I'm not losing the weight. I'm working out." I'm like, "Your body's not getting rid of that body fat because you're not sleeping in that way." So there are these ranges.
Now having said that, there are individual differences. One way of doing it is going to bed, let's say on a weekend, and not waking up to an alarm and see how many hours that is where you feel refreshed because sometimes people can sleep, and sometimes with ADHD, particularly inattentive types, sometimes they have issues with sleeping too much. They'll say they're in bed 10, 11 hours and they're still tired and groggy. There is such a thing as having too much sleep because now your body is almost like, "Okay, we need to get going." For example, I'm like a six to six and a half hour sleeper. I wake up before my alarm most of the time, and I feel good with that. My mom was someone who really didn't require a lot of sleep.
Now having said that though, five hours is not like a little bit of a difference though for me. It's like a big gap though. So if I get five and a half hours, that's a more pronounced feeling to me than if somebody let's say is getting eight hours and maybe they get only seven and a half hours. That might not be as much of a pronounced gap in terms of... So it's like a thin line for me, but I've never been... I'd have to be sick with the flu to be asleep for nine hours. I've never been that person, but I certainly had those times in my early life where I'm like, "Oh, I can get by on four hours sleep because, hey, I'm doing all of these things." And then what we also we always want people to keep track of is, well, one, are you doing those things optimally, and B, is there a fallout that maybe you're not paying attention to.
Pete Wright:
Give an example. What are the kinds of things we're talking about?
Dr. Roberto Olivardia:
So are you sick? In graduate school, I remember a student, one of my classmates saying, "Do you still have that?" because I had a cold that was literally like six weeks. And he said, "Oh, do you have another cold?" And I'm like, "No, this is that same darn cold I can't get rid of." And he's like, "You've had the same cold for six weeks?"
Pete Wright:
Six weeks.
Dr. Roberto Olivardia:
And I'm like, "Yeah. Don't people have colds for a long period of time?" He's like, "No." He goes, "I have a cold that lasts like three, four days or something." I'm like, "Really?" But do you know why I had a cold for six weeks? Because I never allowed my body to stop and to just sort of rest, and build my immune system.
Nikki Kinzer:
Rest.
Dr. Roberto Olivardia:
I used to get laryngitis all the time, I mean, to the point that I named him Larry. I mean, I personified my illnesses, and my friends at the ADHD conference would know because sometimes Larry would be coming to town. I'm like, "Oh my gosh, Larry." I mean, it sounds so, I don't know. I even look back and I'm like, "What was I thinking about this?" But it would get to a point sometimes where literally I could not talk like for two days. I would blow my vocal cords out. What would my doctor say to me? "You need to sleep and you need to just drink. Hydrate and sleep. Hydrate and sleep." And I'm like, "Oh, I'll hydrate, but I can push..."
Now when I feel Larry coming to town, the first thing I do, I'm like, "I am getting sleep," and it might be more than the six hours. Sometimes it could be like seven. And then, oh, Larry decided to take a detour. He's not visiting me anymore. That's all I needed to do. I mean, sleep deprivation, I always tell people there are things in our body that we may not even be aware of that are being taxed because of poor sleep or an undiagnosed sleep disorder that when treated, you realize, "Oh my gosh, all of that had to do with sleep."
Pete Wright:
Yeah.
Nikki Kinzer:
So I'm curious about that, going back to the disorder. So when do you know it's a disorder and you need some kind of treatment?
Dr. Roberto Olivardia:
Yeah. So a lot of times with disorders it's when you realize, okay, this is not just a behavioral thing and this is something that's not just a matter of finding the right pillow, getting good music on, that there's something else sort of happening. I was always a snorer, and my brother and I shared a room growing up. I remember as young as seven, my brother would complain to my mom, and I was a short, skinny kid, and he'd be like, "I don't know how this sound is coming out of him, but he sounds like," referring to me, "he sounds like a drill." But I never thought anything of it. I'm like, "Okay, yeah, roommates of mine in college are talking about my snoring."
