The Connection Between Sleep and ADHD

The relationship between sleep and ADHD

The relationship between sleep and ADHD (attention deficit hyperactivity disorder) is complex and can affect both children and adults. Sleep disturbances can significantly influence both the severity of your ADHD symptoms and how well you’re able to manage them throughout your lifetime.

In children with ADHD, sleep issues can include problems such as difficulty falling asleep, frequent awakenings, restless sleep, and parasomnias like sleepwalking or night terrors. Left unchecked, these disturbances can contribute to chronic sleep deprivation, which can exacerbate core ADHD symptoms such as inattention, hyperactivity, and impulsivity.

Lack of quality sleep can also impact your child’s cognitive functions like attention, memory, and executive functioning, amplifying the challenges they face in daily activities at home and school. For children, poor sleep can also impact their ability to regulate their moods and control their behavior, often leading to increased emotional outbursts and more problem behavioral issues.

In adults with ADHD, the interplay between sleep and ADHD symptoms can also be significant. Sleep disturbances in adults with ADHD often take the form of sleep disorders such as insomnia, restless legs syndrome, or sleep apnea. As with children, having trouble sleeping well can make difficulties with attention, executive function, and emotional regulation worse. Chronic sleep deprivation in adults can also make you more easily distracted, impulsive, and worsen your organization and time management issues.

There can also be cognitive implications associated with sleep deprivation, such as reduced working memory and impaired decision-making abilities. This can have a detrimental effect on your work performance and personal relationships. Other factors, such as high levels of stress, lifestyle, or conditions you experience in addition to ADHD, such as anxiety or depression, can also make it harder to sleep well.

Since disruptions in sleep can make your ADHD symptoms worse, and severe ADHD symptoms can further disrupt sleep, you may feel like you’re trapped in a negative downward cycle. But there are steps you can take to address both sleep issues and your ADHD symptoms and break the pattern.

Whether it’s you or your child with ADHD, by improving sleep hygiene, establishing consistent sleep routines, and treating specific sleep disorders you can improve how well you sleep at night, better manage ADHD symptoms, and enhance your overall quality of life.

ADHD and sleep problems

As someone with ADHD, you have a higher risk factor for sleep disorders such as sleep apnea and restless legs syndrome. You’re also more likely to experience:

• Insomnia and difficulty falling asleep.
• Restless sleep or frequent awakenings.
• Sleep phase delay (difficulty waking up in the morning).

Neurotransmitters and chemicals that impact ADHD and sleep

The relationship between sleep and ADHD can involve several key neurochemical systems that influence both sleep regulation and ADHD symptoms. For instance, imbalances in dopamine and norepinephrine can lead to difficulties with attention and hyperactivity, which can disrupt sleep patterns. Conversely, poor sleep quality can exacerbate ADHD symptoms by affecting the balance of dopamine and norepinephrine.

Understanding how these chemicals impact both ADHD and sleep can help illustrate why sleep problems often accompany ADHD symptoms.

While the hormone melatonin is not typically impacted by ADHD, it is critical for promoting sleep. Disruptions in your body’s melatonin production can lead to difficulties with sleep onset and maintaining a regular sleep schedule for people with or without ADHD.

Effective treatment for ADHD often involves addressing both the neurochemical imbalances and the related sleep disturbances. It’s also important to take into account how any medications you’re taking for ADHD may also be affecting your sleep.

How ADHD medications affect sleep

ADHD medications can have significant effects on your sleep, influencing both the quality and the patterns of your sleep. Whether you’re an adult or child with ADHD, this can be particularly concerning if you’re already struggling with sleep disturbances. How much your ADHD medications impact your sleep can vary depending on the type of medication, its dosage, and how you respond to the medication.

The effects of ADHD medications on sleep can also vary depending on the timing of the medication. Extended-release formulations, designed to provide symptom control throughout the day, may lead to more pronounced sleep disturbances if not managed carefully. Taking stimulant medications later in the day can also cause sleep problems. In some cases, you may initially experience sleep-disrupting effects from a medication, yet over time develop a greater tolerance to the medication, reducing its negative impact on your sleep.

