ADHD & Sleep Problems: What Is the Connection?

What Is ADHD?

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental condition that affects the ability to focus, concentrate, and manage emotions. ADHD is a lifelong condition, with symptoms typically emerging in childhood or early adolescence and persisting into adulthood. Depending on the type of ADHD experienced, symptoms can vary.

Below are the types of ADHD:

• Inattentive ADHD: Inattentive ADHD refers to having primary symptoms of forgetfulness and disorganization without outward signs of hyperactivity. People with this subtype may struggle with staying on task or maintaining focus.
• Hyperactive-impulsive ADHD: Hyperactive-impulsive ADHD refers to heightened levels of physical activity, excessive talking, and acting “on the go.” Adults with this subtype often experience ongoing feelings of restlessness.
• Combined ADHD: Combined ADHD refers to having symptoms from both inattentive and hyperactive traits.

ADHD & Sleep Issues: What Is the Link?

ADHD and sleep problems share a complex relationship. Many may wonder, “Does ADHD affect sleep?” The simple answer is yes. In fact, up to 50% of adults and 61% of children diagnosed with ADHD deal with sleep-related issues.^1,2,5 Due to this high comorbidity rate, many researchers speculate that ADHD can cause sleep disorders and vice versa. Some have even suggested that sleep issues are a symptom of ADHD.^4,6

The sleep issues common in ADHD may stem from various factors, such as hyperactivity, poor sleep hygiene, and neurotransmitter imbalances. Because ADHD occurs on a spectrum and symptoms vary depending on the person, identifying the primary cause behind poor sleep quality can be difficult.

Below are 11 links between ADHD and sleep issues:

1. Poor Sleep Quality

Research shows a link between ADHD and trouble sleeping. Up to 75% of adults with childhood-onset ADHD show signs of the ADHD sleep cycle, which refers to a delayed circadian rhythm phase. Likewise, many adults struggle with “the sleep of the dead” phenomenon, experiencing several awakenings before falling into a deep sleep around 4 a.m. These challenges subsequently make waking up on time difficult.⁷

2. Hyperactivity

Many individuals with ADHD may struggle with hyperactivity at bedtime. Feeling energized, talkative, fidgety, or restless at night can make winding down seem nearly impossible. Other times, some may engage in stimulating activities too close to bedtime, causing them to overlook their natural cues of sleepiness.

3. Abnormal Circadian Rhythm

Abnormal circadian rhythms are common in people with ADHD. 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 lie awake at night and feel tired during the day. For this reason, many individuals with ADHD may become “night owls” and stay up late into the evening, further disrupting their natural sleep cycles.

4. ADHD Medications

The most commonly prescribed type of medication for ADHD is stimulants, which help people feel more alert, awake, focused, and energized. However, insomnia and sleep issues are some of the most common side effects of these medications.

Some non-stimulant medications for ADHD can have less severe but similar effects on sleep. People taking stimulant or non-stimulant medications report more sleep problems than those who manage their ADHD symptoms without meds.^1,2

5. Reduced REM Sleep

Studies show that children and adults with ADHD spend less time in rapid eye movement sleep (REM sleep) than others. REM plays an essential role in sleep quality and health, and this disparity may partially explain the connection between ADHD and poor sleep.⁸ Low levels of REM sleep are also associated with sleep disorders like narcolepsy and specific chemical imbalances in the brain.^2,5

6. Impulsivity

Impulsivity is a common feature of ADHD that 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.^1,3,5,6 Unhealthy habits like staying up too late, partying too often, or overindulging in drugs or alcohol can negatively impact sleep schedules.

7. Poor Time Management & Planning

People with ADHD may struggle with keeping a consistent sleep schedule due to difficulties with time management, making plans, and sticking to a schedule.^{4, 6} For example, procrastination, hyperfixation, all-nighters, and last-minute plans can derail a nighttime routine.

8. “Intrusive” Sleep

Many people with ADHD experience intrusive sleep. This phenomenon happens when someone becomes drowsy or falls asleep without warning after mentally disengaging from a task. This symptom can interrupt nighttime sleep and exacerbate daytime fatigue, particularly if the individual already has ongoing sleep problems. Intrusive sleep can also be dangerous if someone is driving or engaging in another significant task.

9. Poor Sleep Hygiene

Individuals with ADHD may have problems with sleep hygiene, such as going to bed late or engaging in stimulating activities before bed. Sleep disturbances and daytime sleepiness can magnify problems associated with restlessness and insomnia. In addition, many people with ADHD also report difficulties sleeping restfully once they fall asleep.⁹

10. Co-Occurring Mental Health Conditions

ADHD and night terrors are common, along with other mental health conditions that may contribute to sleep problems. Children, in particular, are vulnerable to experiencing ADHD nightmares, and the fear of having nightmares may contribute to insomnia.

Research has also found a relationship between tantrums, hyperactivity, nightmares, and anxiety disorders. This link can exacerbate stress and magnify ADHD symptoms during the waking hours.

11. Neurotransmitter Imbalances

ADHD may stem from dysfunction in the dopamine and norepinephrine systems. While these imbalances may be responsible for the inattentive and impulsive symptoms, they can also interfere with how the brain interprets pleasure. This circuit can certainly affect sleep quantity and quality.¹⁰

ADHD & Common Sleep Disorders

Sleep disorders are consistent and severe enough to interfere with quality of life, health, or ability to function.¹¹ As mentioned, sleep disorders are common for those with ADHD.

For example, research suggests ADHD and insomnia often occur comorbidly, with as many as 73% of children and 66% of adults with ADHD experiencing the condition. ADHD and sleep apnea, narcolepsy, and circadian rhythm disorders are also closely related.

