- ADHD impairs the regulation of brain activity and often affects sleep patterns.
- ADHD can increase the time it takes to fall asleep, the chance of sleep disruptions, and the risk of sleep deprivation.
- People with ADHD are more likely to develop sleep disorders, although they frequently go undiagnosed.
- While medication can improve symptoms of ADHD, behavioral changes and a nightly routine can help individuals sleep better.
Attention-deficit/hyperactivity disorder (ADHD) is a disorder that encompasses symptoms of inattention, hyperactivity, and impulsivity. These symptoms interfere with functioning at school, at work, and in social situations. ADHD is a chronic condition that persists into adulthood for a majority of people, but mindful symptom management can greatly improve quality of life for people with ADHD.
ADHD begins in childhood and is present in approximately 5% of children , but more commonly diagnosed in boys. An estimated 25% to 50% of people with ADHD experience sleep problems, ranging from insomnia to secondary sleep conditions. Doctors are beginning to recognize the importance of treating sleep problems and the positive impact healthy sleep makes on quality of life for ADHD patients and their families .
What is the Connection Between ADHD and Sleep?
Beginning around puberty, people with ADHD are more likely to experience shorter sleep time, problems falling asleep and staying asleep, and a heightened risk of developing a sleep disorder. Nightmares are also common in children with ADHD , especially those with insomnia. Sleep problems in ADHD tend to increase with age, though sleep problems in early childhood are a risk factor for future occurrence of ADHD symptoms.
Sleep problems in ADHD appear to differ depending on the type of ADHD . Individuals with predominantly inattentive symptoms are more likely to have a later bedtime, while those with predominantly hyperactive-impulsive symptoms are more likely to suffer from insomnia. Those with combined hyperactive-impulsive and inattentive ADHD experience both poor sleep quality and a later bedtime.
Many ADHD symptoms are similar to symptoms of sleep deprivation. Among others, adult ADHD sleep problems can lead to forgetfulness and difficulty concentrating during the day. In children, fatigue may present through hyperactive and impulsive behaviors. It can be difficult to tell whether these issues are brought on by ADHD or by a lack of sleep. This may lead to misdiagnoses or may allow sleep disorders to go undetected. Therefore, experts generally recommend screening patients for sleep problems before prescribing medication for ADHD.
What Is the Biology Behind the ADHD-Sleep Connection?
ADHD-related sleep problems may be a side effect of impaired arousal, alertness, and regulation circuits in the brain. Other researchers believe that ADHD-related sleep problems can be traced to a delayed circadian rhythm with a later onset of melatonin production . Despite similarities between certain sleep disorders and ADHD symptoms, research has failed to find consistent sleep abnormalities in people with ADHD.
Some individuals find it easier to sleep with the calming effects of stimulant medications that are commonly prescribed for ADHD. However, for many people, stimulant medications can have an opposite effect. Coexisting disorders such as anxiety, depression, or substance abuse, as well as poor sleep hygiene, are likely to play a role in sleep difficulties.
How Do ADHD-Related Sleep Problems Affect Daily Life?
Though there is little research on the subject of ADHD with accompanying sleep disorders, children and adults with both ADHD and a sleep disorder often report more severe ADHD symptoms and a lower quality of life. They may also be more likely to suffer from depression, anxiety, hyperactivity, inattention, difficulty processing information, and a higher BMI. Over the long term, chronic sleep deprivation leaves people vulnerable to physical health problems.
Daytime sleepiness can have serious effects on school and work. People may judge a person with ADHD for sleeping at inappropriate times, without realizing that it is part of their condition and very difficult to prevent. Sudden bouts of sleepiness may also be dangerous while driving or performing other activities that require concentration and alertness.
Poor sleep quality can also cause daytime fatigue. Individuals with ADHD-related sleep deprivation may feel grumpy, irritable, restless, or tired, or they may have trouble paying attention at school or at work. Sometimes, these symptoms may be mistaken for a mood disorder. In turn, anxiety and behavioral difficulties have been linked to a higher incidence of sleep problems for children with ADHD.
These problems also take their toll on families and caregivers of people with ADHD. Preliminary research shows that primary caregivers of children with both ADHD and sleep problems are more likely to be depressed, anxious, stressed, and late to work.
Sleep Disorders Commonly Found in People With ADHD
People with ADHD have higher rates of certain sleep disorders. Because ADHD symptoms often resemble the symptoms of these sleep disorders, underlying sleep disorders may go undiagnosed. Children in particular may have difficulty conveying what they are feeling, leading to a misdiagnosis of ADHD when in fact their problems stem from a sleep disorder. Or, they may have ADHD plus a sleep disorder, including these common comorbidities.
Those who are rarely hyperactive during the day may still experience racing thoughts and nighttime energy spurts that interfere with sleeping, leading to insomnia. For some, nighttime presents the perfect opportunity to hyperfocus on a project, as there are less distractions. Unfortunately, this makes it difficult to settle down for sleep and can lead to a dysregulated sleep-wake schedule. Over time, insomnia may worsen as people start to develop feelings of stress associated with bedtime.
