Ashwin Lewis
Sleep problems are very common in people with ADHD. Research suggests that nearly 80% of adults with ADHD also have a co-occurring sleep disorder, such as insomnia. People with ADHD are also eight times more likely to be diagnosed with a sleep disorder and 14 times more likely to be prescribed sleep medication than those without ADHD. Sleep disturbances caused by ADHD have been overlooked for a number of reasons, including the late age of onset. However, recent studies have confirmed that ADHD symptoms do not go away at night. Sleep disturbances associated with ADHD generally appear later in life, at around age 12, on average.
| Characteristics | Values |
|---|---|
| Difficulty falling asleep | 75% of adults with ADHD report an inability to "shut off my mind" at night |
| Restless sleep | Individuals with ADHD often wake up at any noise and toss and turn throughout the night |
| Difficulty waking up | More than 80% of adults with ADHD report multiple awakenings until about 4 a.m. |
| Sleep disorders | 80% of adults with ADHD have a co-occurring sleep disorder such as insomnia |
| Circadian rhythm issues | ADHD appears to hamper the body's internal clock, which regulates the sleep-wake cycle |
| Stimulant medications | Stimulants used to treat ADHD can make it harder to fall asleep |
| Other conditions | People with ADHD often have anxiety, depression, mood disorders, or substance abuse issues that can disrupt sleep |
| Caffeine and nicotine | Stimulants like caffeine and nicotine are known sleep disruptors |
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What You'll Learn
Women with ADHD are more likely to have co-occurring sleep disorders
Sleep problems are very common in people with ADHD. Research suggests that nearly 80% of adults with ADHD also have a co-occurring sleep disorder, such as insomnia (difficulty falling and staying asleep). People with ADHD are also eight times more likely to be diagnosed with a sleep disorder and 14 times more likely to be prescribed sleep medication than those without ADHD.
ADHD appears to hamper the circadian rhythm, or the body's internal clock, which regulates the sleep-wake cycle. If ADHD symptoms are throwing off your circadian rhythm, you'll likely have trouble falling asleep at night, or wake up several times throughout the night.
Sleep problems in ADHD differ depending on the type of ADHD. Individuals with predominantly inattentive symptoms are more likely to have a later bedtime, while those with predominantly hyperactive-impulsive symptoms are more likely to suffer from insomnia. Those with combined hyperactive-impulsive and inattentive ADHD experience both poor sleep quality and a later bedtime.
Many ADHD symptoms are similar to those of sleep deprivation. Adult ADHD sleep problems can lead to forgetfulness and difficulty concentrating during the day. In children, fatigue may present through hyperactive and impulsive behaviours. It can be difficult to tell whether these issues are caused by ADHD or a lack of sleep, which may lead to misdiagnoses or allow sleep disorders to go undetected.
There are several sleep disorders that are commonly found in people with ADHD:
- Circadian Rhythm Sleep Disorders: Most individuals with ADHD, particularly adolescents, are more alert in the evening. A smaller pineal gland, irregularities in the body's internal clock, and delayed melatonin release may contribute to circadian rhythm sleep disorders in people with ADHD. Delayed sleep-wake phase disorder (DSPS) is a type of circadian rhythm sleep disorder commonly reported in people with ADHD. DSPS is marked by a delay in the sleep-wake cycle of two or more hours, which can impede time-sensitive activities such as work or school.
- Sleep-Disordered Breathing: Sleep-disordered breathing (SDB), including snoring and sleep apnea, affects up to one-third of patients with ADHD. SDB leads to disturbed sleep and daytime sleepiness and often causes symptoms typical of ADHD.
- Restless Legs Syndrome: People with restless legs syndrome (RLS) experience tingling sensations in the legs that make it hard to fall asleep. RLS or other types of periodic limb movement disorders may occur in almost 50% of people with ADHD.
In summary, women with ADHD are more likely to have co-occurring sleep disorders, such as insomnia, circadian rhythm sleep disorders, sleep-disordered breathing, and restless legs syndrome. These sleep disorders can further exacerbate ADHD symptoms, leading to a cycle of sleep issues and worsened ADHD symptoms.
