ADHDers are typically not strangers to having difficulties with sleep. Falling asleep, staying asleep, waking up, and feeling awake throughout the day can all be trouble for the average ADHDer. Because symptoms associated with ADHD, such as sensory sensitivities and executive functioning struggles, can be exacerbated by a lack of quality sleep, it is important for us to be aware of our sleep patterns and find ways of caring for and, hopefully, improving our quality of sleep.
Sleep Problems Associated with ADHD
ADHDers report sleep issues that can range in severity from a frequent frustration to a clinical disorder. ADHD is associated with increased rates of the following concerns [1]:
- Insomnia
- Circadian rhythm disorders and melatonin disruptionsome text
- Delayed sleep phase syndrome in the most common sleep disturbance associated with ADHD, affecting 73-78% of children and adults with ADHD [2]
- Sleep disordered breathing, such as snoring and sleep apnea
- Restless Leg Syndrome (RLS) and other periodic limb movement disorderssome text
- 44% of people with ADHD have been shown to have RLS or RLS symptoms [3].
- Narcolepsy
- Daytime drowsiness
Factors Impacting Sleep and Difficulties with Sleep Hygiene
ADHD-related sleep problems can be impacted by biological, behavioral, and genetic factors:
- Genetic differences impacting melatonin onset and the metabolization of dopamine can impact the body’s ability to regulate sleep
- Delayed sleep phase syndrome, which causes a later onset of sleep and later natural wake time [4]. When a later wake time cannot be accommodated, the short sleep duration can have additional negative effects and lead to cycles of poor sleep
- Increased physical agitation, restlessness, and difficulty relaxing the body
- Side effects of stimulant medications or use of caffeine
While we are quick to talk about sleep hygiene in response to these struggles (and we will down below), it is important to acknowledge that sleep support practices can be difficult to implement with regularity. Some experiences that can operate as obstacles to engaging in sleep hygiene include:
- Staying up late to utilize the increased focus that some ADHDers have at night. This may be due to the looming need for sleep acting as a natural deadline and therefore, a tool to kick us into gear to tackle tasks.
- Trouble transitioning out of a period of hyperfocus. When we get to the end of the day and finally have time to engage in our interests, breaking out of this focused mode can be physically painful and lead to disruptions in sleep routines.
- “Revenge bedtime procrastination,” which refers to the experience of putting off sleep in order to maximize our free time or alone time before having to face the demands of the next day.
- Differences with interoception causing difficulties registering that you are tired.
There is no shame in struggling to implement sleep hygiene practices regularly. When you are able, utilize the practices that support you - they are always there to come back to.
One quick side note: While many sleep issues can be correlated with ADHD symptoms, they may also be related to underlying medication conditions. If you experience chronic sleep issues, it may be important to talk to a doctor to rule out other conditions.
Poor Sleep Is a Problem Worth Addressing
When we experience poor sleep, especially chronic poor sleep, other difficulties tend to worsen, including symptoms of anxiety and depression and other impairments that impact attention, mood, performance in work and school, and overall quality of life [1]. When we are sleep-deprived, our brains have difficulty filtering sensory information. When sensitivity to sensory stimuli increases, this can quickly lead to greater fatigue, irritability, and overwhelm throughout the day. Further, poor sleep exacerbates executive functioning difficulties due to the impact sleep deprivation has on the prefrontal cortex. When it comes to managing life tasks, work demands, or ADHD symptoms in general, we don’t need the additional challenges that come with sleep problems. When we are well-rested, we can experience greater ease in taking on the tasks of the day, caring for our sensory environment, and processing and regulating emotions.
Try the Good Sleep Hygiene Tips (But First Figure Out Which Ones You Might Actually Need)
If you are an adult with ADHD, it is likely you’ve heard a lot of advice about sleep hygiene over your life. You have also probably learned that, as with all tips and tricks addressing ADHD symptoms, the usefulness and effectiveness of advice related to sleep varies significantly from person to person and requires a lot of personalization.
When it comes to finding strategies that are both needed and workable in your life, intentionally acquainting yourself with your own sleep patterns is a foundational step. When do you notice increased disruptions to your sleep? Consider the circumstances and try to trace back to possible emotional, environmental, situational, social, or physical factors that may have triggered the cycle of poor sleep. By mapping out these patterns, you can begin seeing opportunities to attend to your needs specifically and be responsive to the variables that cause your sleep routines to get out of whack. From here, we work to find ways of resetting to a solid sleep routine for us. This may mean using a sleep aid (like melatonin) to help circadian rhythm issues, getting moving during the day to burn off energy and help sleep earlier, or increasing your exposure to bright light in the morning to assist with waking up.
