Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that affects approximately 129 million children and adults worldwide. This condition is primarily associated with difficulties in paying attention and showing hyperactivity and impulsivity in their behavior.
However, among other lesser-known issues such as executive dysfunction, people with ADHD struggle with falling and staying asleep. Their restless sleep begins the vicious cycle of worsening the symptoms, which makes it even harder to get quality sleep.
Let’s have a deeper look at how ADHD affects sleep patterns and can lead to sleep problems.
What Is ADHD?
ADHD is a psychiatric condition that has long been recognized by persistent patterns of inattention, hyperactivity, and impulsivity. These patterns affect and interfere with daily functioning.
The symptoms of this condition begin at an early age. The child usually shows clear signs of lack of attention, lack of concentration, disorganization, struggles in completing routine tasks, being forgetful, and losing things.
However, it’s also possible for a child who has the condition to not receive an ADHD diagnosis until later in life. Girls with ADHD in particular are
often underdiagnosed
due to how their
ADHD symptoms present.
The
recorded prevalence of ADHD
is higher in men, as 12.9% of men and boys live with ADHD, whereas 5.6% of women and girls are diagnosed with this condition.
The symptoms can continue into adolescence and adulthood, particularly if appropriate treatment is not taken. Many adults with ADHD are undiagnosed and struggle with work, relationships, and daily activities.
Lesser known symptoms of ADHD, aside from inattention or hyperactivity, include:
- Rejection Sensitive Dysphoria, which impacts among other things their ability to
take criticism - Executive dysfunction,
disrupting
their ability to control their own thoughts, emotions and actions - An impaired
sense of time,
making punctuality and completing tasks overall more difficult
While the
exact cause
of this condition is not fully understood, genetics is believed to be behind ADHD symptoms.
And while ADHD is often misconstrued as laziness or burnout, the challenges of people with ADHD are symptoms of a medical condition.
How Does ADHD Affect Sleep?
Sleep and ADHD are bidirectional. The condition is usually associated with certain sleep disorders or disrupted sleep. Many individuals with ADHD experience
- Difficulty falling asleep
- Difficulty staying asleep
- Frequent awakenings
- Daytime sleepiness
- Circadian rhythm abnormalities
- Sleep-disordered breathing
ADHD affects your sleep cycle, which exacerbates ADHD symptoms — beginning a vicious cycle. Poor sleep quality may cause daytime fatigue and make you feel grumpy, irritable, restless, or tired. Studies also suggest that ADHD impacts REM sleep, with individuals with ADHD having a
shorter REM sleep duration.
All these symptoms make it difficult to consistently pay attention at school or at work.
Moreover, the most commonly used
drugs to treat ADHD
are also known to have adverse effects on sleep. In some patients, it was found to impair sleep, while in others, it causes
calming effects.
In children with ADHD,
psychiatric comorbidities
are also commonly found. Usually, kids with ADHD are also diagnosed with bipolar disorder, autism, post-traumatic stress disorder and obsessive-compulsive disorder.
All these psychiatric illnesses are associated with sleep problems, as we’ve discussed in some of our other articles:
Even common sleep disorders in people with ADHD worsen the condition.
Sleep disruptions
also contribute to the development of anxiety, depression, and oppositional defiant disorder.
Common Sleep Problems with ADHD
Sleep issues and tiredness is a frequent concern in people with ADHD. The condition is also frequently
coincident with sleep disorders
such as obstructive sleep apnea, peripheral limb movement disorder, and restless legs syndrome.
Here are some of the most common sleep disorders and problems associated with ADHD. A sleep study may be needed to determine which sleep disorders an individual with ADHD is experiencing.
Insomnia
Insomnia is a frequent sleep disorder in people with ADHD. Around
66.8%
of people with ADHD are reported to have insomnia.
Many studies have reported that insomnia has a
high prevalence
of around 43 to 80% in ADHD patients.