Common sleep disorders experienced by those with ADHD include:^2,8,11

• Insomnia disorder: Insomnia results in problems falling asleep or staying asleep. This sleep disorder is one of the most common in those with ADHD.
• Sleep-disordered breathing: Sleep-disordered breathing (SDB) involves abnormal breathing patterns during sleep, including obstructive sleep apnea and snoring. These interfere with the ability to reach deep, restorative stages of sleep. SDB and ADHD are strongly correlated, 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. RLS tends to be worse at night and prevents people from being able to fall asleep. An estimated 44% of people with ADHD suffer from RLS, compared to just 10% of the general population.
• Circadian rhythm disorders: Circadian rhythm disorders (CRSDs) are abnormalities in the 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 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 severe and debilitating sleep disorder that prevents people from remaining awake and alert. In turn, this disorder can lead to excessive daytime sleepiness. Some evidence suggests people with narcolepsy are twice as likely to have ADHD as the general population.
• Delayed sleep phase syndrome: Delayed sleep syndrome refers to falling asleep at least two hours later than a conventional bedtime (i.e., falling asleep at 3:00 am every night, even when there is a need to wake up at 7:00 am for work). This condition can result in sleep deprivation, excessive fatigue, irritability, and poor concentration throughout the day.

Effects of Sleep Problems in ADHD

ADHD sleep deprivation can affect every aspect of functioning. Children may struggle in school or with friends, and adults may struggle in relationships or work. Chronically poor sleep can also lead to an array of health problems, like heart disease, high blood pressure, and even cancer.

Below are possible impacts of sleep problems with ADHD:

• Poor work/academic performance: Sleep problems often coincide with daytime fatigue, making focusing on normal tasks difficult.
• Irritability: Sleepiness can cause daytime mood swings, and someone may be more prone to outbursts or meltdowns when tired.
• Relationship problems: Because sleep deprivation heightens impulsivity, moodiness, and poor judgment, these problems can seep into relationships.
• Lack of self-care: Taking care of oneself when physically exhausted can be hard. This problem may magnify stress and worsen symptoms of co-occurring depression or anxiety.

ADHD & Sleep Problems Treatment Options

While managing the symptoms of comorbid ADHD and sleep disorders can be difficult, the good news is that many find relief from therapy, medication, or a combination of the two.^1,5,6 Many factors are involved in treating these disorders, so start with a comprehensive assessment to determine an accurate diagnosis and treatment plan. Sometimes, a sleep study or other exam can help in the diagnostic or treatment process.^1,4,8

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 combined with therapy, which can help reinforce the use of healthy coping skills and positive sleep hygiene. The specific kinds of treatment needed to address ADHD and sleep issues will vary depending on the person and their symptoms.^1,2

Treatment options for ADHD and sleep disorders may include:^1,6,8,12

• Cognitive behavioral therapy (CBT): CBT for ADHD helps people manage their symptoms by monitoring and changing their thoughts and behavior patterns.
• Cognitive behavioral therapy for insomnia (CBT-i): CBT-i is a brief, solution-focused approach specifically intended to address insomnia and sleep issues. CBT-i is evidence-based and can help improve symptoms for 80% of people struggling with insomnia.
• Biofeedback therapy: Biofeedback therapy uses devices that monitor heart rate, breathing, and other physiological data to provide real-time feedback. Combining this approach with relaxation training or mindfulness can help people train themselves to relax or focus, aiding in symptom management.
• ADHD Medications: A prescriber may recommend stimulant or non-stimulant medications to improve focus, concentration, and task completion. While some people can manage their ADHD symptoms without meds, many find these treatments help them meet expectations at work, school, or other parts of life.
• Sleep medications: A doctor may prescribe different sleeping medications, including hypnotics, benzodiazepines*, and other sedatives, to help improve symptoms of a sleep disorder. Most of these medications work by helping people fall asleep and stay asleep throughout the night.

*This medication has black box warnings, the most serious kind of warnings from the FDA for abuse or misuse, risk of physical dependence, and risk of serious side effects, including death, when combined with an opioid.

How to Cope With ADHD & Sleep Problems

In addition to seeking professional treatment, you can take steps on your own to manage your ADHD and sleep problems. Maintaining a healthy lifestyle, consistent schedule, and good sleep hygiene are all positive ways to improve your well-being and health.

Below are some tips for coping with ADHD and sleep problems:⁸

• Be active during the day: Exercise and mental health are closely related, and physical activity can improve your sleep, boost your energy, and help you concentrate better during the day.
• Stick to a schedule: The structure of a written schedule can help keep your ADHD brain from getting distracted at night, leading to positive improvements in sleep quality.
• 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. Doing so can do wonders for your sleep.
• Start a mindfulness or meditation routine: Mindfulness and meditation for ADHD can improve concentration and focus, helping you 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: Getting sidetracked is easy. Because of this, blocking out distractions is wise before bedtime. Silence notifications on your phone, minimize tabs on your laptop, and tidy up your workspace to reduce clutter and chaos.
• Write things down: Keeping a written schedule, to-do list, or goal-tracker can significantly improve organization, memory, and follow-through. You can even keep a notepad and pen by your bed for late-night ‘brain dumps’ of your ADHD racing thoughts, making falling and staying asleep easier.
• Use your bed sparingly: One recommendation for people with sleep issues is to spend LESS time in bed. Try limiting time spent in bed to sleep to see if this makes a difference.
• Limit caffeine intake: Although you may feel tempted to drink more coffee to stay alert, be mindful of how much you consume. Consider cutting back earlier to see if you fall asleep faster.
• Take medication early: Talk to your doctor about optimal times for taking ADHD medication. Some people find taking their medication earlier can reduce how awake they feel before bed.
• Avoid screen time before bed: Scrolling through social media or reading the news increases brain activity, making unwinding or falling asleep more difficult.