Become a Creator today!Start creating today - Share your story with the world!
Start for free
00:00:00
00:00:01
ADHD Science episode 12 with Emma Van Andel
216 Plays9 months ago
We are joined by Emma Van Andel, researcher at PsyQ in the Netherlands, to discuss the fascinating connections between light, melatonin, ADHD and sleep.
A much-requested and very important topic.
The paper is here: https://www.researchgate.net/profile/Emma-Van-Andel-2/publication/342535517_Combined_impact_of_ADHD_and_insomnia_symptoms_on_quality_of_life_productivity_and_health_care_use_in_the_general_population/links/6052293f92851cd8ce4b3b3e/Combined-impact-of-ADHD-and-insomnia-symptoms-on-quality-of-life-productivity-and-health-care-use-in-the-general-population.pdf
Recommended
Transcript
Introduction to the ADHD Science Podcast
00:00:06
Speaker
Hello! I completely mistimed that. Hello! As I mistimed most things. I'm Max Davey. I'm Tess Davey. Welcome to the ADHD Science Podcast. Yes, we can do some things in unison. I'm so good at this. We are trained professionals. You are. But not at this.
00:00:28
Speaker
You can tell because this is our third try recording it and we didn't get it in try right. Yeah but we didn't even get as far as 10 seconds the second time so now we're already better.
Interview with Emma Van Andel on Sleep and ADHD
00:00:37
Speaker
So who are we interviewing today? We are going to talk to Emma Van Andel from the Netherlands. Whoa!
00:00:43
Speaker
This is the longest period we've had from me first approaching somebody because then she wasn't available for ages to Actually getting the episode out. I think it's a year since I first approached her about doing this episode. So I'm sorry Emma that it's taken so long. It's partly due to technical issues and partly just
00:01:02
Speaker
Well, this is a long-awaited episode, isn't it? Because it's on a topic that people have been asking us for. Sleep. A significant amount. Sleep. Sleep. She's got some genuinely mind-blowing stuff to say about sleep that I didn't know before I spoke to Emma. I definitely didn't know it. Yeah, but you haven't been running an ADHD clinic for 14 years. But I don't know much. That is your role. It is. To be the questioner. Finally something to look good at. Oh, lots of things to look at, Tess. Ah, ah, ah. Good joke for that.
00:01:32
Speaker
So without further ado, we will plunge you straight into the interview with Emma and see you at the other side. Hope you can swim. Hello.
Emma's Background and Research Focus
00:01:46
Speaker
Welcome, Emma Van Andel. Could you just introduce yourself to the viewer's listeners and we can talk about your work.
00:01:57
Speaker
Well, I'm Emma, and thanks very much for inviting me. I'm excited to be on your podcast. I am a researcher in a group of Professor Sangra Koi at SciQ in the Netherlands. And we study a lot of things about adult ADHD. And in the past few years, we focused on a lot of sleep work, and we're also moving towards ADHD in women.
00:02:25
Speaker
and all other kinds of areas. I myself have a background in biology and cognitive neuroscience. So it was kind of new for me to move into the field of psychiatry, but it's a very nice place to work because you really know who you are working for and what the questions are that people have for you.
00:02:48
Speaker
Um, and during my studies, I, uh, actually got into, I got a passion for sleep research and rhythm research. And that's actually how I got, how I rolled into the ADHD world. Because apparently there's a lot of sleep problems and rhythm problems in that area. Um, I didn't know that much about it when I started already about six years ago, but, um, yeah, I'm all into now. So, uh,
00:03:18
Speaker
Yeah, that's basically where I come from. Great, thank you.
Research on Sleep Interventions for ADHD
00:03:23
Speaker
And I was sort of attracted to your work by a paper about chronotherapy and the effect on ADHD. What is that? Well, that's what we need to find out, Tess. I may not be the person to ask that question. That brings us on perfectly. How did you manage it to our first question? Elegant segue, Tess. So in the research, what question were you answering?
00:03:47
Speaker
Um, we wanted to look at the, find the best intervention for treating delayed sleep phase syndrome in adults with ADHD, which I think also rises, erases a few other questions in there that might need some explanation. But, um, basically the, in short, the background is that 78% of adults with ADHD have a delayed biological rhythm.
00:04:16
Speaker
compared to controls of people without ADHD and it doesn't have to be a problem but for a lot of people it is because you can imagine if you are a really late sleeper but you do have to get up early for school, for work etc.
00:04:33
Speaker
you kind of develop a chronic sleep loss. And that can lead to fatigue, tightness, problems with emotion regulation, also problems with attention. Everyone knows what it feels like to not sleep well for even just one night. And if that happens over a long period of time, that can lead to all kinds of problems with functioning during the day. And also leads to health problems, especially in the long term.
