Sleepless Nights with ADHD


For many people living with Attention Deficit Hyperactivity Disorder (ADHD), life can seem like a never-ending whirlwind. Difficulty with focus, impulsivity, and restlessness are just a few of many symptoms that can crowd much of the day, and for some people, symptoms don’t just end when the day ends. Sleep is by and large considered a time of rest and ease, offering many a final winding down and release from the day. However, for some people with ADHD, as symptoms carry into the night, restful sleep is not as easily attainable.

Of the millions of people with ADHD, an estimated 25-50% are reported to have accompanying sleep problems (Wajszilber et al, 2018). Common sleep orders associated with ADHD include Restless Leg Syndrome, Circadian Rhythm Disorder, and Sleep Apnea. In Restless Leg Syndrome (RLS), which 44% of people with ADHD have, one may experience a strong urge to move their legs as well as discomfort in their legs, ultimately disrupting their ability to fall asleep (Bhandari, 2020). This aligns with the more hyperactive leaning ADHD symptoms. By comparison, Circadian Rhythm Disorders affect the timing of sleep (when someone sleeps or wakes up) while Sleep Apnea affects breathing (interrupted breathing during sleep). In addition to sleep disorders, ADHD may cause non-disorder sleep disruptions. This may be general restlessness, where a person may be trying (or able) to fall asleep, but they cannot stay asleep, so they may toss and turn or awaken from noises frequently (Dodson, 2021). Those with ADHD may also experience other difficulties falling asleep and/or waking from sleep. Approximately three-fourths of adults with ADHD have reposted the feeling of being unable to “shut off my mind so I can fall asleep at night” (Dodson, 2021). In one report over 80% of adults with ADHD have “multiple awakenings before 4 AM” (Dodson, 2021), and when they do fall asleep they have extreme difficulties waking up. 

Sleep problems and disruptions are not just confined to adults. In a staggering statistic,  nearly half of children before the age of puberty with ADHD have difficulty with sleep in comparison to children who do not have ADHD, where only 10-15% have difficulty sleeping (Dodson, 2021). Issues also arise in children in a way that may present themselves differently from adults. For children, in addition to the commonly diagnosed RLS, sleep apnea, and Circadian Rhythm Disorders, may also experience frequent nightmares and bedwetting. In the case of bedwetting, poor impulse control that results in misrecognition of a full bladder and deeper sleep have been found to be associated (Aeroflow Urology, n.d.). 

Though the exact cause of the high prevalence amongst ADHD populations is unknown, associations between several factors and sleep issues in ADHD have been found. Preliminary research suggests that both biological and behavioral factors may contribute to these issues. A possible biological explanation for the high rate of sleep problems in those with ADHD involves neurotransmitters. Both ADHD and sleep disorders have disruptions in the level of the neurotransmitters dopamine and norepinephrine (Harvard Health Publishing, 2010). This pattern of overlap in causal factors is seen further particularly in Circadian Rhythm Disorders, where abnormal circadian rhythms have been seen in both ADHD and Circadian Rhythm Disorders (Harvard Health Publishing, 2010). Behavioral habits involved in sleep disruptions amongst those with ADHD may be stimulative activity at night. Individuals may feel distracted and find it difficult to stop projects (Bhandari, 2020). Children can also exhibit this behavior, often doing activities such as completing assignments, watching TV, etc. later in the night, resulting in delayed sleep. Other contributing factors may be the use of stimulant substances like caffeine-commonly found in foods and drinks such as coffee, tea, and chocolate- or typical stimulant ADHD medication (Bhandari, 2020). 

Research is still needed to further reveal how ADHD is affected by sleep and how disruptions in sleep can be treated at the root. Despite the unknown precise cause of the connection between issues with sleep disorders and people with ADHD, help, and treatment are available for those who may be experiencing problems. Common remedies that are recommended to help reduce sleep disruptions include avoiding caffeine at night, avoiding daytime napping, avoiding electronic media in the evening, and establishing a nightly routine (Bhandari, 2020). Overall, it must be said that in order to improve sleep, it is important for people with ADHD who may have sleeping problems to recognize what may be happening and know that there are solutions to help end those sleepless nights. 

 

References

Attention Deficit Hyperactivity Disorder and Sleep. Harvard Health Publishing. (2010).

Bhandari, S. (2020). “9 ways adhd can cause Insomnia & sleep problems (and how to fix it)”.Web MD.

Dodson, W. (2021). “ADHD and sleep problems: This is why you’re always so tired”. ADDitude.

Helping Your Child With ADHD and Bedwetting. Aeroflow Urology (n.d.).

Wajszilber, D., Santiseban, J. A., & Gruber, R. (2018). Sleep disorders in patients with ADHD: impact and management challenges. Nature and science of sleep, 10, 453–480. 

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