1y ago

Can't Sleep, things going to shit and I don't know what to do

Sorry for being dramatic, but I feel absolutely awful right now and things seem to be moving in the wrong direction, I genuinely don't know what to do next.

So please forgive a long rambly message to people who struggle with just that! I got ChatGPT to make a TL;DR, which I found quite amusing:

The poster is a 27-year-old who was diagnosed with ADHD this year and has been taking medication for the past 6 months, with a stable dosage for 3 months without issue, and generally positive outcomes.
Following that, they have experienced disrupted sleep patterns for the last 3 months, finding it difficult to fall asleep before 3AM even when going to bed at 1AM, which is negatively impacting their routine and work schedule.
Despite struggling with sleep and consistently waking up late, they manage to maintain productivity at work, which they value greatly. However, this is leading to further sleep deprivation, exacerbating the problem.
This disrupted sleep pattern is making them feel constantly tired, disorganized, and slow but they still seem to function effectively during the day.
Their work-life balance is skewed as their hours are shifted back, finishing work later, and they continue to be active until late at night, often forgoing relaxation time for themselves to deal with personal admin, projects, and other work.
They have devised a new strategy to cope with the situation:
They acknowledge that their biggest challenge will be stopping activities by 12PM, given their heightened productivity levels at that time.
Despite the plans to manage their situation, they are feeling increasingly stressed out and overwhelmed, fearing the consequences on their health and personal relationships.
They are seeking advice from the ADHD community that goes beyond typical sleep hygiene tips.

I'm 27, diagnosed this year, on meds for ADHD for around 6 months. All was going well, and was stable on my current dose for 3+ months before this became an issue.

I take 20mg dexamphetamine at 7AM when I wake, then take 70mg of lisdexamfetamine dimesylate at the same time or a bit later. I've tried halving the 70mg for a week or so, but no change. (on sleep)

Over the last 3 months, my sleep pattern has completely gone to shit. I've always been a night owl, and naturally gravitate to a 3AM-9AM sleep pattern when I don't have to be up. But I've worked a full time job for years, which means me waking up at 7AM. So I will usually go to bed at 1-ish, sometimes later. This has always worked quite well.

However, recently I've found it hard to get any sleep before 3AM. Usually, one I'm actually in bed, I've always fallen asleep quickly. My job is fairly physical, so I'm usually at least physically tired. But even when I'm going to bed at like 1AM, I'm literally just lying there unable to sleep. It feels unnatural, like trying to sleep at noon. I have energy, thoughts, and a nice sense of calm and quiet. It's gotten to a point where I haven't had more than 4 hours of sleep in the last couple of months more than a handful of times, and in the last two weeks, on two occasions I've simply opted to stay awake, because it's 0430, it's basically daylight (I bloody hate Summer), the birds have been at it for hours.

Maybe the worst thing is that I can generally get by okay. Morning is hell, always has been, but after about an hour I'm feeling the same as almost any day. I've been struggling to wake up, and have gotten progressively later at work over the last 12 months, where I'm now showing up 30-60mins late as standard. Nobody really cares, I have always worked lots of overtime, so I don't take lunch and work an hour or so later until my work is done. But my work is both important to me, and important to my colleagues. As much as walking away from it for a while may be a good idea, I'd be leaving everyone in the shit. It's a small business, if they had enough redundancy for nobody to be essential, none of us would have jobs!

When I get less than 5 hours, I notice it, but I don't think anyone else does. I feel slow, disorganised and very typically 'ADHD'. But I'm very functional. I'll do a full day, do overtime, come home, work on some other things, get caught up on the bare minimum, look at the clock, and see that its 1AM, and I haven't even done any 'relaxing' stuff for me yet, so that is, of course, the right time to playa few rounds of intense competitive games....

Even 420 doesn't seem to be able to calm me down enough to help.

I'm writing this after getting less than an hour's sleep again.

I've come up with some ideas on how to proceed, I'm just worried that it's the same kind of approach I always take that rarely works, basically schedule everything, ignoring the fact that the schedule will feel miserable, unnatural and that I can ignore it. I've tried to make this a bit more human. Current planned changes:

Must finish work by 6PM, unless we are truly in crisis mode
I will not eat anything after 11:30PM
At 12PM I will have a shower, which I hope will prepare me for bed
No computer after 12 (sorry me)
Reducing morning lisdexamfetamine to 35mg. I don't think it's the medication, but it can't help!

The hardest bit for me is going to be stopping at 12. I have lots to fit in, and not a lot of time, plus I feel really awake and productive at 12. So just walking away from whatever I'm in the middle of is going to be hardest, when I know I could just not. I may shift all of this forward an hour for the first week, otherwise it may simply be too much at once. I'm hoping that, by resting better, I won't have things I still need to do by 12.