Stimulant ADHD medications

Stimulant medications, which are the most commonly prescribed for ADHD, include drugs such as methylphenidate (Ritalin) and amphetamine salts (Adderall). These medications work primarily by increasing the levels of neurotransmitters such as dopamine and norepinephrine in your brain, which can enhance focus, attention, and impulse control.

However, because stimulants increase arousal and alertness, they can also interfere with your sleep. Stimulants can lead to difficulties falling asleep, shortened sleep duration, and reduced sleep quality, especially if you take them too close to bedtime.

Methylphenidate-based medications include Ritalin, Concerta, Metadate, and Daytrana (patch). These medications can increase alertness and reduce fatigue, which can often lead to difficulties falling asleep, shortened sleep duration, and reduced sleep quality. These effects are usually more pronounced if the medication is taken later in the day.

Amphetamine-based medications include Adderall, Adderall XR, Dexedrine, and Vyvanse. These medications can have stimulating effects that disrupt sleep patterns. Issues may include insomnia, difficulty falling asleep, or restless sleep.

Non-stimulant ADHD medications

Non-stimulant ADHD medications, such as atomoxetine (Strattera) and guanfacine (Intuniv), affect neurotransmitter systems differently and generally have a less pronounced impact on your sleep.

Atomoxetine, a selective norepinephrine reuptake inhibitor, can sometimes lead to sleep problems such as insomnia or excessive sleepiness. Guanfacine, an alpha-2 adrenergic agonist, is often used to manage ADHD symptoms while potentially having a calming effect that may improve sleep quality for some people. However, it can also cause drowsiness, which might affect your ability to maintain alertness during the day.

Atomoxetine (Strattera) is a selective norepinephrine reuptake inhibitor. While it tends to have a less stimulating effect compared to stimulants, it can still cause sleep disturbances such as insomnia or, less commonly, excessive daytime sleepiness.

Guanfacine (Intuniv) and clonidine (Kapvay) are alpha-2 adrenergic agonists that can have a calming effect, potentially improving sleep quality for some individuals. They are sometimes prescribed to manage ADHD symptoms while simultaneously addressing sleep issues. However, they can also cause drowsiness, which might lead to daytime sleepiness or affect your alertness.

Tips for managing your ADHD and sleep

Balancing ADHD symptom management with maintaining healthy sleep is essential for your overall well-being. Sleep is crucial for us all, but it can be especially important when you’re also dealing with ADHD. ADHD can make it harder to fall asleep, stay asleep, and wake up feeling refreshed. Poor sleep can then worsen your ADHD symptoms, such as inattention, hyperactivity, and impulsivity.

Ensuring you get the sleep you need can help improve your focus, mood, and the ability to manage stress, all of which can be challenging when you’re dealing with ADHD. By prioritizing sleep and taking the following steps to improve your sleep quality, you’ll feel better rested and improve how well you manage your ADHD symptoms.

Tip 1: Improve your sleep hygiene

Whatever sleep issues you’re facing, creating healthy sleep habits, known as “sleep hygiene”, can help you fall asleep faster, stay asleep for longer, and improve how well you’re able to manage your ADHD symptoms during the day.

Create a sleep-conducive environment. Ensure your bedroom is dark, quiet, and cool. Use a comfortable mattress, pillows, and bedding. If you’re feeling cold, consider using an electric blanket. If you’re too hot, try sticking your feet out of the blanket or using a fan aimed at your bed. Additionally, wearing a sleep mask, using earplugs, or turning on a white noise machine can help mask noise and create a more comfortable sleep environment.

Limit screen time before bed. Turn off the TV, your phone and any other devices at least one hour before bed. The blue light these screens emit can interfere with your body’s melatonin production, making it harder to fall asleep.

Be careful of what you eat and drink at night. Avoid caffeine and eating large meals close to bedtime. Caffeine can cause sleep problems up even 10 hours after drinking it, while heavy meals, especially spicy or acidic foods, can cause stomach trouble and heartburn. Instead, opt for a calming herbal tea or a light snack. Drinking alcohol may make you feel sleepy, but it can interfere with your sleep patterns.

Tip 2: Keep a regular sleep schedule

Keeping a regular sleep schedule that’s in-sync with your body’s natural circadian rhythm can be an important step in improving how well you sleep.

