Comment by tokenadult | Hacker News Reader

Comment by tokenadult | Hacker News Reader

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In general, most people (in the United States, the country I live in) need more sleep than they are getting. One way this is put to the test is by letting people relax in a comfortable reclining chair in a quiet, dark room during daylight working hours. Many people fall asleep in this condition, signaling that they are sleep-deprived, even if they have no regular habit of taking a nap in the daytime.

I have lived in a country (Taiwan) where a siesta, a mid-day nap, is quite a regular practice. The first time I lived there (1982-1985), I was only unlearning my American habit of sleeping only at night near the end of my stay. The second time I lived there (1998-2001), I was better able to adapt to napping in the middle of the day like my co-workers, perhaps because I had become a care-giving parent of young children in the meanwhile.

As the submitted blog post mentions, there is a research basis for thinking that symptoms of what is characterized as "lack of executive function" or "ADD" can be relieved just by getting sufficient sleep. It appears that one of the roles of sleep is letting the brain have opportunity to restructure based on new experiences while awake, so sleep seems to aid learning, planning, and attention control.

I had a friend back in my college days who was a very hard-working research scientist trying to find a cure for diabetes. Her claim, which she read somewhere back in the 1970s, was that an hour of sleep before midnight is just about as beneficial as two hours of sleep after midnight. It does seem to me that I wake up especially rested on the rare occasions when I am fully asleep for the night before 11:00pm. As my own lifestyle changes over the next decade (= as my children grow up and live on their own), I will be eager to try the experiment of better matching my hours of sleep with the actual hours of darkness in my time zone.

AFTER EDIT: The top level comment by rayiner mentions allergies and writes

I jack up a humidifier

and I agree with his statement that it is worthwhile to figure out what helps sleep be deeper and less disturbed, including breathing without obstruction during sleep. Depending on what a person is allergic to, DE-humidifying may be the way to go. Dust mite allergies, for example, will be worse for a person who lives in a humid room. Good luck to all in your experiments.

I wonder how much symptoms of what is characterized as "lack of executive function" or "ADD" can be relieved just by getting sufficient sleep.

If you're a person who reads the description of ADD and says that it sounds like you, maybe a lot.

If you're a person who has the disorder, sufficient sleep is not going to make it go away.

>Ιf you're a person who has the disorder, sufficient sleep is not going to make it go away.

IIRC, the "disorder" is mostly a psychological thing, not something concrete.

And it's uptick can also be ascribed to the willingness of more doctors to diagnose something where there was nothing before (to assist in selling some drugs, among other things).

So the two situations you describe here are not at all contradictory.

I'll bet you $1000 that I've read more about ADHD than you have in the last year.

Dismissing a genetically transmitted brain chemistry problem as "mostly a psychological thing" is extremely unhelpful.

Genetically transmitted brain chemistry may well be involved, but sleep is necessary for all kinds of brain chemistry, too.

You can't have one without the other, perhaps .. perhaps, the reason we have the genetic scenario now, is precisely because lack-of-sleep, or at least sleep-culture-effecting-brains, has been an environmental factor over the period of our evolution where such things mattered.

I think the entire point is, if sleep helps you focus, then for goodness sake: get the proper amount of sleep.

You have completely missed the point.

Sleep is good. Get sleep. But people who actually have ADHD do not simply lack sleep. End. Of. Story.

Your speculation of lack-of-sleep being the cause of ADHD is laughably wrong. If it were true, then my son wouldn't have the disorder.

Its always those who have ADHD, or who somehow profit from its existence, who defend the condition vehemently, while those who question the science behind its diagnoses are always considered 'wrong' because 'mainstream society has accepted that ADHD is a cultural normality'. Well, in some societies anyway - there are plenty of places still left in the world where childrens' behaviours are not incorrectly assumed to be 'faulty, as a result of some flaw' just because the adults can't handle them, or because of some other cultural normative being applied from beyond the fringe of industrialized mental health practictioners.

But I would say to you this: there are other ways to deal with your problems than to form a dependency with a pharmaceutical company and a consumer-dependent relationship on other high preists of industrialized medicine. I know you won't accept that, given your position on the matter is pretty clear that of one who has succumbed to the problem, but the point of view that ADHD diagnoses and treatment is overly exagerated is an equally valid one.

