Attention deficit hyperactivity disorder, or ADHD, is a common psychiatric issue that encompasses symptoms, like impulsivity, hyperactivity, and inattention. These symptoms can become so severe that they interfere with functioning at work, school, and social situations. For most people, ADHD is a chronic condition that continues into adulthood; however, mindful management of the symptoms can significantly improve the overall quality of life.
Research suggests that 25 to 50 percent of individuals diagnosed with ADHD develop sleep issues, which may include insomnia, narcolepsy, and other secondary sleep conditions. Experts have picked up this association only recently and are beginning to identify the importance of managing these sleep problems. Moreover, doctors have also begun to appreciate the effects of treating the co-existing sleep problems in people with ADHD and the positive impact this exerts on the overall quality of life.
If you or someone you love has been suffering from ADHD and continue to suffer from symptoms of sleep deprivation, it is imperative to discuss it with a professional. A professional can conduct interventions to confirm the presence of any sleep disorders and tailor the management plan accordingly for better outcomes. However, before that happens, familiarizing yourself with the association between ADHD and sleep is critical.
ADHD and Sleep: What is the Connection?
For most people, ADHD begins around puberty, causing them to experience problems falling asleep or staying asleep, shorter sleeping times, and an increased risk of developing sleep disorders. Nightmares are also common in younger adults with ADHD, especially those who develop insomnia. Sleep problems associated with ADHD tend to increase with time and age and are considered a risk factor associated with the occurrence of ADHD symptoms in the future.
Sleep problems due to ADHD can occur differently depending on their specific symptoms. For instance, people with predominantly inattentive symptoms have a delayed bedtime, whereas those with hyperactive-impulsive symptoms are at a higher risk of developing insomnia. Those with combined symptoms of inattentiveness and hyperactivity as a part of ADHD can develop insomnia and poorer sleep quality simultaneously.
Many symptoms of ADHD are similar to the symptoms associated with sleep deprivation. Among other children. ADHD sleep problems in adults can also cause forgetfulness and poor concentration, whereas, in children, it may cause fatigue. Many experts find it difficult to tell whether these issues are secondary to ADHD or due to a lack of sleep. As a result, misdiagnoses may occur, and the underlying sleep disorders may continue undetected. Therefore, experts recommend screening patients with ADHD for underlying sleep disorders for timely diagnosis and a better, more comprehensive management plan.
How Can ADHD Affect Sleep?
Even though there is not much research available that connects ADHD with accompanying sleep disorders, both children and adults with these co-existing issues report experiencing severe ADHD symptoms and a poorer quality of life. Such people are also more likely to experience depression, hyperactivity, anxiety, inattention, higher BMIs, and difficulty processing information. In the long run, this chronic sleep deprivation can also make them vulnerable to physical health issues.
Daytime sleepiness can have profound negative effects on work and school. People may judge people with ADHD for sleeping at inappropriate times without understanding that this may be a part of their condition and difficult to prevent. The sudden bouts of sleepiness that such people experience can also prove risky while driving or performing other activities requiring alertness and concentration.
Poor sleep quality also commonly causes daytime fatigue which is why individuals with ADHD-related sleep deprivation often feel irritable, grumpy, or tired with poor attention and focus. Sometimes, experts may mistake these symptoms for a mood disorder. In the long run, ADHD-induced sleep disorders can take a toll on patients and their families. Preliminary studies have also shown that parents and caregivers of children with ADHD are more likely to experience depression, anxiety, and stress, and they frequently appear late to work.
Does ADHD Cause Sleep Problems? Common Sleep Disorders Linked with ADHD
People diagnosed with ADHD have a higher prevalence of sleep disorders, and because both share many similar features, the latter may go undiagnosed. Younger patients, in particular, are more vulnerable to a misdiagnosis as they cannot communicate or convey their feelings more effectively. Following are some common types of sleep disorders that often co-occur with ADHD.
People who are rarely hyperactive or energetic during the day may experience nighttime energy and racing thoughts that interfere with their sleep patterns, inducing insomnia. For others, nighttime is the perfect time to focus on a project with full concentration since there are lesser distractions. However, this may interfere with their regular sleep-wake cycle, causing dysregulation. Over time, this acquired insomnia may worsen as patients develop stressful feelings associated with bedtime.
Many patients with ADHD also experience sleepiness during the day and may find it difficult to wake up easily due to poor sleep the following night. Moreover, they may also have more than one awakening during nighttime which further deteriorates the overall sleep quality.
Circadian Rhythm Sleep Disorders
Because most people with ADHD have higher levels of alertness in the evening, this atypical schedule may make it difficult for them to honor their work or academic commitments. Such people may eventually end up experiencing delayed sleep-wake phase disorder, also known as DSPS or delayed sleep phase syndrome. This type of circadian rhythm sleep disorder causes a delay in the usual sleep-wake cycle by at least two hours, making time-sensitive tasks challenging to achieve. People with DSPS may struggle to sleep in time every night, which may cause confusion, tiredness, and a lack of alertness the next morning. This delay is attributed to irregularities in melatonin secretion by the pineal gland. Hence, supplementation with melatonin is likely to make a difference in more effective sleep-wake cycle regulation.