Establish a sleep schedule. Try to go to bed and wake up at the same time every day to regulate your body’s internal clock. Choose a bedtime when you naturally feel tired. If you find that you need an alarm clock to wake up in the morning, you may need an earlier bedtime.

Avoid sleeping in at the weekend. The more your sleep schedule differs at the weekend, the harder it can be to reset your natural sleep-wake rhythm on Monday. If you need to make up for a late night, try a short daytime nap instead—just don’t make it too close to bedtime.

Do not use your bed for daytime activities. Avoid using your bed for daytime activities like watching TV, talking on the phone, or reading. Reserving it just for sleep and sex can help you associate your bed more strongly with resting.

Give yourself 30 to 60 minutes to fall asleep. If this doesn’t work, evaluate whether you are calm, or whether you are anxious or ruminating, worrying about the previous day or the day ahead. If it’s taking you a long time to drop off at night, there are relaxation techniques such as breathing exercises you can try to help quieten your mind and fall asleep fast.

Tip 3: Unwind with relaxation techniques

Incorporating relaxation techniques such as meditation, deep breathing exercises, or gentle yoga before bedtime can help you fall asleep faster and stay asleep for longer.

Try a sleep-inducing meditation at bedtime. You can use a mediation app that has sleep music or guided sleep medications. Or use HelpGuide’s free Bedtime Meditation for Sleep to help you let go of tension and ease the transition into sleep.

Practice a progressive muscle relaxation exercise. Progressive muscle relaxation, where you systematically tense and relax different muscle groups in the body, can help relieve stress, anxiety, and muscle tension, and promote restful sleep.

Focus on your breathing. The following 9–0 breathing exercise can help interfere with worries and calm your mind at bedtime:

• Breathe in deeply and breathe out slowly, saying in your mind the number “nine”.
• On the next breath out, saying in your mind “eight”.
• Next, say seven, and so on, until you are saying zero.
• Then start over, but this time, instead of starting with nine, start with eight as you breathe out, followed by seven and so on until you reach zero.
• Next, start with six and so on to zero; then start with five; then with four and so on until you have gone all the way down to starting with “one”.
• Continue with the practice, starting over as often as necessary until you fall asleep.

Tip 4: Manage medication-related sleep issues

The impact of ADHD medications on your sleep can vary widely depending on factors such as your individual sensitivity to the medication and whether you have a co-occurring sleep disorder. Trying to balance ADHD symptom management with sleep quality can be challenging, but there are ways to reduce sleep issues caused by your ADHD medications.

Adjust dosage timing. The timing of when you take your medication can be crucial; taking them earlier in the day may help reduce their impact on your sleep. For stimulants, it is generally recommended to take them earlier in the day, although non-stimulant medication may also need to be adjusted based on how it impacts your sleep. Talk to your doctor before making any adjustments.

Try short-acting rather than extended-release medication. While extended-release formulations may provide more consistent symptom control throughout the day, they may also have lingering effects that impact your sleep at night. Consider whether a short-acting medication might work better for you, as its effects can wear off before bedtime.

Regularly review your medication with your doctor. It’s important to monitor the effectiveness and side effects of any medication with your healthcare provider. You may need to consider switching ADHD medication or adjusting the dosage if your sleep disturbances persist.

Tip 5: Know when to seek professional help

It is important to seek professional help when your symptoms still remain unmanageable after following the above tips. If sleep disruptions are impacting your life in a negative way, such as often being late to work or being too tired to perform at your best, it may be time to speak with a mental health professional.

• Sleep therapy can help treat your sleep problems using cognitive behavioral therapy for insomnia (CBT-I).
• You may need to take a multidisciplinary approach, involving a sleep specialist, in-person or online therapist, and an ADHD healthcare provider to help balance your ADHD symptom management with improving your sleep and mood.
• Discuss with your primary care doctor if you need a sleep study to be performed.

Managing your ADHD and sleep

By incorporating sleep and ADHD management strategies, you can improve your sleep quality and minimize the impact of ADHD medications on your sleep. In turn, improving how well you sleep at night will not only improve how well you manage your ADHD symptoms, but also improve your overall mood, health, and mental well-being.