ADHD & Sleep Problems
Sleep Problems & ADHD: This Is Why You’re Struggling To Get A Restful Night
If you are an adult with ADHD, you likely have trouble falling asleep easily and sleeping well through the night. You might not be able to remember the last time you woke up feeling refreshed.
Often, ADHD and the way it causes restlessness - both physically and mentally - can have a large impact on sleep. The exhaustion that commonly follows is detrimental to a person's health and success with ADHD treatment using stimulants. The connection between ADHD and sleep has yet to be fully understood, and more is being discovered on the topic all the time.
Common complaints regarding sleep include:
Struggling to get to sleep
Struggling to stay asleep
Struggling to wake up
Many of the issues surrounding sleep with ADHD lack a medical consensus and can cause confusion for patients interested in managing the effects of stimulants. Sleep problems have clashed with ADHD diagnostic guidance from certain organizations, particularly those with a focus on early life symptoms and look to observe symptoms only before a certain age. Sleep issues common in those diagnosed with ADHD can appear as early as 12 years old for many patients, which means that the magnitude of sleep disturbances as an ADHD symptom have been largely under-researched. Recently, there have been new studies that link sleep and ADHD, recognizing the persistence of this problem into teens and adulthood.
Sleep challenges were originally considered a symptom of ADHD and a criteria to meet for diagnosis. However, difficulty sleeping was removed from the list of symptoms for diagnosis because the evidence was not specific enough. With more studies conducted recently, the presence and prevalence of sleep disturbances has become clearer.
Sleep is still mostly overlooked when discussing ADHD. Sleep disturbances have more commonly been linked to stimulant drugs used to treat ADHD or accompanying mental illnesses instead.
The Four Main ADHD Sleep Issues
There are no scientific studies that list ADHD as a direct or strong cause of sleep issues. Instead, most papers work on the idea that stimulant medications are the primary reason for sleep problems in those with ADHD. However, adults with the condition understand that their ADHD disorder - versus the drugs taken to treat it - are directly causing sleep problems.
Those suffering experience sleeplessness when attempting to go to bed and are often severely tired whey they want to be awake, a condition known as Perverse Sleep.
The four main ADHD sleep issues are:
1. Problems falling asleep
A huge percentage of adults with ADHD say they cannot stop their many thoughts to get to sleep at night. ‘Night owl’ is a title you will commonly hear an ADHD sufferer call themselves, stating that they feel the most energy when the night comes. Many others say that they often feel tired in the day, then their head hits the pillow and suddenly their brain is awake. They have racing and rapidly changing thoughts. Many adults report racing thoughts to their doctors, which leads the doctor to diagnose the patient with an anxiety disorder, when, in reality, the cause is ADHD itself.
Many children with ADHD can have trouble getting to sleep, more so than those who do not have ADHD. Older ADHD patients struggle more with sleep and at an increasing rate as they age, often spending more than 60 minutes a night trying to get to sleep.
2. Restless Sleep
When a person with ADHD gets to sleep, their sleep may be low in quality. They may wake regularly, be woken by the quietest noise, and toss and turn constantly in bed. Patients sleeping with a partner report that they prefer to sleep in a separate bed to support a better quality sleep and to avoid disturbing their partner. They may often wake up with the bed covers on the floor, and/or wake up in the morning feeling even more tired than before they fell asleep.
3. Problems Waking Up
Many people with ADHD wake up many times until the early hours of the morning. They will then fall into a deep sleep which tends to be too late into the night, which causes them even more difficulty in waking up. They will sleep through many alarms, and through their partner or family members trying to wake them up. They may be irritated and quite angry if they are woken up before they feel ready to be. Many feel they are not properly awake before midday.
4. Sleep Intrusion
When a person with ADHD is engaged in activity while using stimulants, they often will not show any signs or symptoms of ADHD, which is an experience doctors label ‘Hyper Focus’. If they lose interest, the change will be abrupt and the person will quickly seek stimulation elsewhere. This can also cause the person to become very tired, very quickly, even causing them to go to sleep. In the extreme, this pattern shows up as brain wave disturbances that can be misdiagnosed as narcolepsy.
Why People With ADHD Have Trouble With Sleep
There are many ideas about why people with ADHD struggle with sleep. Some of these ideas can come with a preconception from the doctor or scientist providing their explanation. Some doctors believe that it is a direct result of ADHD, whereas others believe that it comes from an issue with a person's life patterns.
An ADHD researcher, Thomas Brown Ph.D, is known for popularizing the link between sleep disturbances and ADHD. He describes how sleep disturbances appear because of issues with alertness caused by the condition of ADHD. He states that sleep issues are caused by a problem regulating arousal and alertness. The resulting recommendations for treatment are not common ADHD treatments, but rather, better sleep hygiene and sedative drugs to dampen a high state of mental arousal.
In most cases, it makes sense that sleep issues are directly caused by ADHD. Real hyperactivity is very rare at any age and most who experience it will experience it when they are trying to relax at the end of the day. Around three-quarters of adults say that their mind will move from thought to thought for hours before they finally manage to get to sleep, most often followed by tossing and turning, waking up and restlessness throughout the night.
