Why Sleep Issues Are Common in ADHD

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Do you have a hard time winding down at night? Does your brain feel like it’s in high gear, shifting from thought to thought as you frantically wish you could unplug it? Do you wake up multiple times a night? Have a hard time getting up in the morning because you feel sluggish and unrefreshed? It turns out that these are all common issues when you have ADHD.

According to the non-profit group Children and Adults with Attention-Deficit/Hyperactivity Disorder, or CHADD, nearly three out of four children and teens and up to four out of five adults with ADHD have sleep problems. “Often in ADHD, sleep cycles may be shifted, with people generally falling asleep later and then waking later,” says Jake Behrens, M.D., a psychiatrist and medical director at Envision ADHD in Milwaukee, Wisc.

In fact, sleep disturbances and sleep disorders are the most common comorbidities (conditions that are present at the same time) reported by people with ADHD. Adults with ADHD walk around bleary-eyed and fatigued, unable to focus well or concentrate. Sleep-deprived kids with ADHD may be even more impulsive and hyperactive.

The ADHD-Sleep Connection

Adults with ADHD tend to have difficulty falling asleep, staying asleep and waking up in the morning. In kids, ADHD-related sleep problems like these don’t usually happen until they’re around 12 years old. However, 10 to 15 percent of kids with ADHD have difficulty falling asleep before they hit puberty, William Dodson, M.D., a member of ADDitude magazine’s ADHD Medical Advisory Panel, writes in the magazine. Many experience nightmares and bedwetting too. By the time they’re 12 years old, 50 percent of kids with ADHD have trouble getting to sleep almost every night.

Experts aren’t sure why these sleep issues happen in people with ADHD. One possible reason is that ADHD can goof up your sleep-wake pattern, called your circadian rhythm. When your circadian rhythm is delayed, as it tends to be with ADHD, you may go to sleep and wake up two hours or more later than what’s considered traditional. This pattern of sleep deprivation does not necessarily cause lethargy but in turn can mimic ADHD symptoms of hyperactive and unfocused.

“Sleep disturbances are often seen with untreated ADHD,” explains Behrens. When your ADHD isn’t treated, this can lead to a cycle of trying to stay on top of everything during the day, staying up late, a spinning mind when you’re trying to fall asleep, and then trying to function on less sleep the next day. Experts have found that treating ADHD can improve sleep and treating sleep problems can improve ADHD.

The Role of ADHD Medication

ADHD medications are often blamed for poor sleep, and they certainly can cause sleep problems. Stimulants typically keep people awake, so depending on how they’re used, Behrens says, they can affect people’s ability to fall asleep. The medication may be lasting too long in your system, or you may be taking it too late in the day for it to wear off by bedtime.

“There is often an inverse effect seen, though — where treating ADHD may actually help people with sleep overall,” says Behrens. One theory on this is that if you’re more awake during the day, thanks to the wake-promoting effect of your medication, “this helps to build the sleep drive over the day to hopefully make it easier to fall asleep at night,” Behrens says.

Being able to focus and stay in control of what you need to get done during the day should help reduce the amount of time you spend with your mind spinning through your mental to-do list at night too, Behrens says. As your ADHD symptoms improve, you should feel more confident about getting your tasks done, which in turn should improve your sleep.

The bottom line is this: ADHD experts say that when patients are on the appropriate medication, and following an appropriate regimen, they often feel well rested and ready for bed because they are mentally and physically tired at the end of the day.

If you’re still having trouble getting to sleep when you’re on your medication, talk to your healthcare provider. You may need to take it at a different time or switch medications altogether.

Sleep Disorder or ADHD?

ADHD symptoms are similar to sleep deprivation symptoms. This is why it’s possible for someone to have ADHD-like symptoms when they have only a sleep disorder, or have sleep disorder symptoms that are actually from ADHD, Behrens says. He says it’s always worthwhile to rule out a sleep disorder and get any sleep concerns checked out and treated if needed. And since sleep disorders are more common when you have ADHD, it’s possible that you have both conditions.

People with ADHD, including children, tend to have higher rates of certain sleep disorders. A good example is restless legs syndrome, which affects an estimated 2% of all kids, but affects as many as 50% of children with ADHD, according to the American Academy of Pediatrics.

Sleep disorders that most commonly coexist with ADHD include:

  • Circadian rhythm disorders
  • Insomnia
  • Restless legs syndrome
  • Sleep apnea and snoring
  • Narcolepsy
  • Difficulty falling and staying asleep

How to Improve Sleep

A good night’s sleep is crucial to your mental, emotional and physical well-being. It can affect your mood, behavior, performance at school or work, attention span and your quality of life.

If you’re looking for ways to sleep better, one of Behrens’ most important pieces of advice is to ditch personal devices — phones, electronic tablets, and computers — in the evenings. These devices “are almost like using light therapy to get ourselves activated and more energized in the morning,” he says.

Not only is the blue light close to your face activating your retinas, but “the content of such devices is also engineered to promote user engagement and to keep you clicking, watching, etc.” This is why it’s important to start putting away your devices two hours before bed, Behrens says. If you must use a device in the evening, he recommends using blue light blocking glasses.

Good sleep habits, also known as sleep hygiene, are crucial to improve your sleep. Take a look at your sleep hygiene and work on making any necessary changes. The Sleep Foundation and the American Academy of Sleep Medicine’s Sleep Education (see links below) have plenty of resources to help.

Here are some more tips to help you sleep better:

  • Behrens suggests asking your mental health provider about supplements that help promote sleep, such as melatonin. He says to be cautious when it comes to using diphenhydramine (Benadryl) because it can make you groggy and dehydrated in the morning.
  • Create a routine for bed time and go to sleep and wake up at the same time every day.
  • Use relaxation techniques or cell phone apps to help you relax before bed.
  • Bright light therapy may help you go to sleep and wake up earlier. You’ll need a light therapy lamp or box that you’ll use in the morning.
  • Try cutting back on caffeine and/or alcohol in the late afternoon and evening. Even better, cut them out altogether.
  • Prioritize physical activity every day. It should help you sleep better.
  • Consider using a weighted blanket. The heaviness of the blanket helps many people feel more calm and secure.

Sources:

CHADD: ADHD and Sleep Disorders

ADDitude: ADHD and Sleep Problems: This Is Why You’re Always Tired

Sleep Foundation: ADHD and Sleep

Psychiatric Times: ADHD: A 24-Hour Disorder

MDPI Open Access Journals: Managing Sleep in Adults with ADHD: From Science to Pragmatic Approaches

CHADD: ADHD and Sleep Disorders Diagnosis and Management

AAP News: How to Differentiate Sleep Disorders from ADHD

Nature and Science of Sleep: Sleep Disorders in Patients with ADHD: Impact and Management Challenges

The Sleep Foundation

American Academy of Sleep Medicine’s Sleep Education