Sleep-disordered breathing, or SDB, includes problems like sleep apnea and snoring and may affect up to one-third of patients with ADHD. This sleeping issue can cause poor sleep at night and daytime sleepiness the following day, along with other typical symptoms of ADHD. Treating the problem can also reduce the need for using stimulants in children with diagnosed ADHD. Experts also believe tonsil removal causes sleep improvement in children with ADHD and sleep-disordered breathing, whereas, for adults using CPAP therapy seems like a better choice.
Restless Legs Syndrome
People diagnosed with restless leg syndrome, or RLS may experience tingling sensations in the legs, making it difficult for them to fall asleep. Studies estimate that RLS or other similar periodic limb movements may occur in at least 50 percent of people with ADHD. Children diagnosed with ADHD and RLS spend more time in stage one or light sleep, which may not be restorative for the body. RLS is believed to be caused by deficiencies in iron and dopamine which are commonly prevalent in people with ADHD.
People diagnosed with narcolepsy may suddenly fall asleep during the day and struggle to sleep at night. Such people are also up to two times more likely to have experienced ADHD symptoms during childhood. While the association between the two conditions is not clear-cut, some experts believe that sleepiness secondary to narcolepsy may provoke or exacerbate the symptoms of ADHD. Others believe the two conditions may stem from a similar cause, such as a neurotransmitter issue or a gene abnormality.
Regardless of the type of sleep disorder a person with ADHD develops, it is imperative to manage it with the help of a professional to keep things under control. Ask your doctor to conduct a sleep study to ensure that you are not suffering from secondary sleep disorders, which may require treatment alongside the ongoing management of ADHD. A qualified physician can monitor the potential sleep-related issues on an ongoing basis as they often develop over time.
ADHD and Sleep Problems: How to Improve Overall Sleep?
Many experts remain optimistic about the potential of sleep interventions to improve the sleep of ADHD and sleep disorders associated with it. Preliminary studies have also found that behavioral sleep interventions can improve ADHD symptoms and sleep, along with working memory, behavior, and daily functioning. For children, teenagers, and adults struggling with ADHD, setting a consistent bedtime routine and healthy sleep hygiene practices can positively influence the connection between sleep and bed. Try to make gradual changes and make a system that works best for you.
Following are some times of the symptoms of ADHD and sleeping too little:
- Cut off caffeine, sugar, and alcohol use, especially a few hours before bedtime
- Do not engage in stimulating projects and activities that require hyper-focus during evenings
- Put away all screens at least 60 minutes before bedtime
- Use a weighted blanket to sleep
- Try to go to bed and wake up at fixed times every day. Ensure that the time you choose is realistic based on your age group
- Keep your bedroom cool, dark, and quiet, and use a white noise machine if you wish to keep intrusive noises out
- Set a bedtime routine you thoroughly enjoy, such as spending time in bed, taking a warm bath, or reading your favorite book to relax your mind.
People with ADHD often report finding it difficult to wake up in the mornings. Use light therapy to get out of bed easier. Alternatively, plan something enjoyable close to your waking time to make it more desirable, such as having a nice breakfast. Adults can use a reward-based system to ward off sleeping issues to motivate children. People with ADHD can also maintain a worry journal, use a trusted confidant, or practice relaxation techniques and guided imagery to keep their sleep problems under control.
According to experts, using medication to keep sleep issues under control may not be appropriate for individuals with ADHD. However, some people may benefit from adding supplements to their daily routine or adjusting their existing medications to optimize their sleep patterns.
Why do people with ADHD have trouble sleeping?
ADHD-induced sleep problems can occur as a side effect of impaired alertness, arousal, and regulatory circuits within the brain. Other experts believe these sleep-related issues are due to delays in the circadian rhythm secondary to a late-onset production of melatonin. It is imperative to remember that while ADHD and sleep disorders have many similar features, researchers have not found consistent sleep issues in people diagnosed with ADHD. Many of these people have other underlying issues, such as depression, anxiety, or drug addiction, in addition to their ADHD, making their sleep poorer. In others, the stimulant medications they are using to keep ADHD under control may start affecting their sleep negatively.
How do experts diagnose ADHD and sleep problems in adults?
Doctors take extra caution while screening people with ADHD for sleeping problems as both conditions can have overlapping symptoms, which increase the risk of a misdiagnosis. If an ADHD person complains of having sleep-related disorders, a doctor may begin with a deep history, focusing on asking about their usual bedtime, the time required for them to go to sleep, their daytime energy levels, and more. Sometimes, a doctor may give them a sleep diary to maintain over a few weeks so that experts can know better about their sleeping habits. Based on these initial screenings, an expert may go for diagnostic testing if there is a high suspicion of a sleep disorder. This may either include a nocturnal polysomnography test or a home sleep test.