It wasn't until I had a patient with ADHD and sleep apnea, and I didn't know much about sleep apnea. My vision of it was, oh, people wake up in the middle of the night and they're gasping for air. They can't breathe. I didn't have that experience. I'm reading about it and I realized, oh. No, in fact, most people are not consciously waking up and knowing they're gasping for air. I'm reading this, I'm like, "Hmm, I have a lot of these symptoms." So I'm like, "Let me..." I talked to my doctor, he's like, "Yeah, get a sleep study." First of all, I want to implore for anyone out there who snores or thinks they have sleep apnea, please, please, please get a sleep study because it's a game changer in your health, and I'll put this in a nutshell. So you need 20 events where you're either not breathing or your oxygen levels are super low. 20 events, an average of 20 an hour over a period of three hours to get diagnosed with sleep apnea.
So I'm in the sleep lab, I'm thinking, "I'm not even going to fall asleep. I normally fall asleep at 2:00 in the morning and I have all these wires on me." And they said, "Well, a lot of people say that, but it's kind of boring in here, people end up falling asleep. If you do have enough events, we may wake you up and put a CPAP machine," which is a machine of pressurized air, and I'm like, "Okay. "But we want at least three hours data." So I'm lying in this room thinking, "I'm not going to fall asleep. Oh, I'm so bored." What I think is five minutes later, they wheel in the CPAP, and I'm like, "What are you doing? I thought I had to be asleep for three hours."
Pete Wright:
Wow.
Dr. Roberto Olivardia:
They said, "Sir, you've been asleep for three hours." I mean, it was freaky.
Nikki Kinzer:
No idea. Yeah.
Pete Wright:
Wow.
Dr. Roberto Olivardia:
I was like, "What?" And I look at the clock and I'm like, I literally had the consciousness that I was lying in this room for five minutes, and I'm like, "Okay." So I was told it would take about five weeks to go through all the data, and I told them, because I have Fridays off, I said, "Any Friday if you have a cancellation, if the data comes earlier, I'm anxious to hear." I had the sleep study on a Monday. That Thursday night I get a call and they said, "Oh, we have an opening for tomorrow." And I'm like, "What? I thought you needed five weeks. What are you taught?" And they said, "Oh no, we have the data." Now what my doctor, who was awesome, didn't tell me was they needed me in there immediately because I had 98 events an hour. 98.
Nikki Kinzer:
Oh, wow.
Pete Wright:
Whoa. Wait a minute. I need a flag on the field.
Dr. Roberto Olivardia:
Yes.
Pete Wright:
Can you describe what exactly these events are doing to you? Are you slightly suffocating?
Dr. Roberto Olivardia:
Yes.
Pete Wright:
I don't mean to make that a parade.
Dr. Roberto Olivardia:
I was like, "Balloons, yay."
Nikki Kinzer:
Good job.
Dr. Roberto Olivardia:
But honestly, you know what, Pete? Those balloons are actually justified because I am so grateful that I got this diagnosis and now I sleep with a CPAP machine. So what is that doing to me? When I met with my sleep doctor, her name was Dr. Carden at the time, and she said, "I have been doing this for many years. The highest number I saw was a man in his late sixties who smoked three packs of cigarettes a day, he was severely overweight, and he had 68 events an hour," and I had 98.
Pete Wright:
And you had 98.
Nikki Kinzer:
98.
Dr. Roberto Olivardia:
I said, "Well, I'm an overachiever. What can I say?"
Nikki Kinzer:
No kidding.
Dr. Roberto Olivardia:
So she said, and I appreciated this, she was very blunt, and she goes, "There is such poor compliance with CPAP machines. People don't like to... But I'm going to tell you why this is important." And I was like 32 at the time. She said, "You're an otherwise healthy guy." I don't smoke. I don't drink any alcohol. She goes, "But if you don't sleep with the CPAP," she goes, "You should get..." I had a deviated septum also in my nose, she goes, "You should get a septoplasty. That'll help with daytime breathing, but your anatomy is totally crowded in your throat. You were getting zero oxygen through your throat."
