Guidance for Uncertain Times: Ways to Stay Healthy During the Coronavirus Pandemic
Podcast date: April 17, 2020
- Eating, sleeping and other health challenges faced during the pandemic
- Tips and strategies for healthy eating
- Exercises to do in and around the house
- ADHD and sleep challenges
- Strategies for proper sleep hygiene
Susan Buningh: You're listening to a special podcast of All Things ADHD in response to the coronavirus pandemic. Hi, I'm your host, Susan Buningh, and I'm here today with Dr. Roberto Olivardia. Good afternoon, Roberto.
Roberto Olivardia: Good afternoon. It's great being with you, Susan.
Susan Buningh: Would you tell us a little bit about yourself?
Roberto Olivardia: Sure. I am a clinical psychologist and a lecturer in the department of psychiatry at Harvard Medical School in Boston, Massachusetts, and I specialize in the treatment of ADHD in people of all ages. I work with kids and teens and adults. I have ADHD myself and also specialize in the treatment of other issues like obsessive-compulsive disorder and eating disorders and body dysmorphic disorder.
Susan Buningh: So, we're in the middle right now, or at least in the beginning days, of this huge public health crisis. How is that affecting people with ADHD, especially around challenges such as eating and sleeping, and the kind of health challenges that people might be facing?
Roberto Olivardia: Absolutely. I think, obviously, this situation is affecting everybody in so many significant ways. For my clients with ADHD, it has sort of a particular effect, because here's this massive change and transition of how we're supposed to operate. For a lot of people, it entails them now working from home. They're home all the time. They can't sort of get out the ways that they could in the past to sort of discharge some stress or energy in the same ways and fundamental. You know, when everybody's day is just, in terms of general health, it’s eating and sleeping, and these are two issues that are highly impacted by having ADHD. And I think given the situation, those are two issues I'm hearing a lot about with my clients that are exacerbated with this. And the commonality between these two, other than things that we have to be doing on a daily basis, is that there I look at them is the bottom of a pyramid that if those two things are not managed well, it sorts of starts to topple the structure of the buildings of all the other things that we have to get done and do during the day.
So, we basically need three things to survive: We have to eat, we have to sleep, and we have to drink water. And if two hours, even the water drinking could be, people sometimes have a hard time being mindful of. If those things aren't working, it really can impact people's mood and their ability to get stuff done. And where a lot of my clients are really struggling with working from home and those kinds of transitions.
But I'm hearing a lot of impulsive eating: “I'm eating out of boredom, eating out of stress, sleeping way too much, going to bed at 4 AM because, I don't need to go to school tomorrow”—from my adolescent clients—“so I can play video games or watch Netflix or something,” or my adult patients, who are like, “yeah, I have to work from home, but I can roll out of bed” and their sleep habits are totally off, which is impacting them greatly.
Susan Buningh: Let's talk first about the challenges to healthy eating. What are the challenges people with ADHD face under normal circumstances? And then particularly under the current situation dynamics?
Roberto Olivardia: So, typically, people with ADHD in general circumstances often have problems with executing all of the things that they need to do for healthy eating. Studies show that people with ADHD are more impulsive eaters. They tend to crave foods that are less healthy that are high in sugar, because sugar delivers a good dopamine burst in the brain, or simple carbohydrates, which basically get metabolized and processed like sugar. They tend to not plan for meals as much, because if you think about it, cooking and meal prep requires a level of executive function. So, if I'm going to make meat tonight, I have to think at 8 AM, or maybe the night before, Let me defrost that chicken that's in the freezer,” because if I'm thinking of dinner at dinner time and nothing is thawed, nothing is cooked. Where is that going to leave me? But quick, often highly processed foods, or in the case of fast foods, even with people with this situation, people still can do takeout, and that could lead to an over-reliance on unhealthy food.
People with ADHD also have what we call poor interoceptive awareness, and this is true when it comes to eating and sleep. Interoceptive awareness refers to the ability of us to be mindful of what's happening inside our body in terms of cues that our body is giving us. So, “Am I hungry? Am I full? Am I satiated? Am I tired?” All of these things are very difficult for people with ADHD because, it's almost like an ADHD brain is so externally focused. I remember when I was in college, I didn't even have a concept of “Oh, I'm tired.” To me, defining tired was there was nothing left to do in the day and there was no one to socialize with and therefore, I'm tired., I'm going to bed now. But the idea that there could be fun to be had, but I'm going to go to bed because my body is tired would have behooved me. That was like a perplexing concept, and hunger and food were the same thing.