Your son has a 'disorder' described to you by your high priests. However, maybe he just needs a better way of life, a healthier diet, more interaction, more outside time, less participation in a caustic, chemical society. You wouldn't know that, unless you tried to exceed the imposition of cultural 'normality' imposed on you by your society, by, frankly, leaving it behind.

Your son has a 'disorder' described to you by your high priests. However, maybe he just needs a better way of life, a healthier diet, more interaction, more outside time, less participation in a caustic, chemical society. You wouldn't know that, unless you tried to exceed the imposition of cultural 'normality' imposed on you by your society, by, frankly, leaving it behind.

You have absolutely no idea of how much of an asshole you are being right now. You have your opinion, absolutely no facts about my personal situation, are making a ton of assumptions, and yet think that YOU have the right to lecture ME on this subject.

For the record, my son gets a much healthier diet than is standard in our society. He gets several hours outside every day. We have never had a working TV in his life. As he has grown we have allowed him movies - typically under 4 hours per week. He goes for regular hikes. Yes, we use medicine, but only the minimum necessary to affect his ability to pay attention in school hours.

When he is not on medication, the following sequence is common. I can address him by name, he looks at me, and I tell him to put his socks and shoes on. This repeats 3x at 2 minute intervals. His socks and shoes remain not on, and when I ask him to tell me what I've been asking him to do he honestly doesn't know that I want him to put on socks and shoes. Not because he's malicious, but because he simply was lost in his thoughts.

Yes, that is a culture-specific requirement. But if he was being raised in a "natural hunting/gathering society" he'd be the kid who gets eaten by a tiger because he was too busy looking at a spider to watch out.

Now you may think that there isn't a problem here. But I'm the parent here, you're the stranger, you know nothing about my situation, and it is my job to decide what measures are required to make sure that he grows up to be able to survive in society to my satisfaction. So, in all honesty, it is time for you to fuck off.

Oh, I have a perfectly good idea of how much of an asshole I was being. I'm a total stranger on the Internet and I have no clue about you and your circumstance beyond what you yourself proffer. That is the simple truth.

But look, you put your personal life on the line with this discussion. Did you do that in order to gain sympathy, compassion, understanding .. from an Internet stranger?

Or did you bring your son into this discussion for the sake of winning an argument about social normatives as 'an authority', having read the books, bought the drugs, gotten with the program?

I think you should examine your motives on that.

My personal position is that anyone who drugs their child, for whatever reason, is as much a part of the problem as the perceived 'malady' of the child. Thats my personal opinion - like you have your personal experiences, I have mine too. You can tread on my opinion if you like - after all you are just as much of an internet stranger with the potential to be an asshole as I am. I have absolutely no problems with being called names for having an unpopular opinion (although, careful with the name-calling: you might get us both hell-banned).

>to be able to survive in society to my satisfaction.

So you've chosen your path, as a parent, and I've chosen mine as a parent as well: two boys, neither will ever get anywhere near anyone who might consider industrialized mental health 'solutions' such as drugging them, as a means of imposing society's cultural norms, because my boys don't 'behave' per the standard set for them. Thats just simply not going to happen. I'll live with the consequences of my decision, just as you have lived with yours. To me, your chosen path seems like its more for your sake than theirs, since it is you who is having the communication difficulties, but again: I don't know all the facts. I won't judge you as I have no right..

I urge you, however, to reconsider just how much you truly know about the subject, and how much you've been told to think about the subject without questioning the authorities in power. All humans deserve a chance: drugging children at an early age because they don't meet societys' standards, is in my opinion worse than the so-called symptoms. Not to mention there is a lot of profit being made from legally drugging children in this world today.

Just an opinion from a random internet asshole. Nice chatting with you. I wish you all the best, and your son a happy and productive life, as he sees fit.

I brought my son in to provide personal experience demonstrating that your guess about lack of sleep is completely wrong.

Every guess you've made since about how my family resembles your stereotype of a family that would medicate has been laughably wrong. I don't know what you think you know, or why you think you know it, but you've demonstrated a complete inability to acknowledge any experiential input. In light of that grotesque failure, I suggest that you question your own firmly held opinions. Because so far you're batting 0.