She goes, "And let me tell you why this is important," and she showed me the reading of what my heart was doing. And to your point, Pete, she said, "It is like somebody's putting a pillow over your face for a couple seconds and then taking it off and then putting it back on for 10, 11 seconds and then taking it off." I saw that graph with my heart was like, boom, boom, boom. I had to go through these cardiac tests because she says, "After 30, there's often cardiac damage done, irreparable cardiac damage."
Pete Wright:
Oh my goodness.
Dr. Roberto Olivardia:
Thankfully, my heart was fine because otherwise healthy person, but she said, "If you don't use a CPAP, and I'm going to blunt, by the time you're 50," which I'm 51 now, she goes, "you are at serious, serious risk of dying of a heart attack in your sleep."
Nikki Kinzer:
In your sleep, yeah.
Dr. Roberto Olivardia:
"Everyone will wonder what happened. How did that happen?" She goes, "There are a lot of deaths of people who die in their sleep, and it's not categorized as undiagnosed sleep apnea because it can't really be proven, but a lot of people who have heart..." And I was like, "Enough said, give me the CPAP. I will use it." I hated it for the first five weeks, but it was undeniable what this machine did. I mean, and just like I mean, Larry for laryngitis, my CPAP is Pappy. Me and Pappy are good amigos and we get along.
Nikki Kinzer:
You're good friends, yes.
Dr. Roberto Olivardia:
We are such good friends. We travel everywhere together. He is my lifeline. And going to the weight thing, the first month I used that CPAP, I lost 12 pounds doing really nothing.
Pete Wright:
Wow.
Dr. Roberto Olivardia:
I didn't even enjoy, eating habits, or I used to have bad acid reflux, never had an issue of acid reflux, all these things that I never even attached to sleep, and for the first time in my life, I woke up after using the CPAP and I felt refreshed. I never related to that.
Pete Wright:
Interesting.
Dr. Roberto Olivardia:
When people like, "Oh, what a great sleep, I feel so refresh," I'm like, "I never feel..." Even when I got enough sleep, I'm like, "I'm just glad it's done and I'm out and about my day."
Nikki Kinzer:
Mm-hmm. Mm-hmm.
Pete Wright:
Yeah.
Nikki Kinzer:
Wow. That's interesting.
Pete Wright:
Incredible, yeah.
Dr. Roberto Olivardia:
So please for people out there because if you think you have sleep apnea, please know that this is not just about not being a snorer for yourself or your partners. This is heart health that's at stake.
Nikki Kinzer:
Yeah.
Pete Wright:
Wow. Okay. All right. Well, I need a sleep study.
Nikki Kinzer:
I know.
Pete Wright:
That's on the list.
Nikki Kinzer:
Now I have a question going away from disorders but then going onto the behavioral part, because in coaching, when I'm talking to clients a lot and we're talking about sleep and the importance of it, and like you said, it can make your ADHD so much worse the next day. When you don't get the sleep and you're not eating well, ADHD's going to be very loud. But I also hear a lot of times where what's keeping you from going to bed, and it's the distractions of Netflix and being on your phone and doing games and time blindness then kicks in because you can be on Instagram for an hour and it feels like five minutes.
Dr. Roberto Olivardia:
Absolutely.
Nikki Kinzer:
I mean, it's crazy how fast that time goes. So how do you start to curve that behavior to get to bed earlier? Any thoughts and ideas around that?
Dr. Roberto Olivardia:
Yeah, and this is where I'm so happy I grew up when I did-
Nikki Kinzer:
Without, yeah, I know.