You know that.we say a lot of people with ADHD are on the seafood diet—that if they see it, they're going to eat it. So if I have a package of Oreo cookies in my house, which I rarely will have, that's it. I don't even ask myself whether I'm hungry—they’re there, and it makes it just too tempting to eat them.
So, these are all things that really impact the weight, and the result of that is that people with ADHD or much higher risk for obesity. And that's true of children as well as adults. We’re at higher risk of all the medical conditions, therefore, that come along with obesity—diabetes, hypertension, high blood pressure. As Russell Barkley and his landmark study last year showed, it affects our life expectancy in multiple ways. And a big part of that is how we manage our eating.
Susan Buningh: Can you share some specific tips or strategies for people with ADHD regarding eating healthy during this time?
Roberto Olivardia: So, one of the things I encourage with this situation is to use it as an opportunity to reflect and use it as an opportunity to start to build skills that maybe we always felt like we never have the time to do before. You know, a lot of people are finding that they have a lot more time on their hands now when it comes to eating, they're finding that eating some Ben and Jerry's is a way to pass time. And what I recommend is looking at cooking new things or new recipes, being aware of what it is that you're eating, having some sense of preparation. So even if, let's say, our meal planning, so if the night the day before even you think okay, and it doesn't have to be 100% strict, but generally, what do I want to eat tomorrow for breakfast, lunch, and dinner. Now, even asking ourselves, that question can really set us up for healthier eating. Because for many people with ADHD, we're so in the moment that a lot of times people with ADHD almost kind of cringe at the idea of planning because they say, “Well, I have to see what I feel like eating at the time.” But the problem is that many people with ADHD would feel like eating something, let's say, high in sugar over something that might not be, but it doesn't mean that it's good for them.
And so, when we have some preparation and say, “OK, this is generally what I'd like to be eating,” we have some road map as to how we want to eat. And then we start thinking, “OK, well, if I'm going to make oatmeal, do I have all the ingredients for that? If I want this kind of sandwich for lunch, do I have the ingredients for that?” And then you're almost, and this is all executive planning, basically that you're doing and to keep in mind that this is generalizable. That in other words, when we're good at doing this with our food, we are exercising the same muscle of executive planning for other things for other goals that are not food-related, including sleep as well as other things. So, this is something that we can use as an opportunity of really kind of working out a muscle that those of us with ADHD, it might not always be so strong, you know when it comes to that.
Also, when you are snacking, for example, instead of bringing the bag of chips with you on the couch, take a handful of couple handfuls serving, put it in a bowl, wrap the bag up, put the bag away. Sometimes out of sight, actually can be out of mind. And I've certainly been in the situation where I have the bag of Doritos, and I think I'm not going to eat this whole bag—well, before you know it the movie's done and the whole bag is eaten. But if I only put a couple of handfuls in a bowl, lo and behold, I'm satisfied by that amount in the bowl.
And so again, it really is dependent upon what we're externally putting out there. Being aware of: Are we eating enough fruits? Are we eating enough vegetables? Are we eating food that is high in protein and fiber? These are really substantive nutrients that, for example, like especially protein and fiber, that when we eat foods that are high in those nutrients, we're not hungry a half-hour later. Like we might be eating like most cereals, honestly, or sugar, we eat cereal; I used to say in high school that eating cereal was like eating air, like it would taste good for 15 minutes and I'd be just starving by the beginning of the school day. And then my mom used to make me eggs, or I'd have leftover chicken from the night before—and that was my breakfast a lot when I was a kid—and it totally made a difference.
So, being aware of how does this food make me feel now, this is where mindfulness becomes a big piece of it and these skills that have us be aware. How do I feel after I eat this? Because sometimes we'll eat something and it tastes great going in. And then 10 minutes later, we're like, “Oh, you know, like fried dough is one of those foods for me. I haven't eaten fried dough in years, but I remember the last time I ate it. I said to myself, ‘This is the last time I'm going to eat it.’ That's because they feel gross like afterward, and I'm not saying everybody has to feel that way about fried dough, but I'm sure there are foods out there or amounts of foods, and people out there who are hearing this could relate and think afterward, I don't even feel good afterward. And we need to pay attention to that.
Susan Buningh: Do you have any suggestions for people who might be finding themselves stress eating or emotional eating at this point?