The fact that over three-quarters of adults with ADHD fall into a heavy sleep where it is nearly impossible to arouse them has led scientists to look for answers. There isn’t one theory that fully explains it as of yet. Strangely, some people with ADHD state that they sleep better when they camp or spend a lot more time outdoors.
Some theories suggest that a lack of a circadian clock (in its complete form) could be part of the problem, including the lack of awareness many ADHD sufferers have with maintaining a strong sense of time. Internal clocks don’t work for those with ADHD and time is not experienced in the same way it is by those without ADHD. It will take many more studies to get to the bottom of the links between time and those with ADHD.
How To Get To Sleep When You Have ADHD
Sleep hygiene, which means setting the conditions to get an effective sleep, is critical to managing sleep when struggling with ADHD. The conditions any one person needs to achieve this great sleep hygiene are individual. For example, one person may need silence while another needs white noise. One person needs to eat before bed, and another may need to avoid eating a few hours before bed.
However, some rules can help the majority of people when it comes to improving sleep hygiene:
Use the bed for sleep or sex, not for arguments or problem confrontation
Do not work in bed. This has become more common now during a pandemic.
Have a set bedtime routine and stick to it
Do not nap during the day
*unless trying out whether stimulants actually help you sleep as outlined in the section below.
Two areas of sleep hygiene are particularly relevant to those with ADHD.
The first area is the time that they choose to sleep. Many people with ADHD peak at night because they can think clearly, have minimal distractions and their moods are stable. The main problem with this is that they, like most people, have jobs or families that require they sleep through the night and get up in the morning. They can’t allow themselves to follow their natural yearning to be a night owl. By going to bed and going to sleep at a ‘normal’ time by most people’s standards, you have the best chance of bypassing this natural ADHD yearning to get things done through the night.
Second, you should avoid caffeine. Caffeine stimulates an already stimulated brain and can cause sleep disruptions through the night. You may also find yourself in the bathroom more often, as caffeine is a diuretic.
Treating Sleep Problems When You Have ADHD
The one unexpected treatment for ADHD sleep problems is taking a stimulant ADHD medication just under an hour before you plan to go to bed. This approach is counterintuitive when struggling with sleep.
Many people find that the drug’s ability to make them feel calm is enough to help them get to sleep. Many people are so low on sleep that a nap works well, so you can experiment with this method by attempting to nap 1 hour after taking your stimulant dose. If it works, you can then experiment with taking a stimulant at bedtime. Many people find that medication before bedtime helps them to fall asleep successfully.
Some medical professionals also draw attention to the fact that some ADHD sufferers have sleep disturbances for other reasons, such as a sleep disorder. Some doctors will have their patients do a sleep study in order to find out why they are having sleep disturbances. Tests like a polysomnogram, multiple sleep latency test or home sleeping test may be ordered. Any secondary sleep problems will then be treated by various options available.
There are also some prescription medications available to help, such as sleeping pills. Many doctors prefer not to prescribe these because they can be addictive. It is easy to build a tolerance to sleeping pills, and need to constantly up the dose. Instead, a doctor may prescribe non-habit forming option, such as:
Melatonin - This is a natural peptide that the brain creates when the sun has set. Most doctors recommend you use 1mg at a time, which will begin to work after about a week of regular use.
Periactin - This is a prescription antihistamine that can cause sleepiness, suppress dreams and help with appetite problems caused by stimulant medication.
Clonidine - Around 0.05 to 0.1mg of clonidine before bedtime can provide a sedative effect. It is usually prescribed for high blood pressure but can be an option for those with ADHD sleep disturbance issues.
Antidepressants - Some antidepressants can cause a sedative effect in low doses, but this effect can last into the next day, which can be problematic.
Natural Alternatives
If you want to enjoy natural alternatives to prescription drugs to help you get sleep, you could try the following options:
Melatonin - This is a natural peptide that the brain creates when the sun has set. Most doctors recommend you use 1mg at a time, which will begin to work after about a week of regular use.
Magnesium - Magnesium helps the parasympathetic nervous system to activate, which is the same system that helps you to relax and feel calm.
Lavender - Lavender natural oil sprinkled on your pillow or used in a humidifier is thought to help you feel more relaxed and calm.
Valerian Root - A natural substance commonly used to aid sleep in those with sleep disorders, and in ladies going through the menopause.
Passionflower - Most commonly used for insomnia treatment, passionflower tea steeped for ten minutes could help boost sleep quality.
Glycine - Glycine is a natural amino acid that could help with sleep by potentially lowering the body temperature before bed, letting your body know it is time for sleep.
Trouble Waking Up When You Have ADHD
Struggling to wake up and feel awake can be resolved in a few ways. One way is to use a double-alarm system. You have your first dose of medication by the bed with some water and you set an alarm to take it an hour before you plan to wake up. When the second alarm goes off 60 minutes later you have a good chance of being able to get out of bed.
Another approach is to use special sunrise and sunset lights to help regulate your circadian rhythm. This can help, but it can also be quite expensive to set up.
ADHD sleep disturbances are common, and many are ignored by the current diagnosis system and supporting research. The issues can get worse as you age, and diagnosis may be a challenge if you currently take stimulant drugs for ADHD. Fortunately, many doctors do recognize that sleep issues are related to the ADHD condition, and stimulant drugs are a great option to help treat these issues, rather than being blamed as the cause of those issues.
