Sleep & ADHD

By Maria Ramos
Last Updated: August 13, 2018

According to the Centers for Disease Control and Prevention, about 5% of children in the US have Attention-Deficit/Hyperactivity Disorder (ADHD); and according to the National Institute of Mental Health, 4.1% of the adult population suffer from it, too. In children, it’s more common in boys; girls are less likely to be diagnosed with ADHD. However, in adults the prevalence is about equal between men and women.

There is no universal cause of this mental condition, but some risk factors have been identified. It can be hereditary, or the effect of being exposed to toxic substances while in the womb. Brain abnormalities from birth or brain injuries due to disease or trauma can also be the culprit. Some even believe that problems early in life—a lack of rules and disciplinary figures, a broken or chaotic family, too much TV or online time, or even a simple lack of attention and quality time—can increase the risk of developing ADHD.

Usually discovered in childhood, there are nevertheless cases of late diagnosis. ADHD is linked to many emotional, medical and social problems: alcohol and drug abuse, poor performance and focus at school or work, sleep difficulties, and more.

What Is ADHD?

ADHD is a neurodevelopmental disorder, which means that it is characterized by an impairment of the development and growth of the brain and its functions—including those affecting emotion, learning, memory and self-control. It can also affect other parts of the central nervous system. In particular, ADHD is defined by hyperactivity, impulsiveness, inattentiveness, and a lack of self-control or ability to focus. It is one of the most common mental conditions that affect children and teens, and although the most obvious symptoms may subside with age, rarely does it simply go away once adulthood sets in. Rather, the symptoms and coping mechanisms change depending on the age of the person diagnosed.

ADHD in Children

Because children do not have have years upon years of practice when it comes to social norms and interactions, their ADHD-related behaviors are typically more pronounced—and often thought of as “acting out”. In fact, the discovery of ADHD in most children is due to a noticeable difficulty responding to discipline in both home and school life. Children with ADHD have low impulse and emotional control, and have trouble sitting still or focusing on one task. This cocktail of abnormal behaviors typically leads to underdeveloped social skills; a resulting ostracism by peers; and a dependence on special attention and treatment from parents, teachers and mental health professionals.

There are studies that suggest that at least some children thought to suffer from ADHD are misdiagnosed and actually just suffering from sleep difficulties or disorders, such as obstructed breathing or simply an insufficient amount sleep each night. There are even some theorizing that ADHD itself may be a sleep order. The confusion is not hard to understand; many sleep problems in children have symptoms that are similar to those that characterize ADHD, including hyperactivity and inattentiveness. This is because children behave differently when they’re sleepy, as opposed to the usual markers we look for in adults. Grownups will appear tired and sluggish, but sleepy children usually overcompensate and go the other direction; displaying extreme moodiness, aggression and physical activity when they feel sleepiness closing in on them.

ADHD in Adults

Because ADHD manifests differently in adults, it’s sometimes said that children simply “grow out” of the mental disorder—a dangerous way of thinking, especially without an official diagnosis or a mental health professional overseeing treatment and management of the disorder. Adults with ADHD will usually have a better grasp of social skills and acceptable behaviors; but they will still have trouble focusing. ADHD in adults is marked by difficulties when it comes to organization and time management, which can lead to trouble setting and achieving goals, as well as maintaining a job or important relationships. Self-esteem issues and tendency to develop addictions are also symptoms; as well as physical and mental restlessness that further develop into frustration, anxiety or anger management issues.

ADHD in adults is also commonly accompanied by sleep problems, although again the possibility of misdiagnosis is present. Combined with a lack of academic attention—ADHD is often studied in children, though studies involving adults do exist—symptom overlaps can confuse even the best mental health professionals. ADHD and sleep problems like hypersomnia and narcolepsy share more than a few recognizable symptoms.

How Does ADHD Affect Sleep?

