ADHD and Sleep: Experts Explain the Connection

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Attention-deficit/hyperactivity disorder (ADHD) is a relatively common condition characterized by inattention, impulsive behavior, and/or hyperactivity to the degree that development and daily functioning are impacted. About 5% to 15% of children are affected by ADHD, though there’s some disagreement among experts as to whether this range is accurate, and some cite ranges close to 3% to 5%. Even though ADHD starts in childhood, it lasts into adulthood, though not every adult displays the same symptoms or behaviors. Additionally, some individuals aren’t diagnosed until adulthood.

ADHD is associated with a number of sleep disorders, and the relationship between ADHD and sleep is highly complex. Individuals with ADHD may experience disturbances such as insomnia, restless sleep, or breathing issues. And while not everyone with ADHD experiences one or more of these challenges, many do. One study reported that sleep problems occur in 25% to 50% of people with ADHD.

Fortunately, there are a variety of steps that people with ADHD can take that can set them on a path toward a more restful night.

ADHD is a common disorder that starts in childhood and impacts how the brain develops and functions. Children with ADHD can have difficulties sitting still, focusing, and controlling impulses. Most kids experience these behaviors at one time or another. The difference for kids with ADHD is that these challenges persist for more than six months, are more than what would be expected for a child’s age, and lead to difficulties with family, friends, and in school situations.

Because of these long-lasting and age-inapppropriate behaviors, there are many misconceptions when it comes to ADHD. It was once classified as a behavioral disorder, meaning children with ADHD were perceived to be simply misbehaving when ADHD symptoms would crop up. Experts now know that ADHD stems from neurological differences. And while much of the information on ADHD focuses on children, and while ADHD begins in childhood, it stays with most people into adulthood.

ADHD appears to be more common in boys than girls, with over twice as many boys diagnosed as girls, though some experts believe the condition is underdiagnosed in girls and women.

There are three types of ADHD.

• Predominantly Inattentive: Those who fall into the predominantly inattentive subset of ADHD typically have challenges with organization and completing tasks. They may become easily distracted or struggle to remember their daily routines.
• Predominantly Hyperactive/Impulsive: Individuals with predominantly hyperactive-impulsive ADHD experience difficulties with sitting still for extended periods and may frequently interrupt others in conversation. Their impulsivity can lead to increased likelihood of injuries and accidents.
• Combined: Some people with ADHD exhibit both types, meaning they have symptoms of inattentiveness and hyperactivity/impulsiveness.

Diagnosis of ADHD can be difficult and requires evaluation by a medical professional.

Individuals with ADHD are especially vulnerable to experiencing sleep issues, including insomnia, trouble waking in the morning, and sleep apnea. The relationship between sleep and ADHD can be cyclical. The symptoms of ADHD can make it difficult to sleep, and poor sleep can impact ADHD symptoms during the day.

More research is needed to discover exactly why certain sleep disorders are associated with ADHD, but there’s evidence that the body’s sleep-wake cycle plays a role. The sleep-wake cycle essentially tells us when to go to sleep and when to wake up. This cycle is delayed in some people with ADHD, who are naturally inclined to go to bed and wake up later.

What’s more, those with ADHD may have a hard time calming their minds at night or stepping away from a project or task to go to bed. The delay in falling asleep — combined with having to wake up for work, school, or personal obligations — can make it extremely difficult to get a full night’s sleep.

People with ADHD are also more prone to disorders like restless legs syndrome (RLS) and sleep apnea that can wake them up during the night. It’s not fully known whether ADHD contributes to these disorders or if the disorders may lead to symptoms similar to ADHD. In either case, the result is the same: disrupted sleep.

Sleep issues and ADHD often present similar symptoms, which makes diagnosis by a medical professional that much more important. Fortunately, treating sleep issues typically helps with symptoms related to ADHD, and many experts emphasize that treating the two simultaneously is beneficial.

Sleep problems are common among adults with ADHD. And when adults don’t get the necessary amount of sleep each night, they have difficulties with tasks that require close attention, potentially exacerbating ADHD symptoms.

Sleep disorders that are common in those with ADHD can impact a person’s ability to fall asleep, stay asleep, or get quality sleep.

• Insomnia: People can have insomnia that manifests in several different ways, including trouble falling asleep or difficulty remaining asleep. Insomnia is more common in adults with ADHD than those who do not have ADHD.
• Restless Legs Syndrome (RLS) and Periodic Limb Movement Disorder (PLMD): RLS and PLMD are similar but distinct disorders that can interrupt sleep. RLS causes discomfort in individuals’ legs or arms while sitting or laying down, along with a strong urge to move their legs or arms. PLMD occurs when people twitch or move their limbs during the night. There’s a strong correlation between ADHD and RLS and ADHD and PLMD.
• Narcolepsy: Individuals with narcolepsy experience extreme daytime sleepiness, leading to an urge to sleep at inconvenient times, including while driving or socializing. Narcolepsy commonly appears in adults with ADHD.
• Circadian Rhythm Sleep Disorders: These disorders occur when a person’s natural, daily sleep-wake cycles become disrupted. Individuals with a history of ADHD also commonly experience types of circadian rhythm disorders.

A lack of sleep can have negative effects on a person’s daily life, affecting their mood, judgment, and productivity at work or in school. Treating the above disorders can help adults with ADHD achieve a better quality of life.

