What Makes  Adult ADHD Worse— and What Actually Helps

My ADHD patients consistently tell me that the discomfort or symptoms vary from day to day. Poor sleep, hot flashes and night sweats, rich carbohydrate meals, drinking alcohol for pleasure or relief, and life’s stresses can all give them a difficult day. In contrast, a good night’s sleep, menopausal hormonal treatment when appropriate, exercise, managing their blood sugar, and abstinence from alcohol all calm their emotions and allow their ADHD brains to focus, get a day’s work done, and avoid emotional upset from rejection sensitivity dysphoria, all of which contribute to a better day.

By Leigh Anne Hulva, BSN, RN— Women’s Health Educator

Supervised by William Conway, MD, FACP, FASAM

 

Catching up with Carol.

Carol was first diagnosed with ADHD about a year ago at age 54. Getting the diagnosis was a relief— it finally gave her answers to questions about herself that she hadn’t even realized she’d had.

Carol has a theory. She calls it the Bad Tuesday Formula. It goes something like this. She sleeps poorly on Monday night and wakes up tired the next morning. She hits the sleep timer on her phone, then sleeps through the alarm. She makes up the lost time by skipping breakfast, and by 10 a.m. she’s running on caffeine and cortisol.

Then stress occurs at work-nothing major- a meeting is postponed, a deadline is missed, an email offends her- and Carol goes from a good day to a bad day. Her razor thin emotional balance is shattered. . By the afternoon, she’s snapped at a coworker and is holding back tears in a bathroom stall, trying to pull it together.

She used to think she was just a bad-tempered person. This kind of mini breakdown used to feel like further proof that she was moody and mean. But since her ADHD diagnosis a year ago, she knows what it means.

It was a perfect storm of factors that worked just right with her ADHD brain to create this, a Bad Tuesday. It’s not a testament to who she is as a person. It’s not a guilty verdict. It just means that several ADHD triggers worked together to cause a really bad day. Knowing this helps Carol feel less like a jerk and more like it’s within her power to turn things around. A Bad Tuesday doesn’t mean she’s a Bad Carol. And it doesn’t mean she has to have a Bad Wednesday. It just means it’s time for a reset.

Why Adult ADHD Symptoms Get Worse on Some Days

ADHD is frustrating. One reason for this is its inconsistency. Some days, Carol feels focused and productive. Other days are Bad Tuesdays. To people on the outside, this inconsistency might look like laziness or emotional instability. From the inside, it can feel confusing and demoralizing.

The reason for this inconsistency lies in the delicate balance of her ADHD brain. In a fundamental sense, Carol has emotional stability, which is more fragile in her adult ADHD.  When her emotional stability is rocked, she is thrown into a tailspin by the day’s stress after a poor night’s sleep.

What Makes Adult ADHD Worse? Common ADHD Triggers

Poor Sleep and Adult ADHD Symptoms

Sleep deprivation is one of the most important triggers for Carol’s fragility.  The reason is simple: her ADHD brain, like most brains, does not tolerate sleep deprivation without suffering. The prefrontal cortex is the part of the brain responsible for executive function and emotional regulation. These are the things that ADHD affects the most. When the brain is deprived of sleep (or when sleep quality is poor), the prefrontal cortex suffers, and ADHD symptoms increase.

Chronic Stress and  Adult ADHD

In small doses, stress can increase focus. This can happen when you realize a deadline is imminent, and that sense of urgency makes starting and completing that task almost easy.

Chronic stress is another thing entirely. Chronic stress activates cortisol, which can wreak all kinds of havoc on your mental and physical health. Cortisol interferes with prefrontal cortex activity, making executive function and emotional regulation more fragile and less reliable. For Carol, receiving an upsetting email on an already difficult morning was enough to tip the balance in a prefrontal cortex that was just barely holding on to calm.

Blood Sugar Instability and  Adult ADHD Symptoms

The brain runs on glucose. The ADHD brain is especially sensitive to glucose changes. Skipping meals or choosing high-sugar foods that result in spikes and plummets in your blood sugar levels can dramatically increase ADHD symptoms. Only skipping breakfast on her Bad Tuesday wasn’t just incidental— it helped pave the way for a much more difficult day.

Hormonal Fluctuations, Perimenopause, and  Adult ADHD

Estrogen is a hormone that is used by every system in the body. When a woman is going through perimenopause or is postmenopausal, shifting estrogen levels can dramatically affect her ability to focus. Declining (or erratic) levels of estrogen can also affect sleep and mood, which in turn can impact ADHD symptoms. Treating hormone deficiencies during perimenopause can significantly help women with their ADHD symptoms.

Alcohol and ADHD Symptoms

Alcohol is a triple whammy. It causes blood sugar levels to spike and plummet, it affects mood, and it disrupts the sleep cycle. Add to that the fact that consistent use of alcohol affects many brain neurotransmitter systems negatively, and you have several reasons to consider avoiding alcohol to help your ADHD.

Many people with ADHD use alcohol to try to quiet the mental noise or to help them with social anxiety. This short-term relief is real, but the next- day consequences of poor focus and low mood aren’t worth it. This is true for everyone, but the ADHD brain is especially sensitive to these effects.