Dr. Roberto Olivardia:
... without it, because it undoubtedly would've been a problem, without a doubt would've been a problem for me. That's why as a parent, I was so strict about this and I would tell my kids, "The reason I'm going to be super strict on this is I can understand how difficult it is to manage that." So it really is this sort of vortex that we get sucked into. Who doesn't like watching a good Netflix show at the end of the night? And then it's like, oh, there's only eight episodes. I just went through Baby Reindeer, that show on Netflix, and I'm like, "Oh." I was on episode seven of eight, I think it was. I'm like, "Oh."
Pete Wright:
How do you stop?
Dr. Roberto Olivardia:
I have to stop. I'm like, "Nope, I have to," and I did, and I actually stopped and I'm like, "I'll save the last episode for tomorrow." That would've been impossible for me to do years ago. It just wouldn't. I think it does start with the why, why is it again, as we've been talking about, important to even to get sleep, and then it's this sort of mindfulness around these habits and being honest with ourselves. Can we stop at episode seven of eight? Some people can. Some people can't. And so should we start watching that show at that late hour or maybe start on a Saturday night where maybe we have a little more flexibility of waking up a little bit later the next day, or just starting it at 7:00 pm instead of 9:00 pm? Should we be gaming at 10 o'clock at night?
Again, with any of these, I never have... It's so important that we don't have these blanket statements because if you take something like exercise, for example, that I used to do my working out at this 24-hour gym, and I work late on Tuesdays and Thursday nights till 9:00 pm and then I'd go to the gym and I'd have an intense workout at 10:00, 10:30. There was like eight of us at the gym at this hour, we'd all be like, "Hey." I would come home, I'd take a shower, and I would sleep better that night having just worked out. Now that could be super activating to a lot of people. So I always ask people because I do have some teens that sometimes they game like 9:00 to 10:00 pm and it actually does ground them and they're able to go to sleep. Okay, the proof is in the pudding. Let's see the data. But now if you're gaming and now you're wired and you're like, "Oh, I can't stop because I need to get to this next level," then we have to start being honest with ourselves of what we're doing.
I love the show Law & Order: Special Victims Unit, very dark. I mean, it's a very difficult show. The writing is incredible. I can't watch that show right before going to bed because it upsets me too much. I'm so riled up. So even when I have TV shows, and a lot of times I'm doing some paperwork or something while having, but it's usually sitcoms, something light, or stand-up comedy, something like that that it can't be that cerebral for me because otherwise I'm going to be... So we have to be mindful of what are the behaviors that we're doing and what are we starting. So if I start something even at 7:00 pm, I have to think to myself, "Okay, is this something that if I'm on a roll I'm not going to want to stop doing?" And if that's the case, either A, I have to have some other benchmark to make sure that I stop at a certain time or some accountability around it, or maybe this isn't the right time to start doing the task.
Pete Wright:
Put a timer on your junction box on your house that shuts off all the power at 10:00.
Dr. Roberto Olivardia:
Yeah, oh yeah.
Pete Wright:
I think that's a surefire way.
Dr. Roberto Olivardia:
I mean, there are those apps that block you, they do that, lock it down.
Nikki Kinzer:
Yeah, that do that.
Pete Wright:
Yeah, that lock it down.
Dr. Roberto Olivardia:
And I think absolutely, I mean, as we know with ADHD that it's as long as you're not hurting yourself or anyone else, whatever works, do it.
Pete Wright:
Yeah. It takes the decision away from me, takes the choice away from me.
Dr. Roberto Olivardia:
Yes.
Nikki Kinzer:
Yeah, and what I hear is being so intentional, really think about what is going to affect your decision. Is this something you can stop or is this something that you can't stop? Then maybe it's not the right time. So you're being very intentional with your choices. Something that we've done, and this just works for my daughter and I and my husband, is that after nine o'clock we don't start anything new.
Pete Wright:
If you're in the middle of something, you're okay.
Nikki Kinzer:
So if we started something, we can finish it, but we don't start anything new after 9:00, and then that way we finish whatever we can, but we know that we'll all be going to bed usually between 9:30 and 10:00. That's been sort of a rule that we've been able to stick with. But that can be, I can see too, there are those nights every once in a while, oh, we'll just do one more, but it's not all the time. I mean, we are pretty consistent. So that's what I'm hearing you say too is having some kind of boundary or timeframe that you're looking at.
