Sleep

What's the deal with

Sleep

and ADHD?

Difficulties with sleep affect many people with ADHD. Sleep issues include trouble with falling asleep, staying asleep, the quality and length of sleep, and the ability to keep consistent bedtimes and wake times. Sleep disorders are also common with people with ADHD. Sleep disorders such as narcolepsy, sleep apnea, restless leg syndrome, insomnia, delayed sleep phase disorder, and more, are also more common in people with ADHD.

“Sleep is difficult for many reasons. For example, for more than 80 percent of those with ADHD, the sleep cycles are flipped.' Instead of sleeping deeply in one of the first two sleep cycles like their neurotypical counterparts, they wake up multiple times until about 4:00 a.m. Then they fall into "the sleep of the dead," from which they have extreme difficulty rousing themselves. Because of their deep sleep, many of my clients describe sleeping through two or three alarms, as well as the attempts of family members to get them out of bed.” — Tamara Rosier, PhD, Your Brain’s Not Broken

What it looks like:

Sleep difficulties can result in symptoms such as:

Difficulty falling asleep at night, often due to racing thoughts or restlessness
Trouble waking up in the morning or excessive daytime sleepiness
Irregular sleep patterns or "night owl" tendencies
Frequent nighttime awakenings
Feeling unrefreshed upon waking
Sleep anxiety or bedtime resistance, also called Revenge Bedtime Procrastination
Hyperfocus on activities leading to delayed bedtimes
Irritability, increased anxiety or depression
Memory issues
ADHD symptoms like inattention, emotional dysregulation, and restlessness may become more severe
Long term, lack of sleep can lead to weakened immune system and chronic diseases

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The science:

The relationship between ADHD and sleep issues is complex and bidirectional. Several factors contribute to sleep difficulties in ADHD:

Circadian rhythm differences: Some individuals with ADHD may have a delayed circadian rhythm, making it harder to fall asleep at conventional times.
Differences in sleep cycle: Recent research shows that in many people with ADHD, sleep cycles are flipped. Rather than sleeping deeply for the first sleep cycles, and more lightly towards morning, people with ADHD start with lighter sleep cycles and end in deeper sleep, making waking up more difficult.
Brain chemicals: Differences in the level of brain chemicals like dopamine and norepinephrine can affect both ADHD symptoms and sleep-wake cycles. That may explain why many symptoms of ADHD and lack of sleep can look similar.
Executive function deficits: Challenges with executive functions - the mental skills we need to function - such as time management and routine adherence are common in people with ADHD. These challenges can make it more difficult to maintain consistent sleep schedules.
Hyperactivity and restlessness: Physical restlessness or mental hyperactivity can interfere with the ability to relax and fall asleep.
Medication effects: Some ADHD medications can impact sleep, especially if taken later in the day.

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References:

Complete sleep-wake cycle reversal related to ADHD detected by actigraphy

Healthline- Sleep Hygiene

Sleep Foundation- ADHD and Sleep

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What you can do:

Good habits surrounding sleep, often referred to as sleep hygiene, are important to help your body get rest. Here are some examples of good sleep hygiene:

Same wake/bedtime: A regular time to go to bed and wake up signals to your body it’s time to sleep! To create a new bedtime or wake time, reduce the time by 15 min per week to let your body adjust.
Use bed only for sleep: If you look at your phone, watch TV, or do work in bed, your body associates those activities with bed, not sleeping!
Cut off time for screens: Blue light from phones, computers, and TV can signal to the brain that it’s daylight and time to stay awake! Aim to stop looking at screens 2-3 hours before bed.
Cut off time for food/water: Having a belly full of food and liquid can make it harder to sleep. Aim to stop eating around 3 hours before bed. Try to spread out your water intake so most of it doesn’t happen at the end of the day.
Cut off time for caffeine/sugar/alcohol: Caffeine, alcohol, and sugar before bed can disrupt sleep. Try to avoid caffeine 8 hours before bed.
Limits naps: Keep naps short, ideally 30 minutes or less, and not within 4-5 hours before bed.
Bedtime routine: Do relaxing things in the evening that don’t involve screens- read a book, listen to music or a podcast, journal, take shower or bath, or prep for the next day.
Exercise: Moving your body has many benefits including helping sleep! Even 5-10 minutes of moderate exercise a day can aid sleep. For some people, exercise too close to bed will keep them up, so experiment with what time is best for you to exercise.
Cool Dark Room: Minimize lights in your bedroom and keep the room cool, ideally around 65-68 degrees.
Breaks during the day: Give yourself time to relax throughout the day to help stop Revenge Bedtime Procrastination, where you stay up late to unwind because you feel you didn’t have enough time for yourself during the day. Take breaks by journaling, meditating, breathing, or calling a friend!

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Go deeper:

What Is Revenge Bedtime Procrastination?

Is It Really Just ADHD?

Helping ADHD teens sleep better

Anxiety and Sleep Cycle

The Science of Slumber

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Disorganization

Rejection Sensitivity (RSD)

Decision-Making

Motivation

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