Here is another mistake of yours: if I was medicating my son for my sake, I'd medicate him every day, rather than arranging for him to be under the influence of medication only for the periods that he's in the classroom. In fact the main benefit that I have received so far is that I no longer have to comfort him while he's crying about how frustrating school was for him.

I hope for your children's sake that they never require assistance that you're unwilling to consider for them. Luckily most don't, so their odds are pretty good. But I'm sure that if you get the average result, you'll take all of the credit for them doing expectedly well.

>I brought my son in to provide personal experience demonstrating that your guess about lack of sleep is completely wrong.

On the basis of a single data point.

>I hope for your children's sake that they never require assistance that you're unwilling to consider for them. Luckily most don't, so their odds are pretty good.

.. but then again, this is groupthink at its finest. Are you religious by any chance?

Are you religious by any chance?

You continue striking out. I'm an atheist.

But you seem to be the kind of atheist that gives the rest of us a bad name.

You want to insult, I want to enlighten. My how times change.

The good old "it's over diagnosed so it must be made up" argument.

By the very definition of what you said, if it's "over diagnosed" then in the majority of cases it IS made up. That's what "over diagnosed" means: more diagnoses than actual incidents.

I didn't say it's entirely made up. Some people might legitimately have it. But I'm pretty sure from what I've read that a large majority of them do not. To quote Wikipedia:

"""In the United Kingdom, diagnosis is based on quite a narrow set of symptoms, and about 0.5–1% of children are thought to have attention or hyperactivity problems. The United States used a much broader definition of the term ADHD. As a result, up to 10% of children in the U.S. were described as having ADHD."""

I read those numbers, knowing how the medical "industry" works -- and how societal, work/life balance, dietary and other such issues in the US are fast to be characterized as "diseases" in need of medication -- with huge grains of salt.

100% more cases in the US? Sounds like a good deal of over-diagnosing the non existent to me.

That's what "over diagnosed" means: more diagnoses than actual incidents.

No. "Over diagnosed" simply means that it is diagnosed when it shouldn't be. There is nothing there about how frequently it is correctly diagnosed. If the true prevalence is 6% and 9% of kids are given the diagnosis, then it is over-diagnosed. See http://www.cdc.gov/ncbddd/adhd/prevalence.html for the geographic variation on the diagnosis rate. Clearly there are places where it is over-diagnosed. There are others where it doesn't seem to be.

I do not know why the ICD-10 has different criteria. The US classification is broader on that because a much wider variety of symptoms looks the same in brain scans, and reacts the same way to medication.

Regardless, before medication parent-teacher conferences were elaborations on the theme that my son required more attention than the rest of the class combined, and yet still was behind everyone else on a long list of things (starting with handwriting skills) despite his obvious brilliance. After medication we simply get a note that he is a joy in the classroom, and she wishes that other kids had half of his curiosity.

Note, he gets plenty of sleep, eats well, has carefully controlled TV, etc. (My definition of carefully controlled = no TV, under 4 hours/week of movies. The movies that he chooses are documentaries more often than not.)

>If you're a person who reads the description of ADD and says that it sounds like you, maybe a lot.

I feel this unfairly divides ADD between "people who think they have" and "people who have" but in my experience this is a horrible line to draw.

Many doctors will listen for a stock phrase and hand out a one page questionnaire and diagnose you with adult on-set ADD on the spot.

Bam, then you "have" it, doctor verified and everything.

And yet, that person who "has" it may be no different than the one who read what is basically the same questionnaire online.

Yes, there are bad doctors, and there are cursory or improper diagnoses, but that does not make the valid diagnoses any less valid, or the invalid diagnoses any more valid.

All doctors, from radiologists to orthopedic surgeons, are told not to self-diagnose, and psychiatric conditions are the easiest to improperly self-diagnose, even for trained professionals (which most people on HN are not).

On top of that, ADHD is one of the most difficult conditions to properly diagnose. Unlike more overt disorders, like schizophrenia, the symptoms are less clear-cut, and unlike more visible disorders, like (true) OCD[0], the symptoms usually lie two or three layers deep, making it easy to confuse the cause of the symptoms if you're not careful.

There exist differential diagnoses for this purpose (disambiguating the cause of the symptoms); most people just don't have them done, because they're incredibly expensive (several thousands of dollars), as they're very time-intensive on the part of the doctor.