It’s also common for children with ADHD to experience sleep issues. However, diagnosis can be even more complicated for kids because symptoms of ADHD and sleep disorders are often similar. Symptoms of ADHD are exaggerated when kids are tired, and some kids with sleep issues may even show behaviors that mimic ADHD even if they don’t have it. This is why it’s so important for a doctor to thoroughly diagnose ADHD. Many doctors will use a combination of medical, developmental, and educational assessments to truly understand if ADHD or something else is at play.

The sleep disorders associated with ADHD in children and adolescents can keep them from getting their recommended amount of sleep each night.

• Obstructive Sleep Apnea (OSA): Individuals with OSA experience difficulties with breathing during sleep due to blockages in their airway. ADHD commonly presents alongside this condition.
• Bed-Wetting: Wetting the bed is common among children with ADHD, though it’s not clear exactly why.
• Insomnia: Insomnia refers to difficulty with falling and/or remaining asleep, leading to a lack of restful sleep. Children with ADHD are especially prone to experiencing insomnia.
• Restless Legs Syndrome (RLS) and periodic limb movement disorder (PLMD): Kids who have been diagnosed with ADHD experience RLS and PLMD more frequently than other children. For children with ADHD and RLS, the ADHD symptoms tend to be more severe than in kids with just ADHD.
• Bruxism: Sleep-related bruxism is teeth grinding or clenching the jaw while sleeping. Teeth grinding occurs more frequently in kids who have ADHD.

Treatment and diagnosis of ADHD require close assessment by a medical professional. Pathways vary for children, adolescents, and adults, so treatments and interventions may also differ. Along with getting better sleep by making lifestyle changes, treating sleep disorders can directly improve ADHD symptoms.

How are Sleep Problems Treated in Adults With ADHD?

Treatment for adults with ADHD may include therapy, medication, education, or a combination of several methods.

• Medication: Several types of medication are available to help treat ADHD symptoms, including stimulants and non-stimulants. Stimulants are the most frequently prescribed ADHD medication, but a doctor will perform a complete assessment to identify the ideal medication for each patient based on their medical history, preferences, and possible side effects. It’s worth noting that some ADHD medication can impact sleep, so it might take some trial and error to find the right medication.
• Cognitive-Behavioral Therapy (CBT): CBT is a type of psychotherapy that links thoughts, feelings, and behaviors to overall well-being. Adults with ADHD can use CBT to make changes to their thoughts and actions to improve their daily lives. Many adults use medication and CBT simultaneously.

How are Sleep Problems Treated in Children and Adolescents With ADHD?

The American Academy of Pediatrics (AAP) suggests beginning treatment for children younger than 6 years old who have ADHD by managing behaviors, followed by medication as needed. Among children 6 and older, AAP recommends a combination of medication and therapy.

• Behavior Therapy: Behavior therapy focuses on positive reinforcement and consistency, and suggested therapies vary based on the age of the child. For younger children, experts suggest parents become trained in behavior therapy so they have the tools necessary to help their kids. Younger kids tend to have better success with this model than other types of therapy because it can be too difficult for kids to change behavior without a parent’s guidance. Once kids are around 8 to 10, they may be ready to visit a therapist on their own. Children can receive help and interventions in the classroom, as well.
• Medication: There are a variety of medications that can help children with ADHD manage symptoms. Doctors can help families try different medications and doses to find the best way to manage symptoms and potential side effects. Some medications can affect sleep, so it’s important to discuss any sleep issues with the doctor to identify the ideal treatment.

Improving sleep hygiene has been shown to improve sleep health, especially in individuals with ADHD. Sleep hygiene is a set of health considerations that can help people get to sleep and remain asleep each night. Sleepers can make several lifestyle changes with their sleep hygiene in mind.

• Maintain a Consistent Schedule: Sticking to the same schedule, including a consistent bedtime routine, can help you optimize your sleep health. Aim to wake up and go to sleep at the same time, even on weekends.
• Limit Blue Light Exposure at Night: Exposure to screens too close to bedtime can make it more difficult to fall asleep and may negatively affect your ability to remain asleep. Devices like computers, tablets, and phones emit blue light, which can have a significant impact on getting restful sleep.
• Establish a Comfortable Bedroom Environment: A cozy, quiet room with relaxing elements and a cool temperature can improve your sleep hygiene.
• Increase Exercise: Working out during the day can improve your ability to fall asleep at night.
• Avoid Certain Substances Before Bedtime: Caffeine and alcohol can affect our ability to fall and remain asleep. Avoid these substances near bedtime for better sleep.

About The Author

Dr. Michael Breus

Clinical Psychologist, Sleep Medicine Expert

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Michael Breus, Ph.D is a Diplomate of the American Board of Sleep Medicine and a Fellow of The American Academy of Sleep Medicine and one of only 168 psychologists to pass the Sleep Medical Specialty Board without going to medical school. He holds a BA in Psychology from Skidmore College, and PhD in Clinical Psychology from The University of Georgia. Dr. Breus has been in private practice as a sleep doctor for nearly 25 years. Dr. Breus is a sought after lecturer and his knowledge is shared daily in major national media worldwide including Today, Dr. Oz, Oprah, and for fourteen years as the sleep expert on WebMD. Dr. Breus is also the bestselling author of The Power of When, The Sleep Doctor’s Diet Plan, Good Night!, and Energize!

• POSITION: Combination Sleeper
• TEMPERATURE: Hot Sleeper
• CHRONOTYPE: Wolf

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