Can we please have further discussion on the point about increasing sleep having the same/similar effects as stimulants? This seems like an ESSENTIAL question to study further. If you could elaborate, I'd love to hear more.
Great question, and thank you, Trysa. The key point is that, at the level measured in this study, both sleep and stimulants modulate the same underlying arousal-related brain systems. In other words, short sleep was associated with a specific large-scale brain correlation pattern, and stimulant use largely abolished that pattern, making sleep-deprived children look more like well-rested ones on these measures.
What this suggests is that part of what stimulants do is compensate for insufficient arousal that, in some cases, may be related to altered sleep. Improving sleep should, in principle, move the brain in a similar direction for at least some individuals. Whether that translates into equivalent clinical benefit is a separate and very open question, especially because sleep, arousal, motivation, and cognitive control are not single processes and may dissociate across patients.
Studying this directly, for example by manipulating sleep duration or quality and comparing its effects to stimulants within the same individuals, would be incredibly informative. It could help clarify which patients primarily have an arousal problem versus something else. One potential clinical implication is that proper sleep evaluation should be standard in ADHD management, and that in some cases, trying sleep-focused interventions should take precedence over reflexive prescription of stimulants.
Thank you. To me, this needs to be front page news. Our society has a significant problem with prioritizing and protecting sleep and I don’t think mental health professionals nor parents nor adults with ADHD regularly, as a group, pay enough attention to the possible effects of mild sleep deprivation on ADHD symptom severity. I would love to see more research and more clinical focus on this (among other factors that also may have hidden influence on symptoms, such as subtle blood sugar spikes and dips).
Definitely. Understanding how sleep is changed in ADHD (and other disorders, like Bipolar for example) is really important. Even when standard laboratory measures show sleep is "fine", there may be changes that we neither detect nor understand, which could be better targets for intervention. As a society, it is absolutely essential to continue investing in research. Otherwise, we'll never really know how to address any of these issues that keep getting more complicated. Thanks again.
This reframing makes a lot of sense. Stimulants seem to adjust arousal so existing control processes can operate, rather than enhancing attention directly. In increasingly compressed task environments that overload engagement systems, that mechanism becomes especially visible. ADHD starts to look like one common failure mode when arousal and task structure fall out of sync.
Thanks for a nice overview. FMRI does not capture the attention network directly and putative salience networks in cortex always include motivation data. Neurepi drugs work through the motivation system! The long term confusion has been maintained by pharmas. I will check your work on thalamus. NEUROMIND A CONTEMPORARY APPROACH TO MENTAL HEALTH
Can we please have further discussion on the point about increasing sleep having the same/similar effects as stimulants? This seems like an ESSENTIAL question to study further. If you could elaborate, I'd love to hear more.
Great question, and thank you, Trysa. The key point is that, at the level measured in this study, both sleep and stimulants modulate the same underlying arousal-related brain systems. In other words, short sleep was associated with a specific large-scale brain correlation pattern, and stimulant use largely abolished that pattern, making sleep-deprived children look more like well-rested ones on these measures.
What this suggests is that part of what stimulants do is compensate for insufficient arousal that, in some cases, may be related to altered sleep. Improving sleep should, in principle, move the brain in a similar direction for at least some individuals. Whether that translates into equivalent clinical benefit is a separate and very open question, especially because sleep, arousal, motivation, and cognitive control are not single processes and may dissociate across patients.
Studying this directly, for example by manipulating sleep duration or quality and comparing its effects to stimulants within the same individuals, would be incredibly informative. It could help clarify which patients primarily have an arousal problem versus something else. One potential clinical implication is that proper sleep evaluation should be standard in ADHD management, and that in some cases, trying sleep-focused interventions should take precedence over reflexive prescription of stimulants.
Thank you. To me, this needs to be front page news. Our society has a significant problem with prioritizing and protecting sleep and I don’t think mental health professionals nor parents nor adults with ADHD regularly, as a group, pay enough attention to the possible effects of mild sleep deprivation on ADHD symptom severity. I would love to see more research and more clinical focus on this (among other factors that also may have hidden influence on symptoms, such as subtle blood sugar spikes and dips).
Definitely. Understanding how sleep is changed in ADHD (and other disorders, like Bipolar for example) is really important. Even when standard laboratory measures show sleep is "fine", there may be changes that we neither detect nor understand, which could be better targets for intervention. As a society, it is absolutely essential to continue investing in research. Otherwise, we'll never really know how to address any of these issues that keep getting more complicated. Thanks again.
This reframing makes a lot of sense. Stimulants seem to adjust arousal so existing control processes can operate, rather than enhancing attention directly. In increasingly compressed task environments that overload engagement systems, that mechanism becomes especially visible. ADHD starts to look like one common failure mode when arousal and task structure fall out of sync.
Thanks for a nice overview. FMRI does not capture the attention network directly and putative salience networks in cortex always include motivation data. Neurepi drugs work through the motivation system! The long term confusion has been maintained by pharmas. I will check your work on thalamus. NEUROMIND A CONTEMPORARY APPROACH TO MENTAL HEALTH
Thanks for your thoughts and look forward to you future engagement.
Have they examined using a dual orexin receptor antagonist first?
Nice summary. Thanks