Not many people are diagnosed with Sluggish Cognitive Tempo. Anyone who is would likely know why so I won't get into that. Just to say the ADHD relevance is that 30 to 60% of ADHD-I people are comorbid with it according to research and may even be misdiagnosed as ADHD instead of SCT.
For someone who is diagnosed with SCT, do you have daytime sleepiness even on a regular schedule? Then in the evening naturally be more awake and less symptomatic, even though you may be feeling a little sleepy from being awake or active all day? Then have a hard time falling asleep and staying asleep with quality sleep. Then in the morning find yourself dead tires when you need to get up and, well, sluggish? Me, even if I am tired I have a hard time falling asleep. Eventually I do only to wake up after brief wake ups to roll over about 3 or 4 hours later. Then it usually takes take a while to fall back to sleep. Then another hour or 2 after that I reach deep therapeutic sleep, followed by extreme difficulty getting up when my alarm clock goes off.
When I was on a strict daily schedule for many years and no caffeine after lunch at 12 noon. I would still about once a week not make it through my bedroom doorway on the way to the bathroom for a shower and hit my shoulder on the door jam. After the alarm going off constantly without the snooze bar for 45 minutes and forcing myself to get up so I am not later than usual for work. Then breakfast, get dressed, all while rushing to work. Getting to work 8:30ish, half hour late. Well awake from rushing and have a natural wakefulness that lasts an hour or 2 after I finally get moving. Then a gradual decline so that by 10:30 to ll a.m. I am nodding off in front of the computer trying to use my coping mechanisms just to stay awake, not even to mention the lack of attention and focus falling asleep provides.
I also often would have a second slump in the late afternoon/early evening that could last for hours before I naturally wake up. Even on days I didn't have caffeine or a lot of sugar during the day.
I am not diagnosed with SCT but am positive I have it. I won't get into all the reasons why at this time. Just looking to see if people with SCT have the same issues as I describe them. Reason being, is that if I truly have SCT, and others have my same or similar symptoms. I think I can contact some of the researchers on the subject and advance research a decade just with the understanding alone. Assuming it is true. I did contact one researcher who had done something a while back and not actively doing SCT research. She thanked me for finally being able to put words to it and describe it and be able to utilize that to her own patients. If it is just me, then that is good to know too LOL.
I describe to myself 2 states of mind. My "Day Brain" and my "Night Brain". Seems like whatever the neurochemical issues is during the day, after 12 hours for me give or take, I transition into the more functioning, less symptomatic "Night Brain". Even though being up all day may have its own pressure on wakefulness by the evening. By bed time I am just not tired enough. Have been on prescription that gave me great sleep to rule out sleep disorders for my ADHD differential diagnosis. Helped a lot but symptoms were still enough to be a clinical issue.
If this understanding is correct, I believe researches have been beating around the issue but never really finding it. I believe that issue to be some kind of a deficit with a function of the brain that partially or completely resolves itself at night. Which would give researchers something testable to look for the absence or deficiency in the day vs it's existence or significantly increased incidence in the evening. That should provide a limited set of things capable of these wakefulness issues. Find that or those things, then work can be done on selective drugs for optimal therapeutic effect. Some researchers also believe there may be sub types of SCT so if it is not just me, and I have SCT, and the issues are SCT, then it may only apply to a specific subtype anyway.
And I am fully aware that daytime sleepiness is just one of the many symptoms associated with SCT. So by sleepiness I really mean sleepiness and increased symptoms with it and the opposite at night. Just easier to write al this without qualifying symptoms all the time.
And, just for the record. For myself it is not simply a day/night thing. Otherwise it may just be a circadian rhythm issue triggered by sunlight. With the shift in my schedule, the symptoms shift with it. For example my "Night Brain" as I dubbed it was going this morning from about 4am till about 1pm when I went to bed. And had a hard time waking up (Day Brain) in the early evening when my usual "Night Brain" would be kicking in.
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I am self-diagnosed with SCT (also increasingly referred to as Concentration Deficit Disorder, which seems a much better name for it).
My impression is that because it's not in the DSM-5, most diagnosticians either don't know about it, or won't declare it as a diagnosis because insurance companies wouldn't recognize it. (Although, there is a medical coding for "ADHD, other".)
My official diagnosis is ADHD, Predominantly Inattentive presentation.
Adderall treated my ADHD partially, but did less to treat the SCT symptoms.
Atomoxetine has treated my ADHD symptoms better than Adderall did, and it also treats my SCT traits very effectively.
