ADHD and Sleep

What Is the Relationship Between ADHD and Sleep?

People with ADHD are more likely to have shorter sleep periods, difficulty falling and staying asleep, and a higher risk of developing a sleep disorder beginning around puberty. Nightmares5 are also common in children with ADHD, particularly those who also suffer from insomnia. Sleep problems in ADHD tend to worsen with age, though sleep problems in childhood6 are a risk factor for the recurrence of ADHD symptoms in the future.

Even those who are rarely hyperactive during the day may have racing thoughts and a burst of energy at night that interfere with sleep. Because there are fewer distractions at night, some people find it easier to "hyperfocus" on a project. Unfortunately, this makes it difficult to fall asleep and can result in a disrupted sleep-wake cycle. Insomnia may worsen over time as people develop stress-related feelings about going to bed.

As a result of insufficient sleep, many people with ADHD experience daytime sleepiness and difficulty waking up. Others have restless, unrefreshing sleep with frequent nighttime awakenings.

Sleep issues in ADHD appear to vary according to the type of ADHD7. Individuals with predominantly inattentive symptoms are more likely to sleep later, whereas those with predominantly hyperactive-impulsive symptoms are more likely to experience insomnia. Those who have both hyperactive-impulsive and inattentive ADHD have poor sleep quality and a later bedtime.

Many ADHD symptoms are similar to sleep deprivation symptoms. Adult ADHD sleep problems include, among other things, forgetfulness and difficulty concentrating. In children, fatigue can manifest as hyperactivity and impulsiveness8. It can be difficult to tell whether these issues are caused by ADHD or a lack of sleep. This may result in incorrect diagnoses or allow sleep disorders to go undetected. As a result, experts advise screening patients for sleep issues before prescribing ADHD medication.

What's the Science Behind the ADHD-Sleep Link?

ADHD sleep issues could be a result of impaired arousal, alertness, and regulation circuits in the brain. Other researchers believe that ADHD sleep issues are caused by a delayed circadian rhythm and a later onset of melatonin production9. Despite similarities between certain sleep disorders and ADHD symptoms, research has failed to find consistent sleep abnormalities in ADHD patients.

The calming effects of stimulant medications, which are commonly prescribed for ADHD, make it easier for some people to sleep. However, for many people, stimulant medications cause a slew of sleep issues in and of themselves. Sleep problems are likely to be exacerbated by co-occurring disorders such as anxiety, depression, or substance abuse, as well as poor sleep hygiene.

How Do ADHD Sleep Issues Affect Day-to-Day Life?

Though there is little research on ADHD and sleep disorders, children and adults with ADHD and a sleep disorder frequently report more severe ADHD symptoms and a lower quality of life. They may also be more prone to depression, anxiety, hyperactivity, inattention, difficulty processing information, and having a higher BMI. Chronic sleep deprivation makes people vulnerable to physical health problems in the long run.

Daytime sleepiness can have a negative impact 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 avoid. Sudden bouts of sleepiness can also be dangerous when driving or doing other tasks that require concentration.

Inadequate sleep at night can also lead to fatigue during the day. 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 ADHD as well as sleep problems are more likely to be depressed, anxious, stressed, and late to work.