ADHD & Sleep Problems: What’s the Connection?

What Is ADHD?

Attention deficit disorder with hyperactivity (ADHD) is a common neurodevelopmental disorder that makes it hard for people to focus, concentrate, sit still, and be quiet. The symptoms of ADHD usually begin in childhood or early adolescence but can persist into adulthood.⁵ ADHD medication, therapy, and organization and time management skills are often used to help people manage their symptoms.⁶

How Are ADHD & Sleep Problems Connected?

There is a strong and complex relationship between sleep problems and ADHD, with a high rate of comorbidity.^1,3 In fact, up to 50% of adults and 61% of children diagnosed with ADHD deal with sleep related issues.^1,2,7 The high rate of this occurrence has caused many researchers to speculate that one issue can cause the other. Some have even suggested that ADHD is a sleep disorder or that sleep issues are a symptom of ADHD.^4,8

While experts don’t have all of the answers about how ADHD and sleep are related, this relationship has been explored. The results of these studies have helped to identify some key connections between the two.

Sleep problems may occur in those with ADHD because of:

1. Poor Sleep Quality

There are countless ways that good sleep affects people’s health.⁹ Poor sleep is known to increase a person’s risk for a number of different mental illnesses, including ADHD. While those who struggle with sleep disorders are much more likely to develop ADHD, sleep deprivation can also cause cognitive impairments that mimic some of the symptoms of ADHD. For example, a lack of sleep can cause difficulties with concentration, memory, and impulsivity, which are all associated with ADHD.^1,4,5,7

2. Hyperactivity

People with ADHD struggle with symptoms of inattentiveness as well as hyperactivity. Hyperactivity involves feeling energized, talkative, fidgety, or restless.⁵ These symptoms can make it difficult for those with ADHD to remain still and quiet long enough to feel tired or fall asleep. They may also remain active and busy throughout the evening, causing them to miss their body’s cues that indicate they’re tired or ready for bed.

3. Abnormal Circadian Rhythm

Abnormal circadian rhythms are common in people with ADHD, and may result in a person becoming a night owl who stays up late. The circadian rhythm is a natural internal clock that helps people feel awake or sleepy at appropriate times. An abnormal one can trigger the release of hormones and chemicals that cause people to lay awake at night and feel tired during the day. For those with ADHD, issues may also be linked to certain genetic and brain abnormalities.^1,2,4

4. ADHD Medications

The most commonly prescribed type of medication for ADHD are stimulants, which are formulated to help people feel more alert, awake, focused, and energized. However, they are also known to interfere with sleep, and insomnia and sleep issues are one of the most common side effects of these medications.

There are also some non-stimulant medications for ADHD which can have less severe but similar effects on a person’s sleep. People who take either stimulant or non-stimulant medications often report more sleep problems than people who manage their ADHD symptoms without meds.^1,2

5. Reduced REM Sleep

Studies show that children and adults with ADHD don’t have the same amount of rapid eye movement sleep (REM sleep) as most people do. REM is the stage of sleep where one dreams and plays an important role in sleep quality and health.⁹ Furthermore, research suggests that this disparity may partially explain the connection between ADHD and poor sleep. Low levels of REM sleep are also associated with sleep disorders like narcolepsy, and are associated with specific chemical imbalances in the brain.^2,7

6. Impulsivity & Poor Lifestyle Choices

Impulsivity is a common feature of ADHD, which impairs regions of the brain involved in thinking, planning, decision making, and impulse control. These deficits in executive functions can lead people with ADHD to make poor or irresponsible choices that affect their health.^1,3,7,8 Unhealthy habits like staying up too late, partying too often, or overindulging in drugs or alcohol can all negatively impact sleep schedules. This may also  contribute to the “sleep of the dead” which describes sleeping through alarms and not being able to wake up.

7. Poor Time Management & Planning

Because those with ADHD have difficulties with time management, making plans, and sticking to a schedule, they might also struggle with keeping a consistent sleep schedule.^5,4,8 For example, procrastinating, being hyperfixated on a task, pulling all-nighters, and making last-minute plans can derail a person’s nighttime routine. Because of these tendencies, a person with ADHD might find it harder to set a regular bedtime that allows them to get the recommended eight hours of sleep per night.