But mostly, I just feel like shit. I hate being late every day, I hate days like today where I don't even know what to do, should I go in to work? How to I make sure everything will be okay without me on such short notice? I know this is awful for my health, I feel very 'thin', and my heartbeat is so much more noticeable when I'm on no/little sleep. My BP was fine when I checked after a month of this. To be honest, I almost don't want to check again, because it will be high, and I don't know what I'd do with that, I already know I need to fix this.

Everything just feels like a chore at the moment, every nice plan with my gf is just stressing me out more, because all I see is even less time, more shit building up, and I don't even know how to prepare for a holiday when I'm living like this.

I've never really engaged with the ADHD community, even after my diagnosis, which is pretty dumb. I'm sorry to just dump all this at you, but I really need advice from people who realise that just repeating the same cliches about 'sleep hygiene' may not actually be helpful in this case.

28 comments

I'll also apologize for being dramatic. But you are killing yourself. You should take this seriously.
Don't take any of my advice without first checking with your doctor.
If this were me I would stop all meds over a 7 day period. I would stop coffee, alcohol, weed, nicotine, everything. I would let my body return to baseline. This takes a minimum of 4 weeks. Usually about 7 weeks. It sounds like a scary thing to do but you'll be fine, just make sure to discuss stopping meds with your doctor.
When I do this, the first 3 days are hell, the first week sucks, the first three weeks are ok but I feel dull and flat, then after 4 - 7 weeks I start to get my feelings of well-being back and a sense of peace. I find myself yawning in the middle of the day and enjoying my lack of total central nervous system stimulation. Stimulants and anxiety are usually the two main causes of sleeplessness. This helps with both. If you are still not sleeping after two months of this then you need to see a sleep specialist. Its possible that you are having other sleep issues that you are not aware of.
You're not stopping meds permanently, but you are giving yourself a blank canvas with which you can experiment and discover the root causes of the problem. Slowly add back things one by one and give a week before adding the next thing so that you have had time to experience the change fully. You should easily see if adding something causes problems with your sleep.
Another thing to try as others have suggested is learning to calm your mind. Yoga, meditation and the like will give you more control over your mind (limbic system). Don't make it harder than it needs to be. Youtube has lots of pilates, yoga, meditation videos. Put one on and follow along.
There are ways to brute force the solution, like to take sleeping aid meds or get really stoned, but I'd only try that as a last resort. If you can find the root cause of the probem, thats first prize.
Good luck!

I have two tools that I use to fall asleep, and they have been working pretty flawlessly for me over the years. The primary one is reading a book in bed, when I'm off to sleep. Usually it's not a lot of reading, I get pretty sleepy after 10-15 pages. The other is supplementary to the reading and that's imagining some fiction scenario in my head. For me, it's some simple SciFi or fantasy scene or whatever and I try to visualize the characters, scenery, etc. It's usually just enough to occupy my brain enough so that it doesn't do its thing of running around wherever it wants to, and just not quite enough to give it fuel for active engagement. No idea if either might work for you, but maybe give it a go if you haven't already.
- That's usually worked 100% for me. Either listening to an audiobook, or listening to a genre of video on Youtube I can only describe as "long-form space and quantum physics shit that I don't understand but find weirdly soothing".
  Usually works great, but I just can't seem to switch off, if anything, it can actually start adding to the discomfort. Weird really, maybe I need to find something that fills the same gap, but is different.
  
  Hope you read this:
  On YouTube, search for full episodes of the BBC show Gardener's World.
  The tone and rhythm are soothing, but it's also entertaining if you choose to pay attention and get into it.