I first came across it as CDD myself. I just use SCT since even things that use a different term all mention it is also know as SCT. But not all things that are SCT mention any of the other names that have been proposed.
SCT was actually in the DSM-4-TR for the last couple years before DSM-5 came out. It was called "ADHD Inattentive type (restrictive)". The restrictive being the differentiation between ADHD-I and SCT. Most researchers at this point believe it is it's own disorder and not another type of ADHD. And some researchers also break it down into more than one type.
Atomoxetine is a norepinephrine reuptake inhibitor and norepinephrine is more associated with wakefulness than dopamine where I believe Adderall (amphetamine) is a little stronger on dopamine. But those neurotransmitters influence each other since some of the pathways are shared and can be triggered by either. Also from what I have read some researchers believe a deficiency in norepinephrine is associated with ADHD-I and deficiency of dopamine to be more associated with ADHD-H types. But some people respond better with different meds for reasons still unknown to science.
Strattera was my first med and worked great for a while. But I am supper sensitive to stimulants at night. So it made it harder to fall asleep than usual. Plus being fully stimulated at night kept me wanting to get stuff done. Was working full time, part time on a masters degree, had a girlfriend to share my time with, purchased a 2 family home with total 8 bedrooms that I was renting out individually like a rooming house. Had to learn maintenance and especially how to evict people and the legal system since no one liked to pay rent LOL. So sleep was a luxury I couldn't get. Less sleep equals more sleepy equals more medication needed leading to escalation of dosage till I got to the max dose and not fully effective anymore. Then same thing happened with Concerta. Switched to Adderall which was even stronger. Then like the others Adderall was great at first then eventually started to ruin my life due to the neurotoxic properties and destroying my endocrine system. But that's another story.
Most SCT research I have read, researchers tend to believe modafinil to be the likely best drug for SCT. It is a wakefulness promoting drug. One research report I read tested modafinil and adderall for SCT and ADHD-I symptoms. Conclusion was modafinil alleviated SCT symptoms but only partially for ADHD. And Adderall relieved ADHD symptoms but only partially for SCT. Conclusion was modafinil was best for SCT, Adderall best for ADHD, and those who were comorbid with the 2 would likely benefit from a combined medication solution to cover all symptoms.
I am currently in the process of switching to modafinil with strattera. Took 9 months to find a therapist that would help. Initial plan was to start taking modafinil and strattera. And take a little Adderall as needed to makeup the gap so that I can keep working. Long story short, I stopped working in June and hope to start before the end of the month. Therapist did prescribe me some medication that is supposed to help rebalance my neurotransmitters but it side effects were intolerable. Hoping she has a different one in her bag of tricks I can try. My brain is so downregulated and damaged from Adderall, without it I am so far below my natural ADHD baseline it is ridiculous. Something my therapists kept telling me Adderall wouldn't do unless abused. Well, even at 15 mg twice a day it messed up my brain and endocrine system so that was false information.
I do experience daytime sleepiness, almost every day. I never considered that it has anything to do with SCT.
My circadian rhythm follows a fairly normal pattern:
• Most nights between 2-4am, I will wake up.*
• I wake up for the day about 6am, but struggle to motivate myself to get up.
• (Before ADHD meds, I would experience a wave of tiredness around 10am.)
• About 2pm, I will feel tired and have difficulty concentrating ...and it usually lasts until almost 4pm. (I only recently realized that the nighttime waking and daytime sleepiness are 12 hours apart... exactly opposite each other on the 24-hour cycle.)
*(Note: If I have any struggles with worry, anxiety, rumination or intrusive thoughts at the time, I might end up laying awake for a long time... sometimes the rest of the night. I believe this to be due to Generalized Anxiety Disorder, GAD, but my diagnosis is just "Anxiety", not GAD.)
~~~~~
I hadn't considered a connection between daytime sleepiness and SCT, but given that I am on atomoxetine now, it explains why the 10am sleepiness I previously suffered from now doesn't occur most of the time.
If only it could help the afternoon sleepiness. As an experiment one day last week, I meditated for about 15 minutes at the beginning of my afternoon sleepiness, and I simply let my mind wander. This was the day I listened to a podcast, when the guest was Dr Srini Pillay, the author of a book titled "TINKER DABBLE DOODLE TRY: Unlock The Power Of The Unfocused Mind". Something he said, I think about the mind being unfocused when falling asleep and when waking, and something he said about meditation.
So, that day, I rested and meditated for just 15 minutes, and it rejuvenated me as much as a 45 minute nap would have. My afternoon was much more clearheaded.