00:05:01
Speaker
So that's why it's really important to, you know, find out what's actually happening and how can we help these people to not have these problems. So that's kind of in short the background of the rhythm part. So since there are so many people with ADHD that have a delayed rhythm and have these problems during the day, we wanted to
00:05:28
Speaker
find out what we could do to improve that. And there were already quite some studies on that particular sleep problem, not in ADHD specifically. And there were two small studies that found that, I'll explain the chronotherapy part in a minute, but that found that if you improve that rhythm, so you advance the rhythm,
00:05:51
Speaker
that could actually lead to a reduction of ADHD symptoms and there were two small pilot studies that showed that. So the idea of our study was actually to look into that systematically. So we had a randomized clinical trial and we wanted to see can we actually improve ADHD by targeting the rhythm and the sleep.
00:06:12
Speaker
So can we just go back? That's really, that's a really helpful encapsulation. Can we just go back the delayed sleep phase just to check what, what, what that means? So effectively my understanding is that it means that the natural body clock of a person with ADHD is likely to run later. Yep.
00:06:34
Speaker
And that is essentially night out, exactly. So you and me and my brother. Well, not me. Not you. I don't know, you're an early bird, aren't you? I'm one of the 22%. You weirdo. Yeah, that's true. So's George. That's George.
00:06:49
Speaker
Lovely spit down the middle in our family. And your mum, of course, who's not got ADHD, but is a night out, but they go crazy. Same for me. So there are people who would run from midnight to ten, midnight to eight, naturally, or one till nine for their sleep.
00:07:09
Speaker
The question I have, and actually I probably should know this but I don't, is would someone with that sleep phase, would they naturally get later and later and later if they were left alone?
00:07:21
Speaker
Well, in some people that is the case. It depends a bit on how long your internal rhythm is. It's called a circadian rhythm. I think you've heard that term before. It comes from Latin and it means
Circadian Rhythms and Therapeutic Approaches
00:07:35
Speaker
approximately one day. So people's internal rhythms are approximately 24 hours long, but for some people they are a bit shorter than 24, some people a bit longer than 24.
00:07:52
Speaker
Actually, if you have a rhythm that is longer than 24 hours, so internally, if you were to be left to your own devices and you don't get enough external cues to actually synchronize to the 24-hour light-dark cycle, then you can start what you just explained and it's actually free running. So you can become later and later and later. And you actually see that in a lot of my studies where they
00:08:20
Speaker
put them in like all dark or you know stuff like that. It's not very ethical with people I think very when somebody showed something like that people sometimes do. People sometimes do it themselves in something like the northern hemisphere in the winter when they're just on your Xbox constantly. There's a little bit like that experiment. Feel like that's time to. No the next box.
00:08:41
Speaker
Okay, PlayStation, same thing. Yeah. Is there anything that can change your rhythm or is it a set thing you're kind of born with or something like that? My first instinct is to say a bit of both. It's definitely something you're born with. So some people are just later types than others or earlier types than others. It does shift during your lifetime. So around
00:09:10
Speaker
I think 19 years of age is the peak in lateness for everyone. And then you start to become earlier again towards, well, while you age, but it's not a complete twist. So usually it's not like you were born a morning person and suddenly you become a bit later during late and lessons, but it doesn't flip completely. So it's quite steady in that regard.
00:09:35
Speaker
But there are definitely things that can influence your rhythm and that's also I think what the chronotherapy part is all about. So for example there are some environmental cues that are really important to synchronize your internal rhythm to the external light-dark cycle and the main one is light especially daylight but just light in general.
00:09:58
Speaker
So it's a really strong cue if the sun's up and you, you know, light reaches your eyes and by your brain. That's actually a really strong cue for your clock. It's daytime, you have to wake up, you have to be active. And at night when the light goes down,
00:10:18
Speaker
that's a cue for your body to say it's nighttime, you should go to bed. So that's basically the strongest cue in the environment that you can have. And you can also use it to influence your rhythm. So for example, if you are very, if you are very early time, but you want to stay up later, you know, you keep the lights on, and you stay active, and you maybe have a meal or something. And that light actually stops your body from going into the night.
00:10:48
Speaker
Yeah, night faith. But if you are on late type, you want to get up earlier or be awake in the morning, if you make sure you go outside in the beginning, the early hours of the day or just the first part of the day, that's actually a really strong signal to your body.
00:11:09
Speaker
that it should wake up and so that's actually a sort of natural bright light therapy kind of setting that you can use and it's also I think very important especially in this day and age we are always surrounded by screens and lights and you know we look at a phone in bed and so we are constantly having light in our environment and I think that's also
00:11:38
Speaker
know, it can keep you up and make sure it makes you a later type in that sense. So I don't know if that answers your question. There are definitely things that you can do to influence your rhythm. And also, what time you exercise or when do you have a big meal at all? That's all they are all cues for your rhythm for your clock.