ADHD vs ADD. Diagnosis

Having a diagnosis of either ADD or ADHD increases the risk for sleep problems, but the risk of sleep disorders and problems isn’t the same for both disorders. Research suggests that sleep disturbances are more prevalent in those with ADHD (the hyperactive type of ADD) than with ADD (the inattentive type of ADD).^1,5 Furthermore, those with more severe and debilitating ADHD symptoms are more likely to experience sleep issues.^1,7

Common Sleep Disorders in ADHD

While everyone occasionally has trouble sleeping, a person with a sleep disorder regularly experiences these problems. Sleep disorders are diagnosed when sleep disturbances become consistent and severe enough to interfere with a person’s quality of life, health, or ability to function.⁵ While all sleep disorders affect the timing, quality, or amount of sleep a person gets, the specific kinds of difficulty a person has depends on their disorder.

Common sleep disorders experienced by those with ADHD include:^2,5,9

• Insomnia disorder: Insomnia is one of the most common sleep disorders and is characterized by problems falling asleep or staying asleep. Research suggests that 73% of children with ADHD and 66% of adults with ADHD also suffer from insomnia, which is more than twice the rate in the general population.
• Sleep disordered breathing: Sleep disordered breathing (SDB) involves abnormal patterns of breathing during sleep, including obstructive sleep apnea and snoring. These interfere with a person’s ability to reach deep, restorative stages of sleep. There is a strong correlation between SDB and ADHD, with childhood snoring or sleep apnea doubling the risk of developing ADHD later in life.
• Restless leg syndrome: Restless leg syndrome (RLS) is a sensorimotor disorder that causes people to have strong urges to move their legs, which tends to be worse at night and prevents people from being able to fall asleep. An estimated 44% of people with ADHD also suffer from RLS, compared to just 10% of the general population.
• Circadian rhythm disorders: Circadian rhythm disorders (CRSDs) are abnormalities in the body and brain’s sleeping and waking schedule. These result in the release of hormones and chemicals that make someone feel sleepy or awake at the wrong times. Research shows that many people with ADHD have genetic and neurological markers consistent with those seen in people with CRSDs, which may explain the high rate of co-occurrence.
• Narcolepsy: Narcolepsy is a serious and debilitating sleep disorder that prevents people from being able to remain awake and alert for normal amounts of time. In turn, this disorder can lead to excessive daytime sleepiness. Research suggests that people with narcolepsy are twice as likely to have ADHD as the general population.

Poor Sleep & Worsened ADHD: A Vicious Cycle

Clearly, sleep problems and ADHD overlap considerably, but it isn’t always clear which problem came first. People who have co-occurring ADHD and sleep disorders often find that both conditions affect each other, and a worsening of one condition usually leads to a worsening of the other.^1,4 This can create a ‘vicious cycle’ of sleep deprivation that worsens ADHD symptoms. That’s why it’s so important for people with ADHD to address any sleep issues and ensure they’re well-rested.

Treatment Options for ADHD & Sleep Disorders

While it can be difficult to manage the symptoms of comorbid ADHD and sleep disorders, the good news is that many find relief from therapy, medication, or a combination of the two.^1,7,8 Because there are many different factors involved in treating these disorders, it’s important to start with a comprehensive assessment to determine an accurate diagnosis and treatment plan. In some cases, a sleep study and other procedure or exam may be recommended to help in the diagnostic or treatment process.^1,4,9

Those prescribed medication for ADHD, sleep, or both should always consult with their prescriber before starting or stopping a medication, including natural supplements. Medications are most effective when they’re combined with therapy, which can help reinforce the use of healthy coping skills and positive sleep hygiene to help manage symptoms. The specific kinds of medication and therapy needed to address ADHD and sleep issues will vary depending on the person and their symptoms.^1.2