(Atomoxetine/Strattera isbtheproven in research studies to treat SCT more effectively than most other ADHD medications, with methylphenidate as the stimulant which most effectively treats SCT.)
Wow what an interesting read and I can relate to all in your post . I suffer dreadfully with tiredness during the day and could quite easily fall asleep at this time but have chronic insomnia during the night and wake up at silly o clock and then struggle every morning getting out of bed , I feel like I have a hangover every morning . I seem to be struggling quite badly the last couple of weeks more so for some reason and finding it hard to paint a smile on as inside I just want to cry with tiredness and sore heads . Something I haven’t done like you mentioned is daytime mediation so I may try this also 😊. Love your posts thank you
My day brain night brain as I call it do have a somewhat skewed 12 hour difference. On a premedicated strict schedule deep sleep comes around 4am ish. sleepiness started around 10 ish and by 11 nodding off at my computer. Late afternoon slump may last for a few hours at times but typically piqued 5pm ish. Then naturally wake up and other symptoms alleviated a lot after 6pm.
My schedule the last year has shifted a lot for many reasons. I find my SCT pattern shifts with my schedule but doesn't always match it. So sometimes working overnight and sluggish/sleepy after I get up in the afternoon. But day brain would kick in 12 hours give or take later and then be more alert at the times I would normally be the most sleepy like 4am onward. Sometimes I would even find that if I stayed up long enough, long after my meds wore off I would be more awake and alert than I was on them 20 hours earlier.
Something you might find interesting is that the idea of sleeping 8 hours through the night is not natural for humans. Humans would usually go to bed earlier in the night since there wasn't light and well TV LOL, Our natural schedule was more inline with daylight and night time. So, we would naturally wake up after about 4 hours give or take, get up for a little while, then go back for a second sleep. So waking up after 4 hours ish is actually natural for humans. For me, the hard time falling asleep and low quality sleep for the first 4 to 6 hours and the deep sleep later in the night I associated with SCT most.
I don't have anxiety issues so I can rule those out. For me, meditation is torture. Meditation makes me restless. Anxiety does have a lot of crossover with ADHD and SCT symptoms though.
Being unfocused when falling asleep and waking makes perfect sense. At those points the brain is the least stimulated. And ADHD that is defined by an under stimulation of the brain will be most apparent when sleepy. There are chemicals involved in the process of falling asleep which shutdown certain activity to do it. Although there is a lot of activity in the brain when asleep, it is not all the same activity when awake. But when not totally focused your brain can bounce around and potentially think outside the box and be more creative. Don't know if that was where the guy was going with it or not.
I used to be able to take a 20 minute power nap to refresh. As I got deeper down the rabbit hole with Adderall nap time got longer. Probably due to less sleep at night at least partially. Also when I'd get tired in the later afternoon, at work I used to go out for a 15 to 30 minute walk to get things going again. I only started going down the rabbit hole of nootropic supplements late last year. The first I tried was N-Acetyl-Cysteine (NAC) and Acetyl-L-Carnitine (ALCAR). I was more going for neuroprotection from Adderall and trying to fix my brain. But found that those 2 together for me would allow my brain to keep working longer while I was getting sleepy. Like get 1 to 3 hours of additionally being functional before breaking for a nap or something while sleepy. Also alpha GPC or CDP choline and other supplements to boost choline and indirectly boost acetylcholine which is mildly stimulating and associated with many things including memory and neuroplasticity. You can get Now brand NAC in 600mg capsules or 1000mg tablet. They also have ALCAR from that brand but I started getting it from bulksupplements brand as a powder that I mix with other bulk nootropics. Easily found on Amazon.com. But take vitamin B-complex too to support the function of those things and other things in the brain. Both stimulating for energy and neuroprotective among other things
I haven't seen research on SCT and Strattera. Just over and over again modafinil being mentioned as likely the best choice. I'll have to look for the Strattera research when I get time.
I woke up this afternoon after medium quality sleep around 3pm. Took 300mg of modafinil. Got out of bed around 4pm and started my routine. Modafinil had a very small effect and was far short of being truly therapeutic. Took a nap around midnight I think for about an hour, maybe a little more. It is now 4:30am and I am more awake, alert, and focused than I was at any other time today, even so many hours after my modafinil. Which shows that for me, my cycle is not associated with daylight like a lot of other circadian rhythm issues sometimes are. On a normal schedule this would be my prime deep sleep time.
I'm not sure if SCT is what my diagnosis would be, however I've attributed my ability to concentrate better during non-normal hours because the energy of the community is much lower while everyone is asleep.