Roberto Olivardia: Absolutely. So, I think, again, with this situation, we're all in this kind of a reservoir of uncertainty and I know personally, I hate that feeling. I like to feel like I know what's going to happen, and it's a daily exercise for all of us in tolerating that uncertainty. And food becomes a very easy comfort because it's very sensory, and ADHD brains and bodies really respond to sensory input. And if you think about food, we see it, we smell it, we touch it, you can hear it if it's very crunchy—it hits all of the senses—very tactile, depending on the kind of food, so it makes sense that there is something accessible. It's legal, and it hits all of the sensory buttons—it makes total and complete sense, and I want to tell people who are listening not to shame themselves or judge themselves if they find themselves having a problem like with food or stress eating and things like that. To understand that there's almost like neurological wiring, especially for an ADHD brain, to find comfort in that.
At the same time, we want to work on that, because we don't want it to be contraindicated for our health. So, part of what I recommend is having people do other things that might discharge stress. So, it could be some vigorous exercise, whether it's in their backyard or even in their own homes, putting on their YouTube videos, where people can exercise. Even just some simple cardio just to get their heart rate going. It could be yoga or stretching or very more kind of meditative movements. Just to even ground ourselves, which is a general thing that we all should be doing, even before this situation. Just take five minutes to just take some deep breaths and, like, just let the air sort of go in and out of our bodies.
Similarly, when we're eating, a lot of times when we have a portion of food and we want to get seconds or thirds, give ourselves even five minutes, ten minutes’ pause and see how we feel. A lot of times, if we give ourselves even a five-minute pause, we realize that we're actually satisfied and that we don't need that second or third portion. Talk to people you know, find ways to reach out. If you live alone, online support groups or just even just to Facetime or text people about just what it feels like, that kind of uncertainty, articulating that is really important. That has been proven to be very helpful in stress management.
I'm a big music lover. Music has always been medicinal for me, and so I listen to music and that's a great stress relief. If you have an animal—I have a dog—petting your animal has been shown to be good for your blood pressure and very soothing, and it has that sensory element. And so, sometimes we just might need another, healthier sensory sort of input, whether it's something like music, whether it's something like reading, and just try, knowing that it might take a little time to find what that thing is. But then it's worth it, and know what the initially it might not feel as good as Ben and Jerry's tastes, but you'll feel better afterward, you won't be regretful. For a lot of the patients I work with, they get caught in the cycle of shame around it, and we want to sort of take the shame away from it and just make it about “Okay, this is not working, so I need another strategy to help me because I'm feeling pretty stressed out right now.”
Susan Buningh: Social media has been replete with jokes and cartoons about all the weight people are going to gain during this time. But it really doesn't have to be like that.
Roberto Olivardia: Not at all. And actually, you just reminded me, Susan, of actually one of the most important therapeutic things is humor. I've been a big fan of stand-up comedy and so, Spotify this morning—coming into work, I just couldn't take in the news. I didn't want to absorb it. You know, I want to be educated about what's going on, but I don't want to be inundated and so immersed in it. And that's another thing for people—it's okay to shut off the news. You're not ignorant. As long as you have the basic facts and you're taking the right precautions. It doesn't help, you know. I've turned off alerts on my phone from news sources that tell me another person has died in my state. I feel very, you know, my heart breaks for those families, but I know I'm doing all that I can do in terms of keeping myself and my family safe. Sometimes, as many of us with ADHD are very empathic, I can drown in it and I don't want to drown in it. That's not going to be good for me and good for my patients and good for my family. So—humor. I was listening to standup comedy coming into work, before I started my day, and that is very therapeutic, you know, some funny memes that air, just funny, or YouTube channels.
But you're right, it's not an inevitability that we are all turning, going to have to turn to, junk food and things like that. We don't have to be defeated in that way. We will get through this. And I think that's important to keep in mind that we're going to get through this. And I just would, I'm encouraging people to just use this as an opportunity to just reflect on many aspects of their life, their relationships, their health habits, things like that. What are the things they're looking forward to doing when this is all done and over with? I know for me, whatever the first concert I go to after this, I think I'm going to literally be absorbing every musical note in my DNA, in every cell of my being. And just I'm going to really celebrate that. So, I'm looking forward to that, because I know we'll get through it.
