Attention Deficit Hyperactivity Disorder or short ADHD is widely known for its symptoms of inattention, impulsivity, and hyperactivity. Yet ADHD’s impact on sleep is not often talked about even though research has shown between up to 80% of ADHD’ers, both children and adults, struggle with sleep related problems (Brevik et al., 2017 Fisher et al., 2014; Fuller-Thomson et al., 2016).

Why Do Many Individuals with ADHD Struggle with Sleep Disturbances?

There are many different reasons why someone with ADHD might struggle with sleep disturbances. The hyperactivity and restlessness that are often associated with ADHD and are a very common symptom can make it very difficult to wind down and fall asleep. As someone who has lived with ADHD for all of my life, I've found that my restlessness can make it incredibly difficult to wind down and fall asleep at night. Even after a long and exhausting day, my mind cannot stop racing with countless thoughts going through