So tired, except when I’m not

Dear Lucy: Recently I’ve been having prolonged periods of not wanting to do anything and short bursts of extreme motivation. My sleep schedule has been extremely erratic. Does this have something to do with ADHD or bipolar disorder? —Up and Down

Dear Up And Down: It sounds like you’ve been having a rough time of it lately. Lucy empathizes, and she knew just where to turn for help in answering your questions—MIT Medical Psychologist Xiaolu Hsi, who has special expertise in the areas of both ADHD and sleep problems.
According to Hsi, your comments about sleep schedule may be an important clue to what ails you. “Erratic sleep can wreck havoc,” she emphasizes. “In essence, it puts your brain in a perpetual jet lag, which makes it impossible for the brain to function properly and deliver what you need, when you need it. Disrupted sleep and sleep deprivation go hand and hand with an erratic sleep schedule, putting up a stiff opposition to your motivation, alertness, focus, and any significant amount of sustained mental effort.”
Your sleep patterns could also explain those short bursts of energy you’re experiencing, Hsi tells Lucy. With your brain rendered undependable by sleep deprivation, your energy is likely to vary with the interest or excitement inherent in each task you face—or whether or not you’re facing a deadline, for example. 
Not surprisingly, Hsi’s first recommendation is to “do your brain a favor, and give it a regular sleep-wake cycle.” While that may be easier said than done, Hsi suggests starting with these tips from the American Sleep Foundation. Help is also available from MIT Medical’s Mental Health and Counseling Service for MIT undergrads, graduate students, and affiliates, and from MyLife Services for MIT faculty, staff, postdocs, and their family members.
“The question about a bipolar spectrum disorder or ADHD is also a smart one to ask,” Hsi notes, particularly if improving the quality of your sleep doesn’t result in an improvement in your energy and focus. “But,” she adds, “that would require sitting down with a mental health provider for an in-person evaluation. It’s not the sort of thing you can self-diagnose by reading about the symptoms online.”
Lucy hopes that Hsi’s advice has given you a good place to start and some helpful resources to use going forward. Here’s to good sleep, good health, and a happy and productive 2017! —Lucy

Back to Ask Lucy Information contained in Ask Lucy is intended solely for general educational purposes and is not intended as professional medical advice related to individual situations. Always obtain the advice of a qualified healthcare professional if you need medical diagnosis, advice, or treatment. Never disregard medical advice you have received, nor delay getting such advice, because of something you read in this column.