Susan Buningh: Oh, absolutely, live music will be wonderful. Let's talk a minute about exercise, because that's certainly a challenge right now with gyms closed, yoga studios closed. In some states, parks and national parks, I think are still open, but some parks are having to be closed because people are not observing social distancing. But it is still a good time to exercise—and exercise is so vital to our health.
Roberto Olivardia: Absolutely, and I'm glad you brought that up, because the gyms are closed and a lot of people think, Oh, the gym is closed. I can't work out. Um, no. There are many ways that we can exercise. And just, even if you don't have weight training, let's say, as part of your exercise, you don't need weights to get your heart pumping, to burn off a sweat. There are lots of things. You know, I have two children, one almost 15 years old, one almost 13 years old, and they start their day—because they're not in school now with physical activity—and we have a basketball hoop in our driveway, and they have probably used that more now than ever before. I mean, they used it before, but really are using it now. And then we find workout videos online that are appropriate for their age, and we sort of do them, and then we try to also make it fun as a family, fun things to do to just get our bodies moving. We don't have to have the two-hour weight lifting.
Training, exercise, is just basically just moving our bodies, even if you can walk, again, observing proper distancing. A 30-minute walk a couple of times a week is really good for your body. It could be sit-ups; it could be push-ups. The benefit of things like YouTube and stuff like that is we have access to lots of training videos, if, instead of doing an exercise class, you're just doing it in your own home. But exercise is so important, especially for people with ADHD. Studies show that it improves executive functioning. It clears out stress. It's certainly healthy for the body. It helps with our sleep. It actually helps regulate our appetite. So, studies show that when people who exercise regularly are also more, they tend to be more mindful of what they're eating as well.
As you know, people who eat healthily might tend to exercise, but it also works the other way around. A lot of my patients that I worked with are trying to achieve healthy weight loss. For people who are overweight, we found that even though a large part of that is going to be what you eat; however, for a number of those patients, it's when they started exercising that they started paying attention better to what they were eating. And they would say, “Huh, you know, I just, like, rode my bike for an hour or I just jogged or I just did this. I don't know if I want to eat a doughnut right now,” like that kind of undoes it. And again, there's nothing wrong with having a doughnut every now and then, but if you're trying to sort of eat in a more healthy way, having a doughnut every day might not be the right choice.
So, these are habits that are—not just in these days and times with what's going on, but to really try to adopt as a general strategy. It's so good for you, and to go back to stress relief—exercise absolutely is probably one of the number one things you can do for stress management.
Susan Buningh: So, how would you suggest that people put a workout into their day, or some form of exercise—time for that as well as motivation for that during this time?
Roberto Olivardia: I think definitely having a sort of planned time, like a date with exercise is always more helpful, because with ADHD, we could say, “Oh, I have all day tomorrow to exercise, so I'll do it tomorrow.” Well, for the ADHD brain, tomorrow is anywhere from 12:01 AM until 11:59 PM, and at 11:58 PM you could still be saying, “Oh, I still have time. The day isn't over yet,” and it's over in two minutes. So, the more that you can literally schedule it, and part of that again is mindfulness of being honest with yourself.
I am not a morning exerciser, personally. So, I know people who wake up at 5:30 in the morning, they get their exercise, they love it, they get it done and over with. I've tried—it's not something that's sustainable for me. I'm a night person when it comes to exercise. Now, with this schedule, especially on the days that I'm home, I could do it in the afternoon and do it with my kids. But before all of this situation, I worked out at nighttime and I go to this gym, it’s 24 hours. I'm working out at nine o'clock, at 10 o'clock at night; come home, I take a shower, and I'm actually better able to sleep that night. It doesn't activate me in a way that it might for some people. So, if you're not that 5 AM person that works out, that's okay. Don't again try to fit yourself into a box that just doesn't work for you, and then you end up throwing the whole thing away. It's asking yourself when is the best time for me and then let me schedule and not go, we could be all or nothing, a lot of the times with ADHD, is don't start with seven days a week. Start, if you are not exercising at all right now, just shoot for even twice a week or half an hour, twice a week, perhaps of just something and something ideally, that's enjoyable for you. You don't want to do something that feels just like a bore or dreadful.