There have been many studies looking into the link between sleep and ADHD, especially in children. Some sleep difficulties may arise from the medication prescribed for ADHD, and some may simply co-exist with the presence of the mental disorder. The relationship between ADHD and sleep has never really been completely understood, and even experts cannot unanimously agree if ADHD leads to more sleep disturbances or if sleep disturbances contribute to the development of ADHD.

Since we’re not experts, we’ll pass on taking a stand; instead, we’ll just focus on the sleep problems that do crop up and discuss them in detail below. All of them can be boiled down to one general difficulty: Wide awake when it’s time to sleep, but sleepy during waking hours.

Trouble Falling Asleep at Bedtime

In children, this problem presents itself as something called bedtime resistance. Parents are familiar with the typical whining and complaining of a child that doesn’t want to go to bed yet, but with ADHD this struggle intensifies and likely occurs more frequently. I can take over an hour to get children with ADHD to settle down and finally get some rest.

Adults get to decide when they sleep, and most suffering from ADHD just don’t; not until they are completely exhausted and drained, that is. Those that try to sleep earlier are confronted by a mind that is fully awake, even though they may have felt tired all day. It’s not uncommon for adults with ADHD to think of themselves as night owls, because most tend to be at functioning at their best capacity—wide awake, full of energy, productive and thinking clearly, stable and calm—after the sun goes down. When everyone else is asleep, the house is quiet, the lights are low, and distractions nowhere to be found: this is the prime environment for people with ADHD. However, unless they have built a regular schedule around these long night hours of activity, night owls just make things worse for themselves the next day. Running on an inadequate amount of sleep, daytime tasks are more difficult to perform and commitments are harder to keep—even for a person without ADHD.

Tossing and Turning All Night

When people with ADHD finally do drift off, their sleep is often not the best quality. Tossing and turning are common due to a number of actual conditions and disorders that can make it physically impossible for them to sleep soundly: periodic limb movement disorder (PLMD); restless legs syndrome (RLS); and sleep disordered breathing (SDB), particularly excessive snoring, mouth breathing, and sleep apnea. Because of these conditions, they routinely wake up as tired and exhausted as they were when they fell asleep.

Children with ADHD tend to have more severe symptoms the less sleep they get. It just makes more sense; even adults without ADHD understand the lack of focus and alertness that comes with poor sleep quality. In some cases of children with ADHD, treating the sleep problems observed—instead of the ADHD—may result in the dramatic decrease of issues inattentiveness and hyperactivity, if not outright elimination of symptoms.

In adults with ADHD, addressing the problem of poor sleep quality becomes more complicated. Adults can consume and abuse stimulants like alcohol, caffeine, drugs, and nicotine; making it hard to separate the effects of outside factors from ADHD markers. To make matters more difficult, common co-existing disorders such as anxiety and depression also lead to sleep disorders. This can make prescribing the proper medication and treatment almost feel like a trial and error process.

Difficulty Getting out of Bed in the Morning

This doesn’t really need an extensive explanation. Poor sleep makes for a poor awakenings. When people sleep later than they should and don’t adjust their waking time, they will find it difficult to get out of bed. This likely accounts for the feeling of tiredness and daytime sleepiness most people with ADHD feel throughout the day.

Repeat this enough times and a circadian rhythm sleep disorder (CRSD) may develop; usually in the form of delayed sleep-phase disorder. Simply put, this is characterized by sleeping and waking later than a person should—based on one’s work, school and social schedule.

Sudden and Intrusive Sleeping

In mild cases, this may manifest as daytime sleepiness: inappropriate yawning, an inordinate amount of naps, and an overall sluggishness. But intrusive sleep in severe cases can be akin to what most people think of as narcolepsy. Indeed, it’s often the common misdiagnosis; partly due to the fact that there are not very many studies about this, as the conditions needed to induce intrusive sleeping in people with ADHD are hard to replicate in a controlled environment. Basically, what happens is this: When someone with ADHD gets very bored and loses interest, sometimes the mind disengages from the present task so abruptly that the body shuts down and instantly falls asleep.