00:12:06
Speaker
So people with balconies get better sleep because you can go stay outside in the morning. That's why I'm taking away from this. We need a balcony. Can you put a balcony in my room? We've got a garden! Oh, can't we need a balcony to come all the way downstairs in the morning? That's what the nays would say in our semi-detached house. Just put a balcony in that room which is next to your house. Just felt like it. It's not going to work.
00:12:30
Speaker
So what's the nature of the is the chronotherapy therefore that is in your study? Is that involved in basically the manipulation or the kind of giving of these cues? Is that where you're going with this? Yes. Yeah. So the chronotherapy actually usually consists of melatonin and or bright light therapy.
00:12:53
Speaker
And well, I just talked about light and so bright light therapy is often given in the morning to give that really strong signal. It's time to wake up and.
00:13:02
Speaker
Melatonin is a hormone that is produced naturally in your body towards the end of the day and it peaks during the night and then it starts to drop down again towards morning and when it's low you can wake up and when it's high you feel sleepy and you are ready to go to bed. So melatonin is actually the sort of main hormone involved in the clock in the body
00:13:31
Speaker
So that's why it's also, it can also be used to influence the clock. So basically how that works is if you administer the melatonin, so you take melatonin late afternoon, early evening, it actually tells your body to stop, to start producing melatonin of its own. So you actually kickstart that production.
00:13:57
Speaker
And when you're a really late type, your melatonin naturally starts with really late. So if you want to become earlier, you can take just a bit of melatonin to kickstart that production and kind of shift your rhythm forwards that way. So it's actually a hormone that we naturally have that you can also use in that way.
00:14:18
Speaker
And Bright Light Therapy works on the other end of sleep, so in the morning to actually stop that production of serotonin and to wake you up. So those two are actually, they occur naturally in the environment or in your body. And, you know, we can use them as therapeutic interventions that way. Yeah.
00:14:39
Speaker
I know a lot of my friends take melatonin, but I don't think I've ever heard of bright light therapy. I know that there's a type of light therapy that's used for serotonin production, right? There's seasonal affective disorder. People often have bright lights. That's where I think originally issues and where we started. Our clinic started using it for seasonal depression and we still use it that way.
00:15:05
Speaker
It's also effective in non-seasonal depression and in rhythm disorders that can be used. So what was the regime that you put in place for people in your study?
00:15:21
Speaker
they all get right like therapy and melatonin, what happened? We had different groups, so we had three randomized groups and we had 51 participants, so 17 in each group. Everyone received one session of sleep education, so we talked about what is sleep, what's the rhythm,
00:15:43
Speaker
You know, um, we gave advice on sleep hygiene. So what, what is good for healthy sleep or what shouldn't you do? I drink coffee in the evening and stuff like that. Um, so everyone had that. And then afterwards they received three weeks of intervention. And, um, so we had three groups. One of them, uh, received placebo. One group received melatonin and one group melatonin in combination with bright light therapy in the morning.
00:16:11
Speaker
And the idea was people often ask me, why didn't you have just a bright eye therapy group? Yes. It's an obvious question. Yeah. It was definitely something that would have been very interesting to see. But this study was designed over 10 years ago already. And back then, melatonin was the main intervention for delayed rhythm. And like we just talked about, bright eye therapy was mainly used for seasonal depression.
00:16:39
Speaker
So and there were these few small studies that showed bright light therapy could actually be effective in ADHD. So we added it as a sort of extra on top of the melatonin to see if it will actually add something to the effects of melatonin.
00:16:55
Speaker
we're on to our second question so that's what we need to ask ah so you're surprised by these questions we ask exactly the same question every time okay so in your research what did you find well uh quite a lot actually because it was quite a large study but um i think it's good to focus on like the rhythm and the ADHD because those were the main outcomes um
Study Findings on Melatonin and ADHD Symptoms
00:17:21
Speaker
So we had these three groups that had three weeks of placebo melatonin or melatonin and bright light therapy. And what we found was that the groups that had melatonin, so both with and without bright light therapy, their rhythms were actually advanced by an hour and a half to two hours. So just by intervention. As in advanced meaning
00:17:50
Speaker
They got earlier. Yeah, they got earlier. Yeah. So I think a baseline. So before the interventions, it was there. It's a marker. We use a marker for rhythm where we use the melatonin onset time. I won't go into too much detail because it's very
00:18:10
Speaker
specific, but that was at a quarter to 12, which was really late, which normally is around, I think, half past nine in general population. And we saw that that actually had moved towards an hour and a half earlier. So off the top of my head, I can't calculate it now. So that was a melatonin surge that has moved earlier. So you were measuring that.
