ADHD and Sleep Problems: How Are They Related

Attention-deficit/hyperactivity disorder (ADHD) is one of the most commonly diagnosed disorders in childhood and adulthood; it encompasses inattention, hyperactivity, and impulsivity symptoms. These symptoms can significantly impact many aspects of life, like interfering with school, work, and social functioning.

It has been noted that ADHD and sleep disturbances are intricately intertwined. Sleep issues are prevalent in individuals with ADHD, and people with ADHD are more likely to experience sleep problems. This creates a chicken-and-egg question among researchers, what’s the connection between ADHD and sleep? 

Keep reading to learn more about ADHD and sleep and tips for improving sleep.

What’s the Connection Between ADHD and Sleep

Attention-deficit–hyperactivity disorder (ADHD) is characterised by symptoms of inattention, hyperactivity, and impulsivity, which can significantly impact many aspects of life, including sleep. It is a childhood neurodevelopmental disorder, one of the most common disorders estimated to affect approximately 5.3% of children and adolescents worldwide. 

Sleep problems in early childhood are a risk factor for the future occurrence of ADHD symptoms, and people with ADHD are more likely to experience shorter sleep time, trouble falling asleep as well as staying asleep, which is a risk factor for developing a sleep disorder. This shows that the relationship between ADHD and sleep is highly complex and multidirectional. 

Evidence suggests ADHD leads directly to problems with sleep. For example, people who are rarely hyperactive during the day may experience racing thoughts and a burst of energy at night that interferes with sleep. 

Many people with ADHD may experience sleep disorders such as sleep-disordered breathing, restless leg syndrome, circadian rhythm sleep disorder, insomnia, and narcolepsy. Contrastingly, evidence also suggests disturbed sleep is responsible for daytime symptoms, behaviours and functional impairments characteristic of ADHD. 

In another scenario, sleep disturbances and ADHD interact as bilateral comorbidities. Which means they share a common underlying cause. Therefore, it is important to understand the associations and relationships when assessing and managing patients with ADHD to identify and treat them appropriately. And to avoid misdiagnosis, experts recommend screening patients for sleep problems before prescribing medication for ADHD.

Sleep Disorders Tied to ADHD

Experts often check on the specific sleep disorders associated with ADHD or ADHD-like symptoms when diagnosing ADHD. Sleep disorders tied to ADHD includes:

Insomnia

Several cross, clinical and population studies reported the prevalence of insomnia in adults with ADHD ranging from 43% to 80%. The symptoms of insomnia were strongly and consistently associated with the increasing severity of ADHD symptoms. The relationship between insomnia and ADHD may be further explained by the presence of a comorbid delayed circadian rhythm disorder, such as delayed sleep phase syndrome.

Circadian-Rhythm Sleep Disorders

Circadian rhythm disorder is when the body may not be in tune with the cycle and might not release melatonin at the right time, and cause comorbid conditions such as delayed sleep phase syndrome. The delayed sleep phase syndrome is characterised by a preference for sleep onset after midnight, with difficulty waking, daytime sleepiness, and impaired functioning. 

The links between the delayed circadian phase and hyperactivity are also observed, which suggests that the circadian delay-ADHD relationship may occur across a continuum of psychiatric health. 

Sleep Apnea

The primary symptom of sleep apnea is snoring. People with sleep apnea stop and start breathing throughout the night, which can disrupt resting hours. It is prevalent in 9.3% of adults and 7.5% of children; according to meta-analysis, the symptoms of ADHD and sleep apnea may be causally associated.

In this analysis, studies assessed ADHD sleep issues among children with OSA and OSA among children with ADHD. It was then concluded that children with ADHD should be screened for OSA and treated appropriately before starting medications for ADHD.

Restless Legs Syndrome (RLS)

Symptoms of restless legs syndrome include limb discomfort and a strong urge to move your legs while you sleep. It affects as many as 4–29% of the general population in developed countries and is characterised as pulling, throbbing, aching, or itching inside your leg. Researchers have emphasised the importance of identifying RLS during the clinical evaluation of children with ADHD symptoms. RLS’s impact on sleep could lead not only to daytime ADHD-like symptoms but also to bedtime resistance.

Sleep-Disordered Breathing

Sleep-disordered breathing (SDB) describes a spectrum of conditions ranging from obstructive sleep apnea to primary snoring. It can lead to disturbed sleep, and daytime sleepiness and often cause symptoms of ADHD. Studies have demonstrated that removing the tonsils significantly improved ADHD symptoms in children, while CPAP devices are a better choice for adults.

Narcolepsy

Excessive daytime sleepiness is also a core symptom of narcolepsy. In narcolepsy, people tend to fall asleep suddenly during the day and may have difficulty sleeping at night. Researchers have investigated a possible genetic association between ADHD and narcolepsy traits. The finding suggests that people with ADHD and excessive daytime sleepiness could be considered to have a unique form of type 2 narcolepsy.

How Do ADHD Sleep Problems Affect Daily Life

ADHD sleep problems are quite common in individuals with ADHD. However, sleep disorders are often overlooked and left untreated in ADHD populations.

Furthermore, sleep disturbances in such individuals have been associated with comorbid sleep issues and/or alterations associated with the medications used to treat ADHD. And sleep disturbances that result in sleep restriction or fragmentation can lead to excessive daytime fatigue. It can also interfere with mood, attention, behaviour, and physical health, critical for school/work performance and good quality of life.

Sleep Tips for Children and Adults With ADHD and Sleep Problems

As mentioned before in the article, ADHD and sleep deprivation leads to impaired mood, attention, behaviour, and physical health. And experts are cautiously optimistic that sleep interventions might be the key to improving not only sleep but also ADHD symptoms and ADHD sleep issues associated with the medications used to treat ADHD. 

For ADHD child sleep problems, as well as adolescents and adults with ADHD, a consistent bedtime routine and healthy sleep hygiene practices can help reinforce the connection between bed and sleep. 

Following healthy habits and routines can improve your rest.

• Cut out sugar, caffeine, and alcohol near bedtime (4 hours before bedtime).
• Follow consistent sleep and wake time.
• Avoid napping (at least 4 hours before bedtime) and/or as an occasional pattern.
• Keep the bedroom dark, cool, quiet, and comfortable. If necessary, you can use a white noise machine to block out intrusive noises.
• Avoid stimulating or highly demanding activities in the evening or/and in the bedroom.
• Avoid screen time for an hour before bed; the blue light emitted from the screen restrains the melatonin production.
• Develop a bedtime routine that you enjoy, such as reading a favourite book, taking a warm bath, or a simple brushing and changing into a pyjamas routine; it decreases sleep problems and daytime behaviour problems. 
• Start using a weighted blanket. It has a positive impact on falling asleep.
• If you have ADHD and trouble sleeping, consult your healthcare provider, as they would prescribe a suitable solution.

Final Words

The relationship between ADHD and sleep is highly complex and multidirectional, which can significantly impact many aspects of life. A consistent bedtime routine and healthy sleep hygiene practices can help reinforce the connection between bed and sleep in individuals with ADHD. Furthermore, evidence suggests that effective management of sleep problems associated with ADHD and its treatment may alleviate sleep-related symptoms and improve quality.

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