Incorporate things that are—I mention this because I'm a music lover, I have playlists upon playlists of great music. A lot of times when I'm working out, when I would go to the gym, it's not that I even look forward to going to the gym. You don't have to be motivated to work out in order to work out, and I know that might seem strange for people without ADHD. I'm motivated to listen to music. I love listening to music, and so I know well, “I'll go to the gym and This is a good opportunity to listen to music.” I have patients who listen to podcasts while they're working out, and it's almost like the working out is something that's kind of happening in the background. But the result is the same—they’re still doing it and they're getting it done and they feel great afterward. And they were able to listen to their podcasts. Or, people who might be on a bike or an elliptical watching their Netflix show or something like that. So, combining it with other things that might make it more enjoyable. Being outside, it's going to be nicer weather. It's a little cool here in Boston today, but the nicer weather is upon us. Go outside if that's more helpful in that way.
And then, the other piece, is sometimes because we don't feel that inherent motivation, but we always feel good afterward. I've never said “I wish I didn't work out” after a workout. Never has that happened. I always feel great afterward. At the same time, even as good as I feel, the next time it almost doesn't carry over enough for me to be like, “Oh, I'm going to have this great feeling I can't wait to go to the gym.” It's the same, almost like robotic-like, “Okay, let me just dress in my gym clothes and let me just get there.” But no part of me feels motivated from this, in the same way I'm motivated to listen to music and it would be. But I want to let people out there with ADHD to know, you don't have to be one of those people that are gung ho, “I love to exercise.” If you ask me, do I like going to the gym? The answer is no. But do I like how I feel afterward? Yes. And yet they don't ever meet those two things. They don't ever connect, but I don't need them to. As long as behaviorally I'm doing it to keep myself healthy, that's all I need. And I've recommended to people sometimes put on your gym clothes like whatever you would like workout clothes. And because ADHD people are so externally focused that sometimes even internally, if you don't feel like working out but you kind of look at yourself when you're in gym clothes or sweats, you're like, “Oh, guess I'm going to work out now. I guess it's time to go to the backyard now and do some jumping jacks.” Sometimes all we need to just nudge us and push us, certainly, if you have family members or people. I live in a cul de sac, and I know that in a neighborhood near my house that and another cul de sac neighbors are sort of all working out together with distance, major distance between them all, but they're all just doing jumping jacks and just moving. So, their way is doing it with other people. You can Facetime a friend and say, “Hey, why don't we make a date that both of us will do these certain exercises so you don't feel so isolated.”
Susan Buningh: Or Zoom!
Roberto Olivardia: Or Zoom, exactly!
Susan Buningh: Another good tool for this time. You mentioned sleep a couple of minutes ago, which is such a huge component of good health. What challenges do people with ADHD face when it comes to sleep? And how do you think those might be exacerbated at present?
Roberto Olivardia: I would say, what challenges don't people with ADHD have with sleep, even before this situation? There's a bevy of very strong empirical research studies that show that people with ADHD have a much, much higher likelihood of sleep issues and sleep disorders. In my opinion, it really should be part of the diagnostic criteria. I don't know anyone with ADHD that doesn't have some issue, problem, with sleep or a full-on sleep disorder. I myself have many of them. These are things that people's parents can say and see even in infancy. This goes on from the beginning, this isn't something that just pops up when you're an adult or a teenager with ADHD.
Parents that are interviewed find that their kids with ADHD had much more sleep problems, difficulty falling asleep, difficulty staying asleep, sleep talking, sleepwalking, sleep paralysis, night terrors, paroxysm or teeth grinding, restless leg syndrome, sleep apnea, all of the above. Circadian rhythm abnormalities—something called delayed sleep phase syndrome or DSPS, which I actually have—which showed that my circadian rhythms basically, where most people you know about 10 or 11 o'clock or when the sun starts going down, people start getting tired and melatonin starts releasing, and I almost get this rush of energy at 10, 11 o'clock that could keep me up, if left to my own devices, until two in the morning. Prior to having kids, it was about 2 to 8 AM were my ideal hours of sleep. And when I had a sleep study, and it showed that, it was an incredible amount of validation. Okay, so it's not just all of these other behavioral issues like procrastination and things like that that kept me up late, but there is something there. Now, that doesn't mean that those are the hours I have to sleep, but it does mean it's more challenging for me to get to sleep at an earlier time than somebody else, and I just have to accept that and it will be for the rest of my life.