Sleep deprivation due to
insomnia can affect
the way a person feels throughout the day. It affects attention, mood, and emotion regulation. In people with ADHD, the combined effects of both conditions can worsen the symptoms.
People with
ADHD and insomnia
are at a high risk of poor mental health, inefficient functioning, and reduced productivity.
Restless Legs Syndrome
Prevalence of Restless Legs Syndrome (RLS) symptoms in people with ADHD
is reported
to range from 11 to 42.9% in children and 20 to 33.0% in adults. This condition is characterized by an irresistible urge to move the legs, especially when lying down on the bed.
Having symptoms of Restless Legs Syndrome makes it hard to fall asleep and stay asleep, leading to poor-quality sleep — which leads to daytime sleepiness, tiredness, irritability, and other symptoms.
Sometimes, the symptoms of Restless Legs syndrome can mimic ADHD symptoms. Research suggests that ADHD and Restless Legs syndrome are
linked with iron deficiency.
Sleep Apnea
In patients with Attention Deficit Hyperactivity Disorder, a high incidence of Obstructive Sleep Apnea —
20 to 30%
— has been shown. The symptoms of both conditions overlap each other.
Sleep apnea is associated with repeated interruption in breathing during sleep, causing disrupted sleep. It results in poor sleep quality and onset of daytime sleepiness, tiredness, trouble focusing on tasks, and irritability.
Sleep-disordered breathing has also been linked to symptoms of attention deficit hyperactivity disorder (ADHD) like inattention, hyperactivity, and impulsivity. Difficulty breathing at night also leads to poor sleep quality. It is believed this disrupted sleep contributes to problems with focus, behavior, and self-control seen in ADHD.
Sleep studies
have found that
children with sleep-disordered breathing tend to score higher on tests for ADHD symptoms.
Around one-third of ADHD patients are also suffering from sleep apnea and snoring. A
recent study found
that tonsillectomy — the removal of tonsils — in children with ADHD and sleep apnea may help with the symptoms.
Other surgeries for sleep apnea, such as adenotonsillectomy, may improve nighttime breathing.
Narcolepsy
People with narcolepsy
tend to fall into REM sleep quickly, characterized by excessive daytime sleepiness (EDS), frequent uncontrolled sleep attacks, and sleep fragmentation.
Individuals with ADHD can be more prone to narcolepsy. Studies have found that narcolepsy is more common in patients with ADHD. Some patients find relief in symptoms from a change in ADHD medication.
While the link between these two conditions is not clear, research supposes that it must be due to the change in the sleep cycle. Low serum iron and ferritin levels could be a reason for
ADHD and narcolepsy.
How Does Poor Sleep Affect ADHD?
Just as ADHD can lead to sleep problems, chronic sleep disturbance can also worsen ADHD symptoms. Overall, sleep affects mental health and vice versa, so a loss of one impacts the other greatly.
Disturbing Attention and Focus
Sleep is necessary for our body to repair and rejuvenate. A lack of restorative sleep can significantly impact attention and focus.
Individuals with ADHD already struggle with focus and attention. A lack of sleep in ADHD can further intensify its symptoms. As a result, the inability to concentrate on tasks can become more pronounced — affecting academic performance in children and workplace productivity in adults.
Increased Impulsivity
Poor sleep is known to reduce a person’s ability to
control emotions
— aggression, irritability, and apathetic feelings — and increase impulsivity, a primary symptom of ADHD. People with ADHD can already struggle to handle emotions even after a good night’s sleep.
Sleep deprivation can lead to impulsive decisions and actions and can manifest in various ways, such as interrupting conversations and making rash decisions without concern about consequences.
Emotional Challenges
Sleep deprivation and the ability to control emotions are connected in a vicious cycle. Poor quality sleep makes it hard to balance and manage emotions.
Uncontrolled and improperly managed emotions can lead to mental health issues and result in sleep disturbances.