Dr. Roberto Olivardia:
Definitely, and to know it's not going to be foolproof in that way.
Nikki Kinzer:
No.
Dr. Roberto Olivardia:
Like anything else, whether it's exercise or healthy eating or any health behavior, even if you're doing it right like 50% of the time, that's significant in terms of a health impact, a health index and that.
Nikki Kinzer:
That is such a good call because it is so easy to be all-or-nothing thinkers.
Dr. Roberto Olivardia:
A hundred percent, yep.
Pete Wright:
For sure.
Nikki Kinzer:
So even if you can do it half of the time, that's a huge win. Even if you can just do it one night, that's a huge win. Right? Yeah.
Dr. Roberto Olivardia:
Yeah, because with some of my patients, and I tell them, "I want you to be honest with me because I don't want you to say, 'Oh, yes, yes,' and then you know, like, 'I'm not going to get nine hours of sleep. Is he crazy?'" And they are, and I said, "Okay, so realistically, if you know you're going to get five hours of sleep tonight, five hours, what if you say you can't go more than two nights with that sleep deprivation? Then at least by third night you're getting seven and a half." That at least stops the bleeding, so to speak, in terms of the health impact that even if every two or three nights you're getting good night's sleep, think about that over time, is huge. You're right, I mean, I definitely can be very all-or-nothing about these things. I think when I think of it visually, it's like, well, no, in the same way that if one of our tires flattens if we're driving, we don't think, "Oh, you know what? I'm going to stab the other three tires and flatten [inaudible 00:48:05]."
Nikki Kinzer:
Right. Because that just seems like the right thing to do.
Dr. Roberto Olivardia:
Exactly. Let's be consistent. Let's them all just be on equal level. No, we're going to stop and change the one tire. But it does, sometimes it feels like it makes more sense, and I've had this, and I've had patients tell me this all the time. They're like, "Well, if I know I'm only going to get four hours sleep, I might as well just stay up all night because it could be harder to wake up in the morning." So it's like, no, your body, there's a big difference even getting four hours and getting nothing in that way.
Pete Wright:
Well-
Dr. Roberto Olivardia:
Yeah, go ahead.
Pete Wright:
Well, I was just going to say we're running very close to the end of our time that we have with you today, and I know we have a couple of listener questions for those who are members and are sticking around for the member post-show, and so I think, regrettably... I feel like we could talk about this for hours.
Nikki Kinzer:
A long time, yeah.
Dr. Roberto Olivardia:
Oh yeah.
Pete Wright:
But I think we need to wrap it up, and I'm just so grateful that you are here to help, I mean, because I've learned so much today, and I already think I'm pretty good at the sleep, but now I know why it's so important. I think this has been really illuminating. I hope listeners agree. Where can you send people to learn more about your work?
Dr. Roberto Olivardia:
So I don't have any social media presence at all, so I just tell people just shoot me an email and I can send them resources, roberto_olivardia@hms.harvard.edu. Or another place could be, I'm on the scientific advisory board for ADDitude, A-D-D-I-T-U-D-E, so the website is additudemag.com, and if you type my name in the search box it'll come up with loads of webinars and podcasts that I've done on sleep, on eating, on cannabis, on sobriety, I mean, lots of different topics, and that could be a way people can get info as well.
Pete Wright:
Perfect. Perfect. We'll put that in the show notes. Thank you so much. Thank you, everybody, for downloading and listening to this show. Thank you for your time and your attention. Don't forget, if you have something to contribute to the conversation, we're heading over to the show talk channel in our Discord server, and you can join us right there by becoming a supporting member at the deluxe level or better. On behalf of Nikki Kinzer and Dr. Roberto Olivardia, I'm Pete Wright, and we'll see you right back here next week on Taking Control: The ADHD Podcast.