Reducing distraction helps a lot with ADHD symptoms and probably some other disorders too. And some people are naturally more in the evening. It is hard to say without a deeper dive and someone who knows how to diagnose stuff.
Be sure you don’t have an actual medical sleep disorder (obstructive sleep apnea, restless legs syndrome, periodic limb movements of sleep, others) because sleep disorders can be more common in people with ADHD. Just to add to the fun. And slow processing or a processing disorder too. Sigh, it seems ADHD doesn’t travel alone.
Yes, that is paramount. Plus there are many other things that can cause daytime sleepiness aside from sleep disorders. A simple example is anemia.
For me, I was on Trazadone for a week in my ADHD diagnostic time. I had the best sleep of my life while also for years on a regular schedule. Symptoms improved a lot, but were still clinical. So I know sleep disorders were ruled out for myself.
For me, SCT is mostly about challenges with processing information at a comparable pace to a neurotypical brain. I also get info. overload because I tend to function like a sponge, taking in a huge amount of "data" -- w/out much of a filter -- before I can make sense of something. Having to speak spontaneously or explain a concept (especially anything that's a process with multiple steps) are very hard for me. Vyvanse has helped a lot with all of the above. I've had lifelong struggles with insomnia too, but I think that's a general ADHD thing...
One SCT study I read showed that SCT was associated with a deficit in early selective attention. Which sounds a lot like the first half of your post. Where as ADHD was associated with later information processing. Of course comorbidity of the 2 is worse.
I do wonder if the idea that insomnia associated with ADHD is mostly comorbidity with SCT. Research shows that ADHD-I types are 30 to 60% comorbid with SCT.
Well, I have heard and read that insomnia is fairly common with ADHD-H and ADHD-C, but I think it's for different reasons. Hyperactivity and impulsivity can make it hard for the body and brain to settle.
I think my eldest child (my step-daughter) has ADHD-HI. As a teenager, she sometimes required very little sleep, so she would sneak out of the house at night (because she was a night owl), get home in the early hours, catch 2-3 hours of sleep, and function all day as if she had a full night's sleep.
My third child seems to have mild ADHD-C. At 11 years old, he is usually awake until 10:30-11:30pm (even though his weeknight bedtime is 9pm), then sleeps deeply, and is fully awake around 6am.
Their mom has always gotten by on very little sleep, unless she's sick with the flu. In her teens and 20s, she seemed to always be energetic, and as far as I know, she has always been impulsive (mild in recent years, but was much more pronounced in her teens through mid-30s). So, I think that she has undiagnosed ADHD-HI.
The kids don't seem to ever experience daytime sleepiness, as I do, and their mom didn't until she developed chronic medical issues over the last ten years or so.
I believe I have this too after seeing one of Dr. Russell Barkleys videos on it. I am diagnosed with ADHD but also have the exact same patterns you describe. The only positive Ive found is that ADHD meds help me sleep routinely. I still dont get into a deep sleep until about 4am but Im not cycling through a couple nights with little sleep and then a couple with better sleep. The mornings are still torture and I think completely factor into my failure at life. I am groggy until about eleven even with meds, though they do help reduce the chaos.
Just like to make a general post about SCT. Be careful with self diagnosing. There are many many many things that can cause daytime sleepiness and SCT like symptoms. In fact, daytime sleepiness is only 1 of up to 14 symptoms that may be used for diagnostic purposes. I just focus on daytime sleepiness since it is the easiest for the purposes of my post.
I know there are people actually diagnosed with SCT. Since research publications mention how many people were diagnosed with it who are in their studies. Just don't know if any of them will see my post.
My whole point is if patterns like I described are common for people who have SCT, then I can explain that in better ways to researchers and potentially convince them too look at what is different between the day brain and night brain of people with SCT. If they focus on that, it in my opinion could advance research by decades since every time I read an SCT publication they always seem to me to be missing the point. It might be something as simple as too much Adenosine during the day and too little at night. Or some dysfunction of the Orexinergic pathways which among many other things affects wakefulness and the catecholamines. Or many other things that could be different between day and night. If found to be true, then drugs and therapies that target what ever their findings are could be researched. Maybe see a solution and recognition by therapists within my lifetime. And spare thousands of people from misdiagnosis and less than optimal therapies.
I previously contacted I think about 3 different researchers who have done SCT research and mentioned my theory. 2 I never got a response so don't know if they ever got it. A third was no longer doing SCT research but thanked me for finally being able to describe SCT and the day/night issues. And said it would be helpful for her who is also a therapist, and not just a researcher. Barkley, one of the people most associated with SCT research unfortunately retired a few years ago so that option is gone.
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