Digital Overstimulation and  Adult ADHD

We live in an overstimulating world. Again, this is true for everyone, but the ADHD brain has more difficulty filtering all that noise. The ADHD brain is also primed to be exploited by all those screens.  Scrolling worsens the impact of the negative symptoms of ADHD in Carol.   Social media and constant notifications provide a constant stream of low-effort stimulation that makes real life seem that much duller.

Carol needs to set limits on her time with social media. Setting time limits for screen time, silencing all but the most necessary notifications, and designating phone-free times… these are vital for mental hygiene. Again, this is true for everyone, but for the ADHD brain, this is especially important.

What Helps ADHD Symptoms? Evidence-Based Treatment and Lifestyle Steps

Improve Sleep First in Adult ADHD

If there is one thing that most effectively helps with ADHD management, it’s quality sleep. This needs to be prioritized. Treating sleep problems with someone with ADHD is vital. Consider also whether the hormone decline of midlife might be affecting your sleep and seek treatment for that as well. Whatever the cause of sleep disruption, Cognitive Behavior Therapy for insomnia has been shown to be significantly effective.

Aerobic Exercise for Health, Longevity, and Adult ADHD

Exercise is important for everyone, but for the ADHD brain, it holds special sway. Exercise has widespread benefits for all, especially for promoting longevity and health in aging. Carol aptly calls her usual half-hour morning walks her “free medication.”

Regular, Protein-Rich Meals

Altering your eating habits doesn’t have to involve huge, dramatic changes. Once or twice a day, replace a serving of something high in refined carbs with something high in protein, and you’re already winning. Choose a handful of pistachios over the Oreos. Buy pre-sliced cheese so that when you’re perusing the fridge for a quick nibble, it’s easy to grab a piece. Do away with the comfort foods that spike your blood sugar and replace them with something that will make you feel better, and you’re setting yourself up for a better day.

High protein is especially important for women in midlife and beyond, regardless of ADHD status. We lose muscle and bone mass as we age, and anything we can do to mitigate against that is another win.

Healthy eating for mature women in perimenopause or menopause has clear benefits. Not everything has to be proven by an evidence-based trial to be of benefit.

Stress Management That Actually Works for ADHD

We all know the stress management techniques we’re supposed to be using: meditation, breath work, and taking a walk. These are great all-around helps:

• short bursts of activity,
• body doubling when focus is waning,
• creating a physical environment free of clutter,
• earphones that either cancel noise or pipe in music, depending on what works for you.

That’s the key: find what works for you and implement it. You’re here, you’re reading this, so you’re already on the right path!  For the mature woman, including the ADHD woman, the commonsense solution is to reduce stress.

Cognitive Behavioral Therapy for ADHD

Cognitive behavioral therapy has been proven by evidence-based science to benefit patients with Adult ADHD. The value of cognitive behavioral therapy depends upon the quality of the therapy and the degree of sustained effort you exert. As with all evidence-based treatments in medicine, there is a wide range of benefits, from none to quite beneficial. My patients who have taken psychotherapy over the years all attest to the value they have received.

 

Conclusion

It is never too late to get evaluated and treated for ADHD. If you think this disorder has been holding you back, now is the time to find a healthcare provider with experience diagnosing and treating ADHD.

At Nashville Concierge Medicines,  Dr. Conway evaluates your ADHD after understanding you. Together, we will create a plan for you.

Frequently Asked Questions

 What are the biggest triggers that make adult ADHD worse?

The following are the most frequently documented ADHD triggers:

• Poor sleep
• Chronic stress
• Blood sugar instability (from skipped meals or high-sugar diets)
• Hormonal fluctuations (such as during perimenopause)
• Alcohol
• Digital overstimulation

These factors all affect dopamine regulation, which in turn affects executive function.

Does stress make ADHD worse?

In short, yes. Chronic stress wears on your cortisol response, which affects your prefrontal cortex. This is where all your executive function takes place. While short-term stress can temporarily sharpen your senses, chronic stress has the opposite effect.

Can improving sleep really help my ADHD symptoms?

Yes, significantly. Quality sleep is one of the most effective interventions to improve ADHD symptoms. The prefrontal cortex— where all executive function takes place, as well as emotional regulation— is extremely sensitive to sleep deprivation. Even small improvements in sleep quality can help with ADHD. In women whose sleep issues might stem from hormone disruption, hormone therapy can help significantly.

Author Bio

I’m Leigh Anne Hulva, BSN, RN— a registered nurse, women’s health educator, mother of teenage daughters, and passionate advocate for women with ADHD.

I have been on the other side of this conversation, and I understand how much it matters to feel truly heard. At Nashville Concierge Medicines, Dr. Dr. Conway supervises my work, MD, and I work directly under his licensure as a nurse educator.

William Conway, MD, FACP, FASAM, has reviewed and revised this blog

The level of evidence associated with each of these treatments has been reviewed by artificial intelligence in UpToDate. Please remember that the art of medicine is guided by clinical judgment and a careful understanding of contemporary evidence. Please also understand that the understanding of evidence changes over time.

This blog is not a substitute for the advice of your physician.