Treatments options for sleep disorders and ADHD may include:^1,6,8,9

• Cognitive behavioral therapy (CBT): CBT for ADHD is a structured form of therapy that helps people manage their symptoms by monitoring and changing their thought and behavior patterns. This kind of therapy is widely used by therapists and other mental health professionals to help people with a range of different mental health issues, and is considered an evidence-based treatment for ADHD.
• Cognitive behavioral therapy for insomnia (CBT-i): CBT-i is a brief, solution-focused type of CBT therapy that’s specifically intended to help people struggling with insomnia and sleep issues. This is an evidence-based form of therapy that helps 80% of people who struggle with insomnia.
• Biofeedback therapy: Biofeedback therapy involves using devices that monitor heart rate, breathing, and other physiological data to provide people with real-time feedback. This can be combined with relaxation training or mindfulness to help people train themselves to relax or focus, which helps them manage their symptoms.
• ADHD Medications: Medications for ADHD* are often recommended as a part of treatment. People with ADHD may be prescribed stimulant or non-stimulant medications to improve focus, concentration, and task completion. While some people are able to manage their ADHD symptoms without meds, many find that medication is a key part of being able to meet expectations at work, in school, or other parts of life.
• Sleep medications: Medications are sometimes also prescribed to those who have sleep disorders or related issues. There are different kinds of sleeping medications including hypnotics*, benzodiazepines*, and other sedatives*. Most of these medications work by helping people fall asleep and stay asleep throughout the night.

*All prescribed medications carry a risk for adverse effects, and many medications commonly prescribed for ADHD and sleep problems have addictive qualities. Talk with your prescriber about the pros and cons before starting a new drug. Monitor closely for side effects when starting any new drug, and contact your doctor if you notice any concerning side effects.

How to Cope With ADHD & Sleep Problems

In addition to seeking therapy and/or medication from a licensed professional, there are also things people can do on their own to manage their ADHD and sleep problems. A healthy lifestyle, consistent schedule, and good sleep hygiene have been proven to help people who struggle with these challenges.⁹

Below are some tips for coping with ADHD and sleep problems:⁹

• Be active during the day: Physical exercise has countless benefits for your physical and mental health, including helping to improve your sleep, boost your energy, and help you concentrate better during the day.
• Stick to a schedule: Having the structure of a written schedule can help keep your ADHD brain from getting distracted and also develop a consistent sleep schedule.
• Get up at the same time each day: While you can’t always control when you fall asleep, you can be more consistent with what time you wake up, and doing so can do wonders for your sleep. While you might start with a few rough mornings, getting up early will help you feel more tired at bedtime.
• Start a mindfulness or meditation routine: Mindfulness and meditation for ADHD can improve concentration and focus, making it easier to resist distractions. The best way to reap the benefits of these practices is to be consistent. Even 15 minutes a day using a meditation app can make a difference in your ADHD symptoms.
• Block out distractions: It can be all too easy to get sidetracked when you’re trying to focus on work, which is why it’s a good idea to block out whatever distractions you can. Before you start for the day, silence notifications on your phone, minimize tabs on your laptop, and tidy up your workspace so there’s less clutter and chaos.
• Write things down: Another important tip to help manage symptoms of ADHD is to write things down. Keeping a written schedule, to-do list, or log of your goals can do wonders for your organization, memory, and follow through. You can even keep a notepad and pen by your bed to do a late-night ‘brain dump’ of your ADHD racing thoughts, which can make it easier to fall asleep.
• Use your bed sparingly: One common recommendation for people who have sleep issues is to spend LESS time in bed. Reserving your bed for sleep and sex might sound ridiculous, but it can actually make it easier to fall asleep at night. Try limiting your waking hours in your bed, and see if it makes a difference for your sleep.

Final Thoughts

About half of people with a diagnosis of ADHD also struggle with sleep issues, and having a sleep disorder can increase a person’s risk of developing ADHD by 50% or more.^1,2,8 These statistics suggest there’s a strong correlation between the two. While the exact nature of this relationship isn’t understood, it seems that improving sleep is an important part of managing ADHD symptoms and vice versa.⁴ If you or a loved one struggle with co-occurring sleep issues and ADHD, there are therapies and medications that may help.