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Sleep deprivation amplifies ADHD symptoms
Sleep-deprived brains also have a diminished working memory, which is like a table on which you put all the things you need to think about. When something is on the table, you can use it or find a place to store it. But when you're tired, the table gets smaller, and things start falling off. The ADHD brain loves to collect things on this table, but lack of sleep means there's no room, and things start to get forgotten.
Additionally, a lack of sleep cuts the connection between the emotional part of our brain (the amygdala) and the part that makes sense of emotions (the prefrontal cortex). As a result, we feel our emotions more intensely and are unable to reason through them. This can lead to increased feelings of anger and frustration.
Finally, when we're tired, our brains tend to crave high-fat, high-salt, and high-sugar foods. Our sleep-deprived brains overuse and overvalue the "drive" parts and underuse the "higher thinking" parts. This is a pattern already seen in ADHD, and it can be challenging to resist these cravings when your willpower is low.
Overall, it is essential for individuals with ADHD to prioritize sleep to manage their symptoms effectively and improve their overall quality of life.
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Lack of sleep can cause stimulation overload
Sleep deprivation can cause stimulation overload for people with ADHD. This is because a lack of sleep diminishes a person's executive attention stores, which are responsible for filtering out distracting or extraneous material from their awareness. ADHD brains already find this task challenging, and sleep deprivation depletes their resources even further. This can lead to a feeling of stimulation overload, as the brain struggles to filter out the constant stream of information it receives.
Additionally, lack of sleep reduces the size of a person's working memory stores, which can be likened to a table on which we place the things we need to think about. When the table is full, things start to fall off. The ADHD brain tends to collect many things on this table, and sleep deprivation makes the table even smaller. As a result, important information may be lost or forgotten.
Sleep deprivation also impairs problem-solving abilities, as it makes it more difficult for the brain to access its higher thinking powers. This can further contribute to feelings of stimulation overload, as the person becomes overwhelmed by their inability to process and respond to incoming information effectively.
Furthermore, sleep deprivation weakens the connection between the emotional part of the brain (the amygdala) and the part responsible for making sense of emotions (the prefrontal cortex). This can lead to heightened emotional responses and a decreased ability to regulate emotions, adding to the sense of stimulation overload.
Finally, sleep-deprived people with ADHD may find themselves craving high-fat, high-salt, and high-sugar foods. This is because their brains overvalue the "drive" parts and underuse the "higher thinking" parts, leading to an increased reward response to these types of foods. This can further contribute to feelings of stimulation overload, as the person may experience a sugar rush or other intense sensory experiences on top of their already heightened sensory state.
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Sleep disturbances caused by ADHD are often overlooked
Sleep problems in people with ADHD are very common, with nearly 80% of adults with ADHD also suffering from a co-occurring sleep disorder, such as insomnia. However, these sleep disturbances have often been overlooked for a number of reasons. Firstly, sleep problems did not fit neatly into the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) requirement that all ADHD symptoms must be present by age seven. Sleep disturbances associated with ADHD generally appear later in life, at around age 12, on average. Consequently, this arbitrary age cutoff has prevented the recognition of night owls and sleep disturbances in ADHD. In addition, sleep disturbances were briefly considered a criterion for ADHD but were dropped from the symptoms list as evidence of them was thought to be too nonspecific.
The link between ADHD and sleep disturbances is now becoming clearer, with recent studies confirming that ADHD symptoms do not go away at night. ADHD can increase the time it takes to fall asleep, the chance of sleep disruptions, and the risk of sleep deprivation. Sleep disturbances in people with ADHD can manifest in several ways. Firstly, individuals with ADHD often have trouble falling asleep and report an inability to "shut off my mind" at night. They may also experience restless sleep, tossing and turning throughout the night and awakening easily at any noise. Finally, people with ADHD may struggle with difficulty waking up, needing multiple alarms to get out of bed and feeling irritable and combative when roused.