What Can You Do About It?

No matter what the sleep problem is, the first answer to this question will always be to improve your sleep habits and make positive adjustments to your sleep hygiene. Below, we’ve highlighted some aspects of sleep hygiene that we believe are especially important for people with ADHD-related sleep disorders and difficulties.

Minimize Possible Sleep Distractions in the Bedroom

This is a no-brainer. If the problem is a lack of focus, then it follows that distractions should be removed or kept to a minimum. How do you do this? Keeping computers, gaming consoles, and televisions out of the bedroom helps considerably; as well as staying away from electronic devices like smartphones and tablets in the hours leading up to bedtime. Heavy blackout curtains will also help shield the bedroom from outside noise and light, which can cause sleep interruptions during the night. A fan, humidifier or white noise machine can also relax and calm you, as well as mask unwanted sounds.

Keep a Regular Bedtime Routine

Routine and structure are important with people with ADHD, especially children. A regular bedtime and waking schedule is important to keep—this goes for everyone, not just people with ADHD—and is imperative to overall sleep health. If you are a night owl, you may want to consider finding a job or taking classes that start later in the day. What’s really damaging about sleeping late is not when you sleep, but how little you sleep.

A bedtime routine that’s designed to help you or your child wind down is not only relaxing, but also a good way to train the body to expect sleep at a certain time. This cuts down on bedtime resistance and helps the mind prepare for sleep way before you even step into the bedroom. Possible routines can include a taking a long bath, reading, listening to music, drinking tea, and writing down the day’s events in a diary.

Exercise During the Day

Physical activity may aid in dissipating restless feelings and hyperactive tendencies; it gives people with ADHD something to do with energy that would otherwise be spent on potentially unwanted behavior. It may also make you both more productive and more tired, reducing that wide awake feeling that sets in during nighttime.

If it’s in the form of lessons in something that you are very interested in—like dancing or self defense, for example—it can even help you practice alertness, discipline and focus. However, if more strenuous exercise is involved—aerobics, running, and the like—it may be best to schedule it sometime during the day. Light stretches and yoga can be included in your bedtime routine.

Regulate Intake of Food and Drinks

This is another point that needs no extensive explanation. Stimulant like caffeine, nicotine and sugar keep you up, so avoid them as much as possible after dark. Even alcohol should be avoided; alcohol may help you fall asleep, but sleep disruptions will keep you from achieving a truly restful slumber. A calming, sleep-inducing infusion can be helpful, but not in large amounts; you don’t want to wake up in the middle of the night to go to the bathroom.

Important to note here is that if hunger pains are a common feature of your nighttime activities—especially if you wake up feeling especially hungry—you may need to adjust the time you consume your last meal, or actually indulge in a small snack as part of your bedtime routine.

Consult a Doctor and Get an Official Diagnosis

So you’ve supercharged your sleep habits and you’re still suffering. What now? There’s only so much aggressive Googling can do. It may be time to consult a doctor. It can be intimidating to go to a sleep clinic or a mental health professional—even if the person that may potentially have ADHD is not you, but your child—but it is always worth it, if only for peace of mind and to have a clear picture of what’s going on. You may find that you need to undo more bad habits that you thought you did. You may find that ADHD is not the problem after all. Or, you may find that you’ve been doing everything right all along. Whatever the case may be, talking to a someone that knows what they’re doing is always better than self-medicating.

To that end, it’s worth mentioning that ADHD is typically treated with prescription drugs—often stimulant medication which do not cure the disorder, but merely control it. These stimulants may cause of worsen sleep problems; which is why many people—especially parents of children with ADHD—opt to go with behavioral therapy and other alternate treatments instead. It is worth trying to treat the manifested sleep problem first—but of course, do talk to your doctor before settling on a sleeping pill or a supplement—to see if observed ADHD symptoms lessen as sleep improves.