ADHD and Sleep

Patients living with ADHD frequently report difficulty sleeping. Their thoughts tend to wander while their bodies toss and turn.

Psychostimulant medications may paradoxically help some ADHD sufferers sleep by relieving symptoms, yet often do not last long enough to prevent symptom rebound at bedtime. Objective measures (polysomnography and actigraphy) and subjective measurements (parental ratings and diaries) show divergent results.

What is sleep?

Sleep can be an unconscious state that allows the body to relax; but for others it can be an uphill struggle. I have observed over 80 percent of adults I see reporting multiple awakenings throughout the night; sleep is fitful; muscles tense up with every noise outside their bedroom door and struggle to fall back asleep again – in short they go through what I call “the Sleep of the Dead,” ultimately leaving them exhausted, having spent their nights without adequate restorative rest.

People without ADHD typically find it easier to sleep at night. Their minds and bodies can relax as they drift off to peaceful, restorative sleep without interference from ADHD symptoms. But many find themselves struggling with keeping this pattern intact as the day wears on due to increasing responsibilities; many resort to taking sleep medications which paradoxically end up keeping them awake more than helping.

Studies demonstrate the significance of sleep to numerous bodily processes, from tissue growth and repair to helping strengthen immunity and reduce inflammation. Sleep also plays a critical role in helping the brain function optimally by consolidating short-term memories into long-term ones and clearing away useless information from its nervous system. Finally, sleep allows the glymphatic system to cleanse waste from both brain tissue and other parts of the body through its elimination system.

The relationship between ADHD and sleep can be complex; research of ADHD typically uses subjective parent ratings to measure it, which can be affected by numerous factors. Furthermore, stimulant-class medications used to treat ADHD may disrupt sleep; sometimes acting as sedatives that cause daytime drowsiness while having insufficient duration at bedtime can result in rebound symptoms leading to difficulty falling asleep (Owens et al. 2004).

Studies of naturalistic sleep patterns can also be affected by uncontrollable variables, including parents’ work schedules, home life issues and child behaviors during adolescence. This may cause discrepancies between objective and subjective measures of sleep and it has even been suggested that such variables play a part in causing ADHD-related sleep problems in children and adolescents (Beebe 2011).

Why is sleep important?

Sleep is essential to human development and health, especially those living with ADHD, as it enhances their ability to regulate emotions, think critically and plan ahead. The best way to ensure a good night’s restful slumber is establishing and following a consistent bedtime ritual every night that can include pre-bedtime rituals.

Research indicates that sleep problems are prevalent among both children and adults with ADHD, regardless of medication use. Although rates differ depending on the study and method of measurement used, estimates indicate as many as 70% of youth experiencing ADHD experience some form of disturbance to their sleeping pattern (Hvolby et al. 2008). As well as shorter sleep duration and insomnia, other issues like sleep-disordered breathing, nightmares, restless or fitful sleeping, delayed onset and daytime fatigue are commonly experienced (both medicated and unmedicated individuals).

Depletion of executive attention stores makes it harder for the brain to resist impulses and distractions – an issue common among those living with ADHD. But when coupled with chronic sleep deprivation, fighting impulse control issues is nearly impossible for anyone.

Sleep issues are an integral component of ADHD, contributing directly to its core impairments and necessitating an intensive clinical evaluation that includes an assessment of sleep history for anyone suspected of ADHD. Therefore, comprehensive clinical assessments – including one including sleep history analysis – should always be considered when diagnosing someone as ADHD.

Developmental psychopathology frameworks can be particularly helpful in understanding sleep disorders related to ADHD. For instance, seven-week-old boys at familial risk for ADHD were found to have less stable daytime sleeping patterns compared to comparison infants – this may suggest that dysfunctional circadian rhythm caused by poor parenting practices has an influence on its emergence resulting in ADHD development in some instances.

Scientific literature regarding ADHD and sleep primarily focuses on stimulant-class medications rather than exploring any link between ADHD and sleep problems. My own practice has revealed that about 80 % of my adult patients with ADHD fall victim to “the sleep of the dead,” an insomniac condition which disrupts their ability to stay awake so severely it’s difficult for them to be awakened from.

How do I get a good night’s sleep?

Many individuals with ADHD experience difficulty sleeping. When this happens, they become fatigued and irritable; the good news is that most can achieve better restful nights by making some simple adjustments in their habits – such as maintaining a regular bedtime routine, forgoing caffeine during evening hours, or using the bed exclusively for sleeping and relaxation purposes.

Sleep is essential to everyone, but people living with ADHD may find it particularly challenging. Restlessness associated with hyperactivity may prevent them from sleeping properly, while stimulant medications used to treat their disorder may disrupt restful restful slumber and their poor organizational skills can create chaos in the home environment.

Scientific literature regarding ADHD and sleep doesn’t often take into account that symptoms of this disorder may manifest themselves at night, yet my patients with ADHD frequently tell me they struggle to switch off their arousal state in order to fall asleep, with fitful and often unrefreshing sleep often interrupted by house noise or bed partners, leaving them feeling just as exhausted when they awaken in the morning.

Before initiating medication for ADHD, my practice suggests keeping a detailed journal of one’s sleep issues for several weeks prior to taking any action. Furthermore, patients are reminded to use their bed only for sleep or relaxation purposes; not confrontation or argumentative situations with family. In some instances, polysomnography tests in a laboratory with equipment monitoring vital signs and movements during sleep are sometimes recommended for optimal treatment results.

Studies suggest that people with ADHD tend to experience higher brainwave activity during the middle of the night. This observation fits with my adult patients reporting feeling most energetic, productive and stable late in the day when working or performing family duties.

What can I do if I’m having trouble sleeping?

People living with ADHD often struggle with sleep. This can be an acutely serious issue as sleep deprivation has been linked to obesity, diabetes and heart disease – not to mention difficulty falling or staying asleep leading to lack of energy and poor performance in work or school environments. Therefore it’s crucial that they work closely with a healthcare provider on these matters in order to find solutions.

Sleep issues associated with ADHD may either stem directly from the condition itself or be side effects of medications used to treat it; stimulant medications, for instance, have been known to interfere with some patients’ sleeping while at the same time improving it for others via sedation (Bradley 1937). To ensure an appropriate diagnosis and treatment, it’s crucial that any problems with sleeping be discussed openly with your healthcare provider.

There are various things you can do to enhance the quality of your sleep. First and foremost, try getting to bed early while limiting caffeine, alcohol and heavy meals before bed. Furthermore, switch off all electronics at least two hours prior to sleeping time and do something relaxing; additionally practice meditation or journaling to calm your mind before sleep begins.

If you are having difficulties sleeping, your doctor may suggest seeing a sleep specialist. Some professionals will even administer home sleep studies (polysomnogram) to evaluate symptoms and ascertain if they might be caused by another condition like sleep apnea, obstructive sleep apnea or snoring.

Some individuals with ADHD suffer from delayed sleep-phase syndrome, which interferes with their normal sleeping patterns and disrupts restful restful slumber. This disorder may result in issues related to waking, snoring and daytime functioning.

There are various treatments for anxiety disorders, which incorporate behavioral interventions and pharmacological therapies. Practitioners suggest clonidine at low dosage (0.05 to 0.1 mg before bed) to provide four hours of sedative effects, or antidepressant drugs such as Trazodone (Desyrel) or Mirtazapine (Remeron) taken in lower dosages as alternatives.