If you are newer to the idea of sleep hygiene, this term refers to all the bedtime routines and habits you do to take care of your sleep. Ideally, these practices make it easier to fall asleep and wake feeling well rested. Here are some examples of good sleep hygiene:
- Try to go to sleep and wake up around the same time every day to help your circadian rhythm be more consistent.
- Sleep in a cool, dark, quiet room.some text
- A caveat to this: some folks with ADHD struggle to fall asleep in silence, needing some noise to provide enough stimulation so their minds can go a little quieter. If this applies to you, use what is helpful to you. For some people, white or brown noise or instrumental music is lulling enough to pull them into sleep. For others, the sound of a heavily rewatched TV show or movie helps fill the space without being intriguing enough to keep them awake. The quiet may be ideal for some people, but finding what works for you is most important.
- Get away from the visual stimulation and harsh light from screens a few hours before bed to help keep your circadian rhythm and melatonin patterns on track to wind down before sleep
- Get movement in your day to use up energy and release endorphins to help with emotional regulation, but try to avoid intense exercise in favor of gentle stretches in the few hours before bedtime to ensure your body is regulated and calm when trying to go to sleep.
- Develop a bedtime routine you actually enjoy. Allow yourself to start winding down and begin transitioning to bedtime 30 minutes to a few hours in advance, including relaxing and sensory-soothing activities in your nighttime routine.
Conclusion
Addressing sleep issues in individuals with ADHD is crucial for promoting overall well-being and enhancing daily quality of life. By understanding the interaction with ADHD and sleep concerns, implementing sleep treatments and accommodations, and seeking support when needed, ADHDers can manage sleep patterns and improve daytime cognitive functioning, mood regulation, and overall sense of well-being. Progress often takes time, but with creativity and perseverance, gaining restful sleep is possible. When it comes to managing and caring for our ADHD symptoms holistically, addressing sleep difficulties is a crucial part of the process.
Common Questions About ADHD and Sleep
What are common sleep problems associated with ADHD?
Some of the most common sleep problems associated with ADHD include insomnia, circadian rhythm disorders, delayed sleep phase syndrome, sleep disordered breathing like snoring and sleep apnea, restless leg syndrome and periodic limb movement disorders, narcolepsy, and daytime drowsiness. Delayed sleep phase syndrome affects 73-78% of children and adults with ADHD.
What factors impact sleep difficulties in people with ADHD?
Sleep problems in those with ADHD can be impacted by genetic differences that affect melatonin and dopamine regulation, delayed circadian rhythms, increased physical restlessness, side effects of stimulant medications, and behavioral factors like revenge bedtime procrastination, difficulty transitioning out of hyperfocus, and trouble registering tiredness.
Why is poor sleep a significant issue for people with ADHD?
Chronic poor sleep tends to worsen other difficulties for those with ADHD, including anxiety, depression, attention problems, mood issues, reduced performance at work and school, and lower overall quality of life. Sleep deprivation makes it harder for the brain to filter sensory information and can exacerbate executive functioning difficulties. Addressing sleep problems is crucial for managing ADHD symptoms.
What are some good sleep hygiene tips for adults with ADHD?
Beneficial sleep hygiene practices include: sticking to consistent sleep and wake times, sleeping in a cool dark room, avoiding screens before bed, getting daily exercise, developing an enjoyable wind-down routine, and finding the right level of sound/noise for falling asleep. The key is figuring out which specific strategies are needed and workable for your individual circumstances.
How can I figure out what sleep hygiene practices I need?
Pay attention to your own sleep patterns and when you notice increased sleep disruptions. Try to identify emotional, environmental, situational, social or physical factors that may trigger cycles of poor sleep for you. This can help you see opportunities to attend to your specific needs and find ways to reset to a solid personalized sleep routine.
Sources
- Wajszilber, D., Santiseban, J. A., & Gruber, R. (2018). Sleep disorders in patients with ADHD: impact and management challenges. Nature and science of sleep, 10, 453–480. https://doi.org/10.2147/NSS.S163074
- Díaz-Román, A., Mitchell, R., & Cortese, S. (2018). Sleep in adults with ADHD: Systematic review and meta-analysis of subjective and objective studies. Neuroscience and biobehavioral reviews, 89, 61–71. https://doi.org/10.1016/j.neubiorev.2018.02.014
- Konofal, E., Lecendreux, M., & Cortese, S. (2010). Sleep and ADHD. Sleep Medicine, 11, 652-658. https://doi.org/10.1016/j.sleep.2010.02.012
- van Andel, E., Bijlenga, D., Vogel, S. W. N., Beekman, A. T. F., & Kooij, J. J. S. (2022). Attention-Deficit/Hyperactivity Disorder and Delayed Sleep Phase Syndrome in Adults: A Randomized Clinical Trial on the Effects of Chronotherapy on Sleep. Journal of biological rhythms, 37(6), 673–689. https://doi.org/10.1177/07487304221124659