That said, the entire claim which precipitated this discussion - that ADHD is somehow related to sleep deprivation - is completely preposterous. ADHD is perhaps inappropriately named, yes, but that suggestion is like saying that the cure to depression is to "stop being sad".

[0] I say "true" to distinguish clinical obsessive-compulsive disorder from the casual use of the term (eg, "oh man, my OCD kicked in when I saw Comic Sans mixed with Papyrus").

> That said, the entire claim which precipitated this discussion - that ADHD is somehow related to sleep deprivation - is completely preposterous.

There's quite a bit of research on the subject, and researchers don't generally consider a relationship preposterous. It's reasonably well established that sleep disturbances and sleep deprivation can at least exacerbate the symptoms of ADHD. Some research suggests that they may also be a risk factor for developing the condition in some cases, or alternately (depending on unresolved questions about etiology) that a differential diagnosis is needed to distinguish non-sleep-related ADHD from symptoms related to sleep disorders. The diagnoses do empirically seem to co-occur quite frequently, which is one factor driving the research, but the mechanisms aren't well understood.

Nature published a short review of the (very large) literature on the subject last year: J. Cassof et al., Sleep patterns and the risk for ADHD: a review, Nature 2012(4): 73-80.

> Yes, there are bad doctors, and there are cursory or improper diagnoses, but that does not make the valid diagnoses any less valid, or the invalid diagnoses any more valid.

It calls into question, somewhat, whether there actually are any valid diagnoses, if a disease is well-known to be very commonly diagnosed improperly.

In the case of ADHD there happens to be sufficiently good evidence of real cases, along with brain scans showing what is happening inside of the brain, that we can be very confident that the disorder is real.

However if a random person claims to have it, we may not be confident that they were correctly labeled.

The division here is between the underlying causes of the distractibility. And that's a pretty important distinction to make.

Many things can cause distractibility, from sleep deprivation to thyroid disorders. ADD/ADHD is only one of them. The effective treatment for any of these will not help the others. That is why the DSM-IV includes as a diagnostic criteria that you have to screen for other possible causes of the behavioral issues and rule them out.

The "many doctors" that you describe are simply not doing their job properly. By comparison the screening process for my son's diagnosis took about a month. Possibly not coincidentally I live in California - a state that has one of the lowest rates of diagnosis of ADD and ADHD. (Look at http://www.cdc.gov/ncbddd/adhd/prevalence.html to see your state diagnosis rate - I'd be suspicious of any diagnosis made in Alabama.) I am confident that my son's diagnosis is correct - my son has responded well to medication, while children without the disorder don't.

So here is my point again. If you're noticeably distractible and possibly sleep deprived, try getting more sleep. It might make a big difference. If you've actually got ADHD or ADD it won't hurt you, but it won't fix the problem either. There are other things that can also produce the same symptoms. Go to a competent doctor if you've got reason to be concerned.

The effective treatment for any of these will not help the others.

This isn't entirely true. A person that isn't getting enough sleep can "fix" the problem with ADD medications, and thus maintain the erroneous belief that they have ADD and therefore require that medication. How often that happens is debatable, but it is one of the (many) things that lead to over-diagnosis.

Good point.

And since a side-effect of the medication is trouble sleeping, I could see a vicious cycle starting.

> One way this is put to the test is by letting people relax in a comfortable reclining chair in a quiet, dark room during daylight working hours. Many people fall asleep in this condition, signaling that they are sleep-deprived, even if they have no regular habit of taking a nap in the daytime.

That is not a valid way to test that people are sleep deprived. Most people will fall asleep with plenty of sleep. Put them in a warm room with little noise and nothing to keep their attention and they'll fall right asleep no matter how much sleep they've previously had.

I know someone who is an extreme example of this. My wife will go to bed at 11 on a Friday night, wake up around 8, go out to the living room, then fall right back to sleep. I thought it might be that I was snoring but she claims she is sleeping through the whole night. On top of that, she's not a particularly long sleeper in the week (7.5 or so hours). I don't get it to be honest.

In any case, just want to reaffirm that the test proposed in the top comment is way off target.

Indeed - isn't this essentially a nap?

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