So, there are a lot of challenges with just even calming the brain down for a lot of people with ADHD, because one of the best quotes (and I don't remember who said it. I actually heard it in an ADHD conference) said, “For people with ADHD, going to sleep is lying in a dark room, waiting for nothing to happen.” It's just boring. It's like, “What do you do?” Oh, you're just, like, lying there, and what happens is that we start thinking. I have a very vivid imagination; I know a lot of people with ADHD do. And sometimes I'll start thinking about things that make me anxious; like, here's this situation that we're in with the coronavirus, that that's what people are thinking about a lot of the time. But sometimes it could even be something I'm looking forward to or something about my day, and I'm thinking, “Oh, this is not the time Roberto, to be thinking about this. You're supposed to just let go of everything.” That's so hard for an ADHD brain. Also, for a lot of people, they're going to bed too late because they might have issues with procrastination of getting work done, or in the case of college students I work with, getting their studies done, and so it’s pushing them now into one, two, three in the morning. It could be a show their binge-watching, video games, all of those reward-center behaviors that keep people up in the night time.
And so, it's so important, and this is something just, you know, I have this kind of twisted affair I say with the concept of sleep, because theoretically, I've always known how important it was. But it's probably been in the last five years of my life, that I truly, truly respected and understood it. Part of that is because I've had major consequences of not paying attention to it. When you don't sleep well, your immune system suffers, your mood can be dysregulated. I remember getting shingles in my early thirties, and it's not normal to get shingles in your early thirties, and it was totally caused by a wave of sleep deprivation night after night. So, it wears the body down, and especially given what we're living in these conditions, keeping your immune system up is paramount and poor sleep habits absolutely assault your immune system. So, for any reason, I'm urging everyone out there, now is the best time to work on these healthy habits of good eating but especially good sleep because you're boosting your immune system.
I used to think of sleep as a passive activity. There are so many other things I could be so much more productive with, like sleep was almost an interference in my productivity. And now, even though biologically I understood that it's a very active process, actually, when we're sleeping, we’re doing a lot. Our bodies air replenishing and consolidating information and regulating our metabolism and discharging stress and toxins and building our immune system. But I didn't really connect to that until fairly recently, where now I'm like, No, sleep is actually medicinal. I have to see it as a medicinal thing. I have to really respect it, and I can't say I did that when I was younger, and that's something I honestly regret because a lot of times we think of “Oh, I'll make up for sleep on the weekends. I'll sleep extra.” The truth is, and I remember hearing this fact from a sleep expert. It depressed me. He said, “We never actually make up for lost sleep. We don't. Yeah, we might sleep 14 hours after being sleep deprived for three days, but we're not undoing the damage that we've done to our bodies. And that could shave years off your life,” he said. And that scared me. I thought, oh, I don't like hearing that. I like the idea of feeling like I could reverse the damage. And it's like, no, you can't. It's gone, it's done.
Susan Buningh: So, then, what are some ADHD-friendly strategies for proper sleep hygiene?
Roberto Olivardia: So, really first and foremost is to get in that mindset and really look at sleep as something that, again, you have to respect and really have a respectful relationship with, and not look at it as, like I have to go to sleep or, you know, as they were, or look at it as the thing that's interrupting your binge-watching or the thing that's interrupting the good time. It's like, no, I have another day tomorrow and I have another day after that, too. There's fun to be had in all of those days. So now is the time—in fact, I'm more likely to have more fun and be more present if I get a good night's sleep tonight.
So, first is to really kind of click into that mindset and ask yourself what happens when I don't get a good night's sleep? Because again, this is part of that interoceptive awareness. Many people with ADHD, when I asked them, “You know what? What does it do for you when you don't sleep?” Well, sometimes people say, “I don't know.” But then, when I asked them to really observe that they're like, they say, “You know what? I realize I'm much moodier or my family says I'm more snappy or more irritable. I eat much more high fat, high-sugar foods when sleep-deprived.” And that's true. Actually, sleep deprivation is one of the factors of obesity. Actually, in this country is that when we're not sleeping correctly or proper amount or a not appropriate amount, our body involuntarily—and this is to keep us alive—it lowers our metabolism to conserve body fat, and it simultaneously craves high-fat, high-sugar foods to the point, Susan, where our sense of smell towards high-fat foods is heightened. So, it's like, if you almost think about it, in the days when we were cavemen and cavewomen, before we had supermarkets and plenty and abundance of food around us, that it makes sense because the only way our brain would think, “Oh, we're going to let go of this amazing resource of sleep, which does all these replenishing things for our body.” The only way to do that is to hunt or get food because it anticipates a famine state. And so it wants you to be alert. But it means that you better conserve that body fat or else you've you're utilizing extra energy, and those calories are burning. You could starve yourself because the brain doesn't recognize that there's a McDonald's around the corner. But the problem is, we do live in a society here in Western culture, we live in a society where there is that food.
