6 Sep 2008 @ 8:23 PM Reply # 8
ClaireSMassa Join Date: Sat 30th Aug 2008
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ADD& DSPS
The concept of DSPS is still pretty new to me. I think it is relatively new to many professionals, and yet there are still many who have never heard of the disorder. I read that it is usually mistaken for and misdiagnosed as a psychological disorder. It is easy during adolescence for adults to dismiss the signs for laziness or, rebellion, or simply "just a phase". Being as DSPS affects only a small known percentage of our adult population and its symptoms can very often mimick other conditions, it also often goes unseen in adults as well.
I knew that something just didn't feel normal. I don't feel "mentall ill". I know I'm not sick. I don't have anxious thoughts that sustain me in insomniatic warfare. It's just that I'm... well, NOT tired at night. And then after I wake up, I'm SO tired. Before I read about DSPS, I would try and describe it to doctors by saying that it felt more like the hormones or biological rhythms in my body were just "off." I'd receive streams of advice from all directions from friends, family, professionals wanting to help: "All you have to do is..." etc, etc. Then they get frustrated when I decline each and every suggestion, but they don't understand - I've already TRIED that. I've tried sleeping meds, healthy diet, exercise, consistantly trying to put myself to bed early and wake up accordingly, keeping myself awake through the next day in attempts to restart my internal clock, alcohol, sleep hypnosis, and everything in between. I'm not depressed. I'm not stressed. But I'm BECOMING more depressed and stressed as I begin to see the manifestations of this struggle as I begin to embark on my adult life.
It has affected EVERYTHING, and no one really "GETS" it, even me until just recently. People think I'm lazy, and it's just not true. I am so ambitious in my mind, and I become so frustrated because it feels like my body just won't cooperate with me to function like I would give anything to. I just can't get up and go about my day like everyone else, and if I try to, I am pretty much useless, mentally and physically. I have taken more stimulants than you would ever imagine, all the while desperately trying to self-medicate myself just to get by.
But I know it's not even THAT simple. The specialists I've seen have all been more or less at a loss for what to make of it. They advise me within their own fields, but it just feels like it's more than just one area that factors into the equation. I told the last psychologist & psychiatrist I spoke with that I don't believe that this will be a simple diagnosis, but I didn't really know what else was was going on until I read about DSPS. I was thinking chronic fatigue, thyroid, blood sugar, stimulant abuse that had perhaps rendered me weak and immobile, and finally I started to believe that maybe I was just helpless or lazy. I just couldn't put my finger on it.
"Physicians often seek to exclude behavioral or lifestyle preferences, inadequate sleep hygiene, and psychophysiologic insomnia as causes for DSPS" (www.sleepdisorderchannel.com). Other exclusionary criteria are mental disorders, including none other than ADD. Yet the Wikipedia page on DSPS notes that stimulant meds are used to treat patients with both ADHD & DSPS. It seems to me that professionals are still trying to understand and define what is entailed in a true diagnosis of DSPS. One thing I have noticed throughout my psychology/premed education is that diagnosing many both psychological and physiological conditions begins by determining such exclusionary criteria so as to avoid misdiagnosis. But why are would ADD need to be ruled out when diagnosing DSPS?
It appears to me from my own experience, from the testimony of others, and from the research I have done personally in regards to a common dopamine deficit that undermines both disorders, that there is a clear link between the two. Does DSPS decrease cognitive functionality due to a lack of essential restoration during sleep, resulting in ADHD-like symptoms, or even causing/promoting the development of ADHD in those who may be already predisposed biologically? Does ADHD promote unhealthy sleep hygiene and habits that assist in perpetuating the severity of DSPS? I have also read that if you can correct the condition on your own, that you do not have a true diagnosis of DSPS, yet all known treatments for this condition can be performed ON YOUR OWN (with the exception of sleeping medication, which you can probably also get a prescription for on your own). They say that poor sleep hygiene further develops DSPS throughout time, so why are those same habits also considered to be exclusionary criteria in diagnosis?
After much research on my own (when the doctors and literature left me with still unanswered questions), I have come to tentatively believe that these two disorders, when observed comorbidly, are both manifestations of the same system. There are, of course, many things that can contribute to the evolution of either ADHD and DSPS of course. But one common factor appears to be the low levels of dopamine present in both. Dopamine is a hormone that, among many other functions, helps us to be motivated, focus and concentrate yet paradoxically also enables us to fall into a normal deep, full nights sleep. Another way to understand it is that it assists in the regulation of sleep/wake patterns. People with DSPS and ADHD have both been noted to show low levels of dopamine when tested. It is not so cut and dry, though, because hormone levels wax and wane throughout a 24-hour period. Perhaps it is possible that the inability to concentrate, in addition to being enhanced by a lack of productive sleep, can also be attributed to circadian rhythms administering low levels of dopamine during the daytime (which is also likely to be during the time when many patients were observed with this dopaminergic decrease). This would explain the decreased functionality in earlier times of the day. Please note that I am not a doctor, and this is all my own speculation based on a limited amount of exposure to information and literature that may or may not be entirely medically accurate. That is, though, what medical research is - the observating interactions, supplying theories, and testing those theories again and again until a strong enough link can be made. Even after all the research, I am still unable to determine any sufficient information beyond the common role of dopamine deficits that characterize both disorders.
I think that maybe the reason they try to rule out ADHD before they make a diagnosis for DSPS is because not necessarily all people who have ADHD have DSPS, and I would guess that not everyone with DSPS has ADHD, so it is logically necessary to discriminate between the two. But hormone levels in the body are so complex and individual that there may not be a clear distinction when these kinds of things seem to collide. The factors that contributed to the development of both ADHD and DSPS vary from individual to individual, so it is not feasible that we will better understand until we have examined our own physiology and history.
I am in no real position to solicit advice, but since all seem to be more or less in the dark, I CAN say what I am doing personally to cope with all of it. In determining the causes, this condition has two contributing branches - biological predisposition and habitual catalyzers. I separated the habitual factors and examined their potential influence on my symptoms. Understand that even without a chemical imbalance, these types of habits can promote an unhealthy sleeping routine. This link talks about sleep hygiene. (http://www.umm.edu/sleep/sleep_hyg.htm) Chronotherapy is also aimed at regulating and controlling consistency in times of sleep and awakeness through monitoring behaviors and habits that are considered to be good sleep hygiene.
At this point, however, I've exhausted all the tips for healthy sleeping without any success. I believe that, for any number of reasons and in any number of ways, the levels of dopamine in my body are not conducive to a normally functional sleep/wake pattern. So while equally as important, I don't believe that chronotherapy alone would suffice as a sole treatment in my case. This is why I began researching dopamine. Light therapy increases dopaminergic activity, so I am going to find out more on that. I also saw my psychiatrist and got him to prescribe me Adderall and Ambien. He didn't have any information for me about DSPS, and I don't know if this is the right or best medication for me to take, but it seems to be at this point and I guess I will be able to tell more in the next few weeks. I am going to see someone about a referral to a specialist who would be able to help me more on this matter. Hopefully I will have more information then.
Hope this may help someone. I know firsthand that understanding these issues can be very elusive to pursuit, and very frustrating as well. It's nice to know I'm not alone.