Emotional dysregulation is a common issue for those with ADHD. Lack of sound sleep can make individuals more irritable, anxious, or even depressed — making it difficult to cope with the emotional challenges associated with ADHD.
Adverse Effects on Cognition
Cognitive functions like decision-making, problem-solving, and critical thinking require an active mind that can interpret and think in different ways to figure something out.
Poor sleep quality affects cognitive abilities, even in normal individuals. People with ADHD may already struggle with executive function, and not having quality sleep can make it worse.
Tips for Better Sleep for People with ADHD
Making sure that you are getting better sleep with ADHD can be challenging.
Studies
have found that melatonin, behavioral therapy, and weighted blankets can be great solutions to help improve sleep in adults with ADHD.
However, for children, a provider-instructed sleep hygiene routine with ADHD improves sleep quality and may reduce ADHD symptoms.
Here are some tips to help you sleep better with ADHD.
- Make sure you have a consistent bedtime routine — go to bed and wake up at the same time every day — even on weekends. It helps regulate your internal clock.
- Avoid screen time, stimulating activities, and eating sugary foods before bedtime.
- Move enough and expose yourself to sunlight during the day
- Develop a winddown routine to help you fall asleep
- Keep your bedroom cool, dark, and quiet, and use white noise to ease delayed sleep phase syndrome symptoms.
People with ADHD often report difficulty in waking up in the morning. Light therapy is beneficial and effective for circadian rhythm sleep disorders and insomnia symptoms.
For individuals with sleep problems, which mostly overlap with symptoms of ADHD, treating the disorder first can help alleviate symptoms.
FAQs
Do people with ADHD need less sleep?
No, people with ADHD need enough quality of sleep to live through their day without worsening symptoms. Adequate sleep is crucial for managing ADHD symptoms. Though sleep disturbances are common in individuals with ADHD, the perception that they need less sleep is not scientifically proven. In fact, it is known to worsen the symptoms.
How much sleep does ADHD need?
The amount a person needs varies by age, but lack of sleep can exacerbate ADHD symptoms. Individuals with ADHD struggle to sleep for longer hours but need the same amount of sleep to function properly. Children with ADHD should aim for 9-11 hours, while adults with ADHD should aim for 7-9 hours.
Do people with ADHD sleep well?
Individuals with ADHD struggle with sleep disturbances and issues, such as difficulty falling asleep, restless leg syndrome, and sleep apnea. These challenges make it difficult to sleep properly and can worsen the symptoms. However, it is possible for a person with ADHD to get a good night’s sleep with the right treatment plan.
Why is it so hard to wake up with ADHD?
Difficulty waking up in ADHD may be linked to irregular circadian rhythms and sleep problems. Some stimulant medications to treat ADHD can also affect the sleep routine, causing difficulty in waking up.
Why do people with ADHD get so tired?
Sleep disturbance is a common symptom of ADHD, which results in poor sleep quality — a primary reason for feeling tired during the day. Individuals with ADHD require extra mental effort to get things done, which is also very draining and can contribute to feeling fatigued.
Conclusion
In summary, ADHD and sleep problems often go hand-in-hand. The symptoms of ADHD, such as difficulty focusing, hyperactivity, and impulsivity, can make it challenging to fall asleep and stay asleep through the night. In turn, lack of quality sleep exacerbates ADHD symptoms like inattention, emotional dysregulation, and impaired cognition.
Common sleep disorders associated with ADHD include insomnia, sleep apnea, restless leg syndrome, and narcolepsy. Getting an accurate diagnosis and treatment plan for any underlying sleep disorders is crucial. Improving sleep hygiene by sticking to a consistent bedtime routine, limiting screen time before bed, using white noise, and getting enough natural light exposure in the daytime can also help.
While managing ADHD and sleep issues can be difficult, it is possible to find an effective treatment plan. Paying close attention to sleep quality and addressing any sleep problems proactively alongside ADHD treatment is key to managing symptoms and improving overall health and well-being for both children and adults with ADHD.