Many people with ADHD experience daytime sleepiness and difficulty waking up as a result of poor sleep. Others experience restless, non-refreshing sleep with multiple nighttime awakenings.
Circadian Rhythm Sleep Disorders
Most individuals with ADHD, particularly adolescents, are more alert in the evening. This atypical schedule can make it difficult to honor work or school commitments. A smaller pineal gland, irregularities in the body’s internal clock, and delayed melatonin release may contribute to circadian rhythm sleep disorders in people with ADHD.
Delayed sleep-wake phase disorder, also referred to as delayed sleep phase syndrome (DSPS), is a type of circadian rhythm sleep disorder commonly reported in people with ADHD. DSPS is marked by a delay in the sleep-wake cycle of two hours or more, which can impede on time-sensitive activities such as work or school. DSPS can make it harder to fall asleep at night, which may cause excessive tiredness, confusion, and lack of alertness the following morning. Taking melatonin supplements at targeted times or using bright light therapy may help regulate the sleep-wake cycle and diminish the effects of DSPS.
Sleep-disordered breathing (SDB), including snoring and sleep apnea, affects up to one-third of patients with ADHD. SDB leads to disturbed sleep and daytime sleepiness, and often causes symptoms typical of ADHD. Treating SDB may reduce the need for stimulants in children believed to have ADHD. Studies suggest that removing the tonsils may help with ADHD and sleep apnea symptoms in children, while CPAP therapy is considered a better choice for adults.
Restless Legs Syndrome
People with restless legs syndrome (RLS) experience tingling sensations in the legs that make it hard to fall asleep. RLS or other types of periodic limb movement disorders may occur in almost 50% of people with ADHD. Children with both ADHD and RLS appear to spend longer in stage 1 light sleep , which is not as restorative. Researchers believe RLS is caused by iron and dopamine deficiencies, which are commonly associated with ADHD.
Individuals with narcolepsy tend to fall asleep suddenly during the day and may have difficulty sleeping soundly at night. Adults with narcolepsy are twice as likely to have experienced ADHD symptoms as a child. While the link between the two is not clear, researchers believe that the sleepiness brought on by narcolepsy may provoke ADHD symptoms. It is also possible that both disorders stem from a similar cause, such as a gene abnormality or a problem with neurotransmitters. Narcolepsy is usually treated with medication.
Diagnosing and treating underlying sleep disorders is an important step toward improving sleep for people with ADHD. Ask your doctor for a sleep study to rule out any secondary sleep disorders that may need to be treated along with your ADHD. A qualified physician should monitor potential sleep problems on an ongoing basis, as these tend to develop over time.
Sleep Tips for Children and Adults With ADHD and Sleep Problems
Experts are cautiously optimistic that sleep interventions may be key to improving not only sleep, but also ADHD symptoms and the effects of ADHD medication . Indeed, preliminary studies have found that behavioral sleep interventions improve sleep, ADHD symptoms, daily functioning, behavior, and working memory.
For children, adolescents, and adults with ADHD, a consistent bedtime routine and healthy sleep hygiene practices can help reinforce the connection between bed and sleep. Try making gradual changes and note where you see improvements to develop a system that works for you. Some tips include:
- Cutting off sugar, caffeine, and alcohol intake within a few hours before bedtime
- Avoiding screen time for an hour before bed
- Avoiding doing stimulating activities and projects that require hyperfocusing in the evening
- Making the bed a stress-free zone reserved for sleep and sex
- Getting enough exercise and sunlight during the day
- Developing a bedtime routine that you enjoy, such as rereading a favorite book, spending time with pets, or taking a warm bath
- Keeping the bedroom dark, cool, and quiet, using a white noise machine if necessary to block out intrusive noises
- Going to bed and waking up at the same time every day, choosing a time that is realistic to get the recommended sleep for your age group
- Using a weighted blanket
People with ADHD frequently report having trouble waking up in the morning. For help getting out of bed, try using light therapy or plan something enjoyable for when you get out of bed, such as exercise or a nice breakfast.
The Children and Adults with ADHD organization recommends using a reward-based system to manage sleep problems in young children with ADHD. Caregivers can also offer reassurance by checking frequently on their child. For people of any age with ADHD, talking with a trusted confidant, keeping a worry journal, or using relaxation techniques such as guided imagery may help make bedtime less stressful.
Sleep medication may not be appropriate for people with ADHD, but some people may find it helpful to talk to a doctor about adding supplements or adjusting their medication schedule to optimize sleep. Some people with ADHD report that taking their medication about an hour after waking up improves levels of alertness throughout the day. Adolescents and adults with sleep problems may benefit from cognitive behavioral therapy for insomnia (CBT-I).