00:18:37
Speaker
Yeah, we were measuring it from saliva. It's actually fairly easy to measure. So we have people chew on sort of cotton swabs every hour between eight p.m. and three a.m. for one night. So before the intervention and after the intervention, we made them do that. So it was a quite, you know, they didn't really have a problem with staying up late, but
00:19:05
Speaker
That way you kind of catch that really first surge in melatonin in this group of people. So we saw that melatonin actually started up earlier, which was basically what we wanted to do.
00:19:19
Speaker
The next question was, did it also impact ADHD? Because that was the main thing while we wanted to do it. And interestingly, we saw that if you give people melatonin only, the ADHD symptoms reduced by 14%.
00:19:38
Speaker
How do you quantify ADHD symptoms? We measure the ADHD rating scale. That's a questionnaire, validated questionnaire. Oh, yes. We use also in the clinic. Yeah, to actually kind of see what's happening with after intervention. In the clinic, we always strive to get 30% reduction that we call remission.
00:20:02
Speaker
Um, so it's not quite in the same league, but if you, it's still 14% that's quite a lot. Yeah. And it's just a biological intervention. We didn't give any coaching or ADHD treatment whatsoever. So it was just met its own intake on its own. Did that. So that's, that's, I think the main thing. And we were really surprised and really happy with that. Um, so yeah, I think the main
00:20:28
Speaker
conclusion was we were able to advance the biological rhythm and reduce ADHD symptoms with melatonin. Success! I'm sure you said that in your discussion though.
00:20:45
Speaker
I can't remember if you said in your discussion of the paper. What about, was there an additive effect? Was there an extra effect from the light therapy in the morning? Well, in terms of the rhythm, so melatonin only shifted the rhythm with an hour and a half.
00:21:05
Speaker
And in combination with bright light therapy, it was two hours earlier. Statistically, it wasn't a significant difference, but still it looks like there is some additive effect of bright light therapy. But when we looked at the ADHD symptoms, the group that had bright light therapy didn't improve. So that was no. So we were really surprised by that because they did shift forwards two hours.
00:21:31
Speaker
We were really puzzled and we really went into the data to see what was going on and if we could explain that. I think we found a reasonable explanation.
00:21:41
Speaker
Because we also asked these people how easy was it to adhere to this strict schedule of getting up between 7 and 7.30am for that bright light therapy every morning. And over half of our group said it was very difficult to do. And they still did it, so we were really happy they were so committed to the study.
00:22:05
Speaker
But yeah, you can imagine, we calculate that actually having to get up that early was about two and a half hours before they would normally wake up. So you can imagine that's quite a big step all at once to just get up that early for three weeks straight. And we also looked more into the sleep.
00:22:28
Speaker
and we saw that unfortunately people didn't go to bed earlier so their bodies were ready for sleep earlier in the evening but it's very difficult to change behaviours. So is that across all the groups people didn't actually go to bed earlier? Yeah all the groups so yeah and I think it makes sense in a way I think because you give people
00:22:53
Speaker
a purely biological intervention and we did give them advice on sleep hygiene and stuff like that, but we didn't really say we had to do this. I mean I know very well that giving people advice on sleep hygiene makes absolutely no difference to them. No, exactly. It's definitely a waste of time. Exactly, so what we do now
00:23:13
Speaker
What I'm saying, for standing there telling you what you should be doing isn't helping me. I'm just saying, when I go into certain people's rooms at certain times of night and tell them to go to bed, certain people don't always listen to me. And this isn't targeted in any way. Yeah, you're not too bad. Yeah, exactly. Yeah, so I think it makes sense that, you know, people didn't really change their behaviours that much, even though they were really, you know, motivated and committed. It still, it doesn't happen overnight.
00:23:43
Speaker
But this is what fascinates me so much, and this may become quite technical, so I apologise. You've found two things that really surprised me. What time, by the way, did you give the melatonin to the group who were having? Very good question. I didn't mention that before, but that's very relevant also for answering this question.
00:24:04
Speaker
In contrast to the bright light therapy timing that was fixed early morning, the melatonin intake was individualized. So we measured people's rhythms at baseline and we actually calculated, based on previous studies, the most effective time of melatonin administration.
00:24:25
Speaker
Okay, so what is the most effective time for a moment? There is some discussion, but I think the consensus is that if you give it three hours before the dim light metatonic onset, so the marker I was talking about earlier, that gives the strongest effect. And I think in normal terms, if you calculate back from your average bedtime,
00:24:54
Speaker
I think it's five and a half hours before that.
00:24:58
Speaker
that should be the most effective for melatonin. There is some debate on the most effective time, but that's what we use to calculate when to give melatonin. So that's very interesting. That's not the conventional teaching in the UK, which is not saying it's wrong. And that's fascinating that that's the approach has been taken. So therefore, what you're doing when you're measuring the melatonin in the saliva, you're not measuring the dose that you've just given.
00:25:29
Speaker
No, measuring the melatonin you've just given the person. No, the measurement took place on a different day. So before we started the melatonin administration and like a day afterwards. Yeah, so they weren't taking melatonin when we were measuring the melatonin if that makes sense. But if you're measuring the melatonin
00:25:54
Speaker
the way that melatonin insert changes, the timing, presumably you're then measuring the melatonin on a day when you've given it. Now what we did was we measured the day after the final administration. Oh okay, so while they're taking melatonin you don't measure them and then at the end of the
00:26:16
Speaker
At the end of the administration, you then measure them again. And what you've done is essentially trained their system to have this surge earlier in the evening. I mean, that was very clear to me from what she said earlier, but that's just me. No, but it's a good question because otherwise we would just be measuring what we did. Otherwise, of course, you're measuring what you actually get. Yeah, what you did. Well, maybe I was listening.
00:26:45
Speaker
the day after the last melatonin intake. So then it's the body's own production. And if you measure it just the day after, we think it's still, you know, it's still the same as the weeks before. We also measured it two weeks later. So after the end of treatment, and then we actually saw that it had gone back to the way it was before. So it doesn't really hold.
00:27:14
Speaker
And the obvious question is, have you as your group or anyone else looked at bright light therapy in isolation since your paper or is there any work going on at the moment on that? That's a good question. We are going to do that this winter, actually. Cool. It's a small pilot study, so it's not a controlled trial in any way. But like I mentioned, we give bright light therapy for people with seasonal depression.
00:27:42
Speaker
And now also for people with rhythm disturbances or insomnia, for example. So we are going to look into the effects of bridal therapy on its own. I think there must have been some work done since, but I have to admit that I don't have it ready. I can have I can have a look around maybe and put some stuff on there. But I'm sure there is a lot of work currently on sleep, rhythm and ADHD. So
00:28:12
Speaker
We'll see what's going on when this comes out. Yeah, exactly. There are some groups working on it, definitely. That is very interesting. I've never... I mean, it makes sense that it could be used for people with disrupted sleep cycles, but I guess I just never thought about it. Crazy. Because we learn about that in psychology when we're talking about depression. But I'd never made the... The connection. The connection that, you know, light wakes you up, so why not use this light to wake you up?
00:28:41
Speaker
Exactly. I'm a genius mum. And modest as well. Should we go into a third question then? I think we should. No, that's the second one. What does this mean for people working with ADHD people, like clinicians or parents of young children?
Clinical Implications of Sleep in ADHD Management
00:29:01
Speaker
Well, I think the main thing is, if you are seeing people with ADHD on a regular basis, always ask about their sleep, their rhythms. And sometimes people don't realise that they are always tired. So you really have to ask, how are you sleeping? How are you functioning?
00:29:22
Speaker
So, yeah, I think being aware of the fact that sleep is usually impacted in some way in ADHD is very relevant for people working with people with ADHD. Especially the late rhythm, it's just so common. Like I said, 78% of adults and I think 73% of children with ADHD have a late rhythm.
00:29:48
Speaker
So, you know, just ask about sleep and be aware of that, I think. And if you do see these types of problems, think about the intervention, think about melatonin, think about bright light therapy. And of course, sleep hygiene, but with more, you know, more extensive coaching rather than just saying you have to do this, but really
00:30:12
Speaker
And what we see in the clinic is what really helps people is that we have a sleeper group and people actually make their own goals. So really small achievable goals regarding sleep. And that really helps. And that way you can actually, you know, get control over it and improve your sleep or your rhythm. So I think that's very important to keep in mind if you're working with people with ADHD.
00:30:41
Speaker
Because the fact that you, the fact that with melatonin, you didn't actually find a behavior change is really important implication as well, isn't it? I mean, I know it's not the world, it's a big study, but it's not the world, you know what I mean? It's not absolutely conclusive, but it does say, it does indicate to me that just giving melatonin, if you're not actually changing behaviors will change you physiologically, but it won't actually change the amount of sleep you get necessarily. Yeah, exactly. Could it change the quality of the sleep that you get? Oh yeah.
00:31:10
Speaker
That's a very good question. We didn't find that, unfortunately, so we didn't see any improvements or anything. But I think if you were to target the behaviour too, I think you can actually get really good results. That's what we see in the clinic now, because this is the way we are treating sleep. And one of my colleagues is actually leading a study called Sleep for Attention by Attention to Sleep.
00:31:41
Speaker
And I think that will, no pun intended, but chat some more lies because she actually looks into ADHD treatment, sleep treatment or a combination. And I think that will show some very promising results in that direction that you see if you really treat that specifically. Yeah, you can get really strong effects, I think.