The causes of sleep disturbances in people with ADHD are multifaceted. One factor is the stimulant medications often used to treat ADHD, which can make it harder to fall asleep. In addition, people with ADHD are more likely to have co-occurring conditions such as anxiety, depression, mood disorders, or substance abuse problems that can contribute to sleep difficulties. Additionally, ADHD appears to hamper the circadian rhythm, or the body's internal clock, which regulates the sleep-wake cycle. This can result in a delayed sleep-wake phase disorder, marked by a delay in the sleep-wake cycle of two hours or more, leading to excessive tiredness and lack of alertness.
The impact of sleep disturbances in people with ADHD can be significant. Persistent sleep problems can worsen overall health, leading to mood and behavioural changes, increased susceptibility to illness, and exacerbation of ADHD symptoms. It can also affect daily functioning, causing daytime fatigue, irritability, and difficulty concentrating. For children with ADHD, fatigue may present as hyperactive and impulsive behaviours. Sleep disturbances can also take a toll on the families and caregivers of people with ADHD, who are more likely to experience depression, anxiety, stress, and work-related issues.
While the link between ADHD and sleep disturbances is complex and not yet fully understood, it is clear that these sleep problems cannot be overlooked. Addressing sleep issues is crucial for improving the quality of life for people with ADHD and their loved ones.
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Sleep problems can lead to worsening health in the long run
The impact of sleep problems on health is significant. Persistent sleep issues can lead to mood and behavioural changes, increased susceptibility to illness, and exacerbation of ADHD symptoms, creating a cycle of worsening sleep and health. Sleep deprivation amplifies ADHD symptoms, impacting the same areas of the brain, resulting in even less fuel in the executive functioning stores, leading to a constant state of mental and physical fatigue.
Additionally, lack of sleep can affect problem-solving abilities, increase anxiety and frustration, and disrupt emotional regulation. It can also lead to unhealthy food choices, with a preference for high-fat, high-salt, and high-sugar foods, further contributing to health issues.
Furthermore, daytime sleepiness caused by ADHD-related sleep disturbances can have serious consequences on daily life, including school, work, and social situations. It can lead to judgement from others, difficulty concentrating, and even dangerous situations when performing activities that require concentration and alertness, such as driving.
In conclusion, addressing sleep problems is crucial for individuals with ADHD to maintain their overall health and well-being. By managing sleep disturbances, individuals can break the cycle of worsening health and improve their quality of life.
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Frequently asked questions
While there is no evidence to suggest that women with ADHD need more sleep than men with the condition, women with ADHD do experience unique challenges when it comes to sleep. Women with ADHD are more likely to experience mental and physical restlessness, which can make it difficult to fall and stay asleep.
ADHD can impair the regulation of brain activity and often affects sleep patterns. People with ADHD may take longer to fall asleep, experience more sleep disruptions, and are at a higher risk of sleep deprivation. They are also more likely to develop sleep disorders such as insomnia, circadian rhythm sleep disorders, sleep apnea, and restless leg syndrome.
ADHD-related sleep deprivation can lead to symptoms such as forgetfulness, difficulty concentrating, irritability, and fatigue. These symptoms can be mistaken for a mood disorder or may worsen existing ADHD symptoms, creating a cycle of sleep issues.
Here are some strategies that may help improve sleep for people with ADHD:
- Establish a consistent sleep schedule and bedtime routine.
- Create a relaxing sleep environment by minimising noise, light, and electronic devices.
- Limit caffeine, nicotine, and alcohol intake, especially close to bedtime.
- Engage in regular physical activity during the day but avoid exercising too close to bedtime.
- Practise relaxation techniques such as mindfulness, meditation, or deep breathing before bed.
- Talk to your healthcare provider about adjusting your medication regimen or trying supplements like melatonin.
Yes, certain medications and supplements may help improve sleep for people with ADHD. Melatonin supplements, for example, can help regulate the sleep-wake cycle. Additionally, stimulant medications commonly prescribed for ADHD can have a calming effect for some individuals, making it easier to fall asleep. However, for others, these medications may have the opposite effect, making it more difficult to sleep. It is important to consult with a healthcare professional to determine the most appropriate treatment options for your specific needs.