So, when we're playing around with our sleep, it messes with our appetite. And that's very important. Understand the link between those two? They're hormones that just are secreted. That literally does, you know, do that. So we want to respect sleep. We really want to try to have a schedule of “Okay, I want to get seven. At least seven hours of sleep. I need to be in bed at, let's say, 11 PM.” So now if you want to be in bed at 11 PM, you don't want to just think about going to bed at 10:59 PM, which a lot of people with ADHD do. And then at that point, they're like, “Oh, but I'm in the middle of something.” And then that 11 PM time is in the distance. You want to set an alarm on your phone, perhaps at 9 PM, and maybe change into your sleeping clothes, again externalizing something that internally might not be kind of, you know, the wheels might not be grinding internally to say, “Oh, I'm supposed to be in bed in two hours.” But if we start changing into our sleeping clothes, we’re aware of what we're doing. Not engaging in too high debating activities or even movies or TV shows that could be very activating.
I'm a big fan of Law and Order Special Victims Unit, I love that show. I think it's one of the best-written shows out there. That's not a show I can watch right before going to bed, because it's obviously the content is very emotional, very heavy. But I love the show, and I think it's written really well. But I can't watch that right before going to bed. Comedy, sure, comedy is something that, you know, is more light-hearted, things like that. I certainly am not watching the news or reading the news, especially now, right before going to bed. The last time I look at news headlines, probably about 6 PM, and then the next morning, look at the headlines again. Being aware of what content you're bringing in and what you are doing is picking something, maybe, that's more soothing. If you're a reader, to read, If you like puzzles, if you listen to music, these are things that are kind of more on the soothing side.
Certainly, be very aware also of your bedroom and how that’s set up. For a lot of people with ADHD, we want the bed to be a very comfortable place for the body, to say this is where I need to be. A lot of times, I recommend that people keep their room very cool, and a lot of people with ADHD do very well—again, that sensory input—with something heavy on top of them. So, regardless of the time of year, my bedroom is pretty cool, and I have a very heavy comforter. I cannot sleep with just a sheet on me, that feels like a feather tickling me. It's a very uncomfortable feeling. I need that weight. And actually, this is why I mean a lot of kids and adults I work with have weighted blankets. If you've ever seen those, some of them are fifteen, twenty-pound blankets. That really helped them in terms of physically grounding them in their bed. That says, this is where you need to be. Setting up, not having any lights in the room, even the light from a clock or your phone. Some people do very well with soothing music, perhaps like on repeat, like an instrumental song, and artists like Enya, one of my favorites, one of her songs on repeat at very low volume so it's enough that you can listen to, but not too much that you’re overstimulated by it. I know some people that listen to podcasts. That doesn't work for me. But some people, they sort of fall asleep listening to certain podcasts, especially ones that they might even have heard before. I have a number actually of adolescent ADHD patients who are big Harry Potter fans, who have read the books countless numbers of times, and they go to sleep to an audiobook of Harry Potter, and it works for them.
Part of having ADHD is we are going to be our own researchers on our own experience. One of the benefits of having to do this, it's challenging and it could be frustrating, but I always tell people, especially young people that I work with, is if you start this way of operating and figuring out what works for me and not judge. It might be unconventional for other people, but this is what works for me. You really get this keen sense of awareness of who you are when you are older. I know at this point in my life what is going to work for me and what is not, very, very well. That comes from a lifetime of experience of having to figure that out, because there were big consequences if I didn't figure that out. And earlier in my life, I could have been frustrated by that, and some of it was painful. But now, well, the upside to that is I'm pretty good at knowing what I need to do in order to make things work—and sleep was definitely one of those kinds of things.
Some people sleep better with a wedge pillow. Some people find that even where and the position of how they sleep could be helpful. Some people do better listening to ocean waves. So really just experiment and try things, because you can have two people with ADHD who are totally different in terms of what helps ground them when it comes time to sleep. The other thing I recommend, especially if you find that you are inundated by thoughts before you go to sleep, when you're lying in bed: Have a journal, and I recommend a journal over typing this on a computer—there is something studies have shown, when we write something, our brain almost kind of records it in a more imprinting way than when we type it—have this journal where you just write out almost, like, purge out all of your thoughts, and anything that for the next day you want to think about. Say “Okay, you know what? Here is the thing. These things right now are not the time to think about them. But I do want to think about some of these things, so I'm going to write them down, and tomorrow I will get to them.” And that could be a helpful way too, because some of the time, if we're lying in bed, we're thinking, “Oh, there's this thought and I am invested in thinking about this thing, and I'm afraid I'm going to forget it.” Well, writing it down becomes a really great way of doing that. But try to do that beforehand, like at least a half-hour before you go to bed.