00:32:07
Speaker
There are two things I don't understand. And this is really interesting because usually Tess is sort of the lay person and I'm sort of saying, well, this is role reversal. So you don't have to talk like... I don't know what's going on with my brain today. Okay, two things I don't understand. One is how you got an improvement
00:32:27
Speaker
in ADHD symptoms if you didn't have an impact on the amount of sleep? Good question. That's what we didn't understand either. But we tried to understand of course.
00:32:40
Speaker
So we also measured sleep with an sort of active watch thing, but I think a lot of people are familiar with the smartwatches. It does something similar, but we get this really like activity pattern and you can see when people are sleeping, when they are awake, the quality of the sleep, so you can really see what's happening.
00:32:59
Speaker
And we thought perhaps something is still happening in sleep that they may not report. But like I said, nothing really changed in the area. So we didn't really, we couldn't say that the improvement was due to better sleep. So, and that was what we were expecting, you know, you advance your rhythm, you advance your sleep, you sleep normally, you sleep better. So you will have fewer ADHD symptoms maybe.
00:33:28
Speaker
but that wasn't the case. So we are not really sure what's happening actually. Fair enough. It's incredibly mysterious anyway so it's nice that it's foxed us again. There was some very careful indication that maybe people did go to sleep slightly earlier
00:33:49
Speaker
And that might, so the time of going to sleep might still be kind of the target we should be looking at, but that was all very, very careful and very speculative. And, um, but that might be still, yeah. So we, we don't really know yet. Um, so yeah, it's, it's very interesting to see that just mettonin can actually reduce ADHD symptoms. We don't know how or why.
00:34:18
Speaker
And the second question, just in case my brain is not... Okay, holding up your fingers for your audio. The second question is, what's the mechanism by which giving melatonin
00:34:40
Speaker
then promotes the brain to secrete more, the body to secrete more, because usually when you give a hormone, that actually will suppress the body's natural supply. Yum, yum, yum. Very good question. I have to admit I'm not...
00:34:55
Speaker
that familiar with the molecular workings of melatonin. But I think it has to do with the dose we give. I'm not entirely sure about this. But what I do know is that if a lot of people use melatonin as a sleeping aid, so they take it an hour before they go to bed and a rather high dose, and it actually makes you sleepy and you fall asleep. And replacing the body's natural
00:35:25
Speaker
secretion you're doing something different here then yeah we're giving a very low dose and a bit earlier in in the day um and i think you are then still in that phase that normally occurs in your body too you know when it starts to rise that's actually it's rising rising rising until a certain peak is reached and then it drops again so i think like i said i'm not entirely sure i think that's what what we are targeting right giving that
00:35:53
Speaker
you know if you start early enough and you give that your body is still it might think oh this is my own melatonin and this is the point at which I have to make start making more until I reach that peak and then it goes down again so don't take my word for it entirely but just to get back to the implications for clinicians actually
00:36:16
Speaker
there's a sort of late largish dose, sort of the two milligrams kind of thing that we might use or one milligram. And then you could go early and do a tiny dose that might actually also have an effect, but it's almost two different ways in which the same drug can work just different times, which is so amazing and fascinating. Yeah, it really is. And I think there's still a lot of work being done on all those different approaches. Um,
00:36:44
Speaker
because usually people use high doses, like two milligrams up to five, I think are very common.
00:36:52
Speaker
We deliberately chose a low dose because there have been some studies comparing the effects of, for example, three or five milligrams to 0.3 and 0.5 milligrams. And they saw it was just as effective. But the problem with high dose is that you can actually get a hangover effect. So it can stay in your bodies until next morning, next afternoon.
00:37:15
Speaker
which will actually keep you sleeping. So sometimes people think melatonin is working, I'm going to take more, whereas they should be taking less. So it's still it's still a mysterious thing. Like you said, it has different uses. And I'm, like I say, I'm not that familiar with all the molecular workings or more like the point two point three dose. Yeah, the tiny dosing.
00:37:44
Speaker
And that's different to giving high dose. And that's just, I mean, that's mind blowing. Very, very unusual for medicine for this is exactly the same molecule to have a completely different, well, not completely different mechanism depending on the time of day and the dose. Yep.
00:38:03
Speaker
I have heard, could be wrong, unreliable source. No offense, Maya. That you cannot buy melatonin over the counter in the UK. Correct. Well, you can in other countries. Yeah, you can in the Netherlands. Yeah. Well, in the Netherlands, it's over the counter. So you can buy it in any pharmacy, like up to at least five milligrams, maybe even higher. Not entirely sure.
00:38:32
Speaker
Um, and I think it doesn't have to be a problem because when people use it as a sleeping aid, you know, that's, that's okay. But for people with rhythm disturbances, it's really important to get that timing right. Yeah. Timing is more important than the dose, I think. Um, so if you have no idea about its effect on the clock, on the rhythm, you can actually mess it up if you use it incorrectly. So I think I'm always a bit.
00:39:01
Speaker
When I see it in a pharmacy, I'm always a bit like, is that a good idea or not? So there is the bait going on about that. Because it's so natural to just keep upping and upping the dose. And I have lots of discussions with my patients. We want more dose, we want more dose. And treating the dose doesn't actually help.
00:39:18
Speaker
sometimes you should go lower sometimes yeah exactly and we have tried that it's so counterintuitive for people especially if someone reports feeling sleepy all day i think that's a really strong cue that you may be getting too much because it stays in the body and you don't really keep it high rather than getting a rhythm yeah and i'm working with kids so they can't necessarily say
00:39:45
Speaker
do you think that people take too much melatonin then they're sleepy all day and then they go oh i'm so sleepy i need more sleep tomorrow and then they have more melatonin could be could be i think funny i think yeah well funny in a kind of you're taking an escalating location that you don't need
00:40:03
Speaker
I'm sure it happened. I'm not. At least I can't. Ruffle. No. Tess loves it when I say internet acronyms. It's so cool. I just can't get an eye.
00:40:18
Speaker
Well, gosh, in answer to your question, Tess, you can get lower. I was going to say you can't get melatonin in medicinal doses over the counter in the UK. You can get melatonin in much lower doses in places like Holland and Barrett, other health shops, food shops are available. And of course, people, lots of people get stuff off the internet.
00:40:40
Speaker
But actually, if you, if you want, you want to do is change your biological rhythm. Actually that might be, you might, you might accidentally have a really nice effect in a very different way to giving the sleep aid, two milligrams, three milligrams that is in the UK. Not only not available over the counter, but it's actually extraordinarily difficult to get GPS to prescribe because it's unlicensed and blah, blah, blah. Anyway, it's annoying.
00:41:04
Speaker
um i have to write to the gp every time and do the whole form every time i want them to yeah very different from um it's completely uninteresting to anyone who's not actually doing my job um but it's my podcast you can do what you want you can cut this if you want um um okay so
00:41:28
Speaker
Let's, I mean, I think we've almost answered this, but let's do our fourth question. Fourth question. What does this mean for ADHD people themselves? Yeah, also a very good question. Well, I think a lot of people are, you know, they
00:41:47
Speaker
When they hear you talking about this, and I realized that there's always someone saying, Oh, that's me, or that's my brother, or that's my mother, or, you know, so a lot of people recognize this. And I think, yeah, I think it's really good to, you know, to have that awareness. And what my study in particular means for those people is that I think knowing that you can impact your sleep and your rhythm, and I can also help you with your ADHD, I think is very promising.
Future Research: Hormonal Impacts and Sleep in ADHD
00:42:16
Speaker
I can imagine. So you can actually tackle it from both sides. You have the ADHD and you get coaching and you get treatment and et cetera. But you can also target that sleep or that rhythm specifically. And I haven't found it, but I think my colleagues will report that if you do both, I think that can have a really good effect and that can really help people.
00:42:43
Speaker
So hopefully this study or this research has added to the implementation of using melatonin or targeting sleep, I think. That can already help people a lot because that's usually one of the big things. I'm tired or I can't fall asleep. So if you can improve that, I think it's very good. It's very nice to know.
00:43:12
Speaker
excellent good so what let's do our fifth question this has been had a very hard day and i think our brains are starting to work to wear out our extraordinary brains yeah that was a nice little enjoyable beautiful brains i've had my drama fun exam today i'm knackered um so what's your next question what are you looking at next
00:43:37
Speaker
Oh, so many things that this study actually led to so many new questions. I can't just pick one, but I think what I briefly mentioned in the beginning that we are working on a couple of
00:43:51
Speaker
big areas like ADHD and women, but that's quite unrelated to what I did in this study. But I think, as I mentioned, we are doing a live therapy study this winter. And in that I also, yeah, we're also going to look at the timings of bright light therapy. We are going to individualise the timing of bright light therapy, sort of similar to what we did with the melatonin. Yes.
00:44:18
Speaker
So that it's not the main question of that study, but we are taking it, you know, we are implementing it. So I think that's, it feels like a bit of a next step in that sense. Because if you've had previously who didn't tolerate the bright light therapy very well, an individualisation might help that.
00:44:36
Speaker
Yeah, exactly. And I also mentioned my colleague's work. So she is still, I think she just finished her inclusion of that Sleep for Attention study that I mentioned. So she looked into ADHD treatment, sleep treatment, or a combination to study the effects on sleep and ADHD. So she's going to write that up in the next few years probably. These things take time, don't they?
00:45:03
Speaker
Yeah, so it's not my work but I'm still involved. What's your research questions when it comes to women and ADHD? What kind of area are you? We have developed a survey and it's going to be internationally distributed. It's an online survey. We are still waiting for ethical approval but hopefully later this year we can start it up.
00:45:29
Speaker
And it's actually really, really broad and patient organizations wanted this to happen and we said, okay, we can do that. We ask a lot about physical health, menstrual cycle, but also the process of getting an ADHD diagnosis or why you are not able to get one. So barriers in that regard, treatment,
00:45:57
Speaker
Basically anything we could think of is included in the survey. Sleep is also a part of it. So we really want to give women with ADHD a voice because they have been under misrepresented for so long and we really don't know a lot about it.
00:46:16
Speaker
That's a big thing we are working on. And we are also starting up a few small studies on just mapping the menstrual cycle in ADHD, just to see what it looks like. Is it different from people without ADHD? Yeah. Because we know there's a lot of PMS related complaints.
00:46:36
Speaker
pre-menstrual worsening of ADHD symptoms, so that's a big area we're also working on. We also want to look at... That's so neglected. We've never even thought about that. I've heard a couple of people talk about it but it's very much in the kind of, we need to look at this, we haven't really looked at this kind of... Yeah, no it's very new and
00:47:01
Speaker
everywhere we go there are people saying we really need to do this and we're glad you're doing it and you know there are groups popping up that start to do it so that's really good. We also want to do a hormone study to actually look at you know the menstrual cycle and the impact of hormones on ADHD. So that's the women in ADHD part of our future. I'm really excited for it. Amazing, have you got any other questions Tess?
00:47:31
Speaker
I'm all good here. You're going to fall into a deep and restful sleep, aren't you? No, I don't think so. Because you are a late chronotype. Yeah. Yeah. You're going to go and sit on the internet for three hours. Nice. I should probably do some more of my APC. I'm not going to. Anyway, thank you so much for joining us, Emma. Thank you for having me.
00:47:57
Speaker
Do come back if you have other things that you want to talk to us about, you work with women in an ADHD, it's a menstrual cycle, absolutely vital stuff. So are we really, really excited, assuming we carry on doing this? I hope so. I'm enjoying it. Hey. Then, yeah, do come back sometime and thank you very much. Thank you. Thank you so much. Thank you. Bye. Bye.
00:48:21
Speaker
So, there we are, that was Emma and her wonderful and brilliant brain. What's next for the ADHD Science Podcast? For the ADHD Science, I'm still thinking about Beyonce, sorry. Why? Why are you thinking about Beyonce? She's released some new songs and she's going country, I'm quite excited about it. Has she done it already or is she about to do it? She's released a few songs in anticipation for her new album.
00:48:44
Speaker
Which is in March. Oh I don't know, I'm just focusing on the cool outfit she's been rocking. I mean I watched her Super Bowl ad and I couldn't make head in the tail of it. Oh well that was the advert, that wasn't her. It was two in the morning and I was quite tired. I wasn't asleep at that point, I'm pretty sure. Right, so what's next for the podcast? Not for Beyonce. Slightly less, actually quite a lot less important. Just to be clear.
00:49:08
Speaker
The next series we have started recording today and there's going to be a mixture of the typical content of interviews with amazing researchers who do just this incredible work but also we're going to try out a couple of new formats and
00:49:28
Speaker
and what formats are those? So one is a Q&A format so we want you the listener to send us questions about what the science says about anything you want to know about ADHD or related conditions just anything
00:49:43
Speaker
Tess will then read those questions to me and I will try to answer them using a combination of having read some stuff up and also my clinical and personal experience of ADHD. So start thinking of your questions now and we will we will tell you how to give them to us on our social media.
00:50:01
Speaker
Yeah, but broadly speaking, if you go to the ADHD UK website and the section devoted to the podcast, there will certainly be something there where you can enter your questions. And there is no bad, no silly question. I will not be mocking any of the questions.
00:50:17
Speaker
Well the other thing I was looking at, we very much do good science here and I go through a lot of papers to select out the ones that I think are going to be most useful to the audience and most interesting frankly to me. So we've got very high quality science which we actually cover.
00:50:35
Speaker
There is quite a lot of bad science or questionable science, shall we say. Yeah, I'll say controversial science. Fine. About ADHD. So if you've seen something, a press release or a news story about ADHD, and it sort of seems too good to be true,
00:50:51
Speaker
not quite kosher I suppose you could say then do send it to us and we'll have a look at it and see if it is really bad science I was gonna go fad or bad but they're both bad maybe we'll discover some new incredible science while we're there maybe the like lemon and salt combination that you rub on your feet will work who knows find out
00:51:44
Speaker
later later bye