The older you get, the more such lack of sleep will slow you down. People might not notice when you're 27 and can power through tired, but you'll start to lose that within the next ten years. Take it from me.
Didn't see in your post: what are you doing for exercise?
Don't exercise for physical health, your appearance, or to lose weight. The sole reason for people like us to exercise is to calm your amygdala, to calm your fight or flight instinct. This will help you manage your emotions through the day and into the evening, and will help you fall asleep.
What are you doing at night that is stopping you from sleep? For me, I related to the idea of "revenge sleep procrastination." Staying away because it was more fun than going to bed, basically. Exercise helps. It's a struggle.
- I managed to last for another 10 years, but right around when COVID ramped up (Age 47 for me), my ability to manage sleep went sideways. Part of that may have been sleep apnoea with anoxia, with my doctor prescribing APAP + Nocturnal Oxygen, but if I get less than 9 hours of sleep, things start going bad for me quickly.
  My suggestion for OP is melatonin 30 minutes before bed, cutting back blue lights by either going for night-mode on screens or just not using them, and either setting up nightlights with 2700K bulbs or getting something like Hue or other colour changing lights, and white noise in bed. This is helping, but I still wake up at 5am without fail. :(
- I don't really do any specific exercise. I work quite a physical job, although these days I sometimes spend all day at a desk, but I'm usually on my feet all day, lifting heavy things. Perhaps doing more office work and not doing exercise to compensate could be a big part of this.
  What kind of stuff do you do? I'm quite limited as to what I could do at home due to hours and noise, I'd default to something like press-ups. I could do something more substantial in the warehouse when everyone else has gone home, though! I don't know anything about how much or what kind of exercise is required to satisfy my amygdala, but I'll do some research!
  Yeah, revenge procrastination is definitely big for me, I'll often only get the boring shit finished quite late in the day, then think 'but I haven't had any chill time yet!' and spend a few hours gaming or something. This is my usual issue, which I generally manage okay with. Usually when I hit the pillow, I'm asleep pretty fast, but recently I'm just in bed lying there, completely alert.

Hey, I’m sorry you’re having a rough time, sleep disturbance can be brutal. I’ll cut to the chase and share a couple things that have helped me with sleep issues in the past. Feel free to have ChatGPT TL:DR this if I rambled on too long :)
Having a bedtime routine that is consistent and, in some way, special. For me, I move to the couch, take melatonin, have a snack, and read or watch a short video. (If I pick a video it’s a soft rule that it has to be short, something like 10 mins or less so that I won’t get sucked into the phone.) I don’t spend much time on that particular spot on the couch during the day, so it’s sort of like my “bedtime routine spot.” I also try to avoid eating my bedtime snack foods during the day, so that they are reserved for the bedtime routine. Trying to make the bedtime routine special in this way seems to really help me transition from being active mentally to winding down, and it helps me feel better about “having” to go to bed. (I never really *want *to go to bed, but I do want the comfort of the bedtime routine.)
I got into the habit of ending the day by writing down what I have going on the next day, and trying to write out any stray thought that seems to be rattling around. I do it digitally and will often only spend a couple minutes doing it. Even taking 30 seconds to type “tomorrow I have work and nothing else planned” seems to help.
Overall, the most noticeable improvement to my sleep has been from working on managing my anxiety with a therapist. This is super vague I know, and perhaps not very actionable. At times I felt as though I had my anxiety under control during the day, but at night it would ramp up. Taking extra steps to manage that anxiety a little bit during the day (even if it feels minor or unnecessary at the time) seems to help a lot. Curiously, when I asked my therapist for help with sleep specifically we didn’t seem to get anywhere, but working through anxiety and other issues with them helped much more.
It sounds like you have a good plan for some things to try. I’ve found I need to be a little more flexible with my routines, but I totally get that instinct to set a hard time for things. Also, I can totally relate with feeling the most productive/awake before bed, I have the same exact pattern with my energy. I often feel like I’m enjoying my day the most at that time and I always have to cut it short!
I hope things improve for you soon. My last parting thought: try not to beat yourself up when things aren’t going according to plan.

I couldn't sleep properly for the most part of my life, neither undiagnosed nor after my diagnosis and treatment. Then my doctor told me to take some melatonin pills before going to sleep. You don't need any prescription to buy them where I live, it's a natural treatment, and they can be bought in supermarkets too.
Anyway, after taking 2 mg of melatonin before going to sleep, I'm finally able to sleep for the whole night, without overthinking and moving myself for hours trying to go to dreamland.
You should ask your doctor about melatonin, maybe he or she gives you a prescription or tells you "yes, go ahead and buy them".
- My doctor told me the correct way to take Melatonin: Take the smallest dose possible when the sun goes down. This will get your Circadian rhythm aligned with the sunlight. You won't feel sleepy, but when bedtime comes, you will fall asleep much faster.
- Don't start with a full pill/dose.
  Nibble on a fraction, see how it works that night, fine-tune the dosage so it hits the right spot.
  For many people the full dose of melatonin in pills is too much.
  Start low, increase slowly and notice the results.
- Where I am you need a prescription but having ADHD makes you eligible for one. My daughter slept through for the first time in her 8 years of life when we started giving her melatonin. Two years later I would argue that the melatonin made a greater difference than the Ritalin. She’s thriving.
  
  @lusule Ritalin is awful.
- This is me. Got my dad to pick me up melatonin in the states. Absolute game changer for my sleep deprivation

@gundog48
Sleep stuff sucks, sorry you’re having a hard time. One thing that helps me - I bought some smart lights and programmed them to a schedule. They all go red and dim a couple hours before bedtime so I know to start winding down. The tv backlight also gets dimmed. It’s a nice little routine / cue. Supposedly minimizing blue light exposure before bedtime is good for your sleep?

Ok so... I can't say much about the medication because I'm still unmedicated.
But I definitely know what it's like to be stuck being awake doing shit when I should be sleeping.
This is going to sound trite but have you tried exercise? Tiring your body out will make it easier to sleep. Even going out for a long walk at night and listening to something on your phone.
I can schedule really effectively for like... 3 days. I have planned out my budget to the cent before. It never sticks because I find another obsession.
Do you find you ping pong between good and bad habits over the months? I do. If so, relax, stability will come back round again and try to hold on to it longer this time.
I'm new to knowing I have adhd so I can only offer basic advice.
- Thanks, appreciate it! Yes, definitely ping-pong between good and bad, you have a very similar outlook to me, in terms of having phases of good and bad and trying to make the good ones last!
  I have an active job, but I think some kind of other exercise would be beneficial. Unfortunately whatever I do would need to be quiet, and preferably not involve trying to sneak in and out without setting my parents' dog off! I was just thinking pushups or similar.
  I hope you find the tools you need too, sounds like medication may help you, although I found it doesn't help with all the new obsessions!
  
  Yoga with slow, gentle poses may help you wind down in the evening if that's not something you've considered.

So first off, I can 100% commiserate. I could have written basically the same thing you did about your preferred sleep schedule and sometimes just giving up and staying awake. Clearly you already know that is not sustainable (and I’ll say as someone a decade-ish older that I feel the impact of sleep-deprivation even more now than I did when I was 27). I have had to cancel appointments when I’ve had nights like those and I know I’m not good to drive. I also know that my meds are not very effective when I’m sleep-deprived.
The fact that things changed suddenly after 3 months is probably something to bring up with your doctor. I don’t know what it would be, but they may have some idea. They may also be able to prescribe something for sleep, but I can’t speak much to that.
Having a plan for changes is good, but it also looks to me like you are just doing too much, and you can’t schedule your way out of that. You may have to really look at what you’re doing and decide where your priorities are (and one of those priorities should be some downtime). I do think it’s good to put some boundaries in place for yourself about screentime, etc, but I’d warn against being too rigid, as that is something that has just added to my anxiety in the past, which then means that I lie awake even later, etc. I do better when I set up little rewards for myself instead (sadly I am very motivated by a weekend dessert, haha).
Obviously I don’t know your specific work situation and your vocab doesn’t sound US, so you can take or leave this, but from the outside I’m seeing a few things:
if you taking off a day or two will truly be a catastrophe for the other employees then the company is poorly-managed. Does no one ever take any time off?
Are you salaried (so all this overtime is unpaid?) Are you doing it because you feel obligated/guilty? Have you slipped into prioritizing your coworkers over your actual family/girlfriend? I know you said your work is very important to you, but is this the only place you could do that type of work?
If you are coming in an hour late every day anyway, would it be possible to make that your official start time? That could take off some of the pressure of being “late”.

Reducing morning lisdexamfetamine to 35mg. I don’t think it’s the medication, but it can’t help!
It's the vyvanse. Yeah, it's really helpful, but it's definitely the vyvanse.
- Hm, I've been on it for about 6 months now which has made me doubt it. I will continue on this lower dose and see if it helps!
  
  Do you ever take days off of Vyvanse? I find that I need to skip it at least once day per week if I want to be able to sleep and that's with 10mg of Trazodone every night and only 30mg of Vyvanse.
  
  I was on it for around 8 years. Even exercising doesn't quite take care of the falling asleep thing. Eventually I was able to get to a point where I could 'decide' to fall asleep, but that didn't even work 100%. As far as adjusting the dosage, it's tricky because if you lower it too far, you won't make it through your day again.

If you haven't already. White noise is the only way I can sleep. Anything thunder related works for me. Having some sleep headphones playing that means I fall asleep even when trying not to. Without it I can lie awake for hours.

First off, talk to your doctor about the sleep issues.
Personally though melatonin helps me I just have to take it 30 minutes before I want to be in bed and be sure to not use anything with a screen an hour before bed.
Listening to slower music for that hour helps a lot too.
You need to fix that sleep issues as it can cause all kinds of issues if you don't. Especially in regards to your mental health.

My situation is the exact opposite, my sleep pattern has gone to shit since I stopped taking the meds.

28 comments