Susan Buningh: Roberto, thank you so much for all of these fabulous tips for staying healthy through these times—healthy eating, sleeping, and exercise—such important things. Is there anything else you want to say to our audience?
Roberto Olivardia: I guess just again to reiterate that all of these all three areas can be very easy for a lot of people. Everyone with ADHD has the experience of witnessing other people fluidly do things without pause. It's just very easy for them. It literally still astounds me that people just go to bed and their head hits the pillow. They fall asleep; that's just so weird to me, it just feels like, Are you a unicorn? Like how does that even happen? And I tell people not to get wrapped up into negative self-talk around the fact that these are challenges for us, and that's okay. We just have to work through them, and then there are other parts of having an ADHD brain that are going to work very well for us. But those things, those strengths or gifts or all that can come along with an ADHD brain, those will not be realized unless we figure out this bottom part of the pyramid. Eating, sleeping, exercise—these are the fundamental things that we really need to grasp and to really see as very, very important.
A lot of times, people would say, “Oh, I don't have time for exercise. I don't have time.” We do have time and what we have to understand is that what we're prioritizing. When we exercise, when we sleep healthfully, we’re boosting our effectiveness to be productive that next day. So it's not like I used to think: “Oh, I could sleep three hours and then in those hours I'm not sleeping, I could get stuff done.” What didn't click with me until later was I'm not doing those things very efficiently. I'm not doing them robustly. And, in fact, if I slept the six to seven hours, then when I do do those things, I'm doing them so much faster, clearer, more coherently, more cohesively. And that's what I needed to understand. And the same with diet. When we eat better, we're going to think better. We're going to feel better. It just has this incredible domino effect in a good direction, and it can have an incredible domino effect in a bad direction, in terms of health. So, respect those three things as just nonnegotiable. We just have to work at it.
Susan Buningh: Thank you so much for your time this afternoon.
Roberto Olivardia: My pleasure, my pleasure. I hope everyone out there is doing well and staying safe and healthy.
Susan Buningh: CHADD and its National Resource Center on ADHD are here to help. We are committed to continuing to be the resource on which you can rely. For more information, visit our website at CHADD.org and follow us on Facebook, Instagram, Twitter, LinkedIn, and Pinterest. Now more than ever, you need the best information on ADHD. It's the perfect time to subscribe to Attention magazine, with articles from experts on children as well as adults. Find out more about subscribing to the digital or print editions at CHADD.org.
- Plan and Shop for Your Pantry. ADHD Weekly, April 16, 2020.
- Articles on healthy eating, Attention, June 2012 edition.
- Including Exercise with Behavioral Interventions Can Increase Benefits, ADHD Weekly, February 20, 2020
- Exercise for ADHD: Ready To Start And Stick With It? ADHD Weekly, April 5, 2018
- 30 Minutes of Exercise Can Increase Attention. ADHD Weekly, January 19, 2017
- Sleep is not always easy when you have ADHD, ADHD Weekly, February 15, 2018
- McGavern, Katherine, The Most Valuable ADHD Advice You'll Ever Hear. Attention, August 2014, v21 n4, pp. 16-17.
- CHADD National Resource Center on ADHD (2019). ADHD and Sleep Disorders
CHADD National Resource Center on ADHD (2019). ADHD and Sleep Disorders Diagnosis and Management
- Olivardia, Roberto (2019). Redefining Healthy Eating and Our Relationship With Food. CHADD National Resource Center on ADHD, Ask the Expert webinar.
- Arnold, L. Eugene (2018). Nutrition in Support of ADHD Treatment. CHADD National Resource Center on ADHD, Ask the Expert webinar.
- CHADD National Resource Center on ADHD (2017). How to Start Eating Well When You Have ADHD (with Dr. Roberto Olivardia).
This podcast is supported by Cooperative Agreement Number NU38DD000002-01-00 from the Centers for Disease Control and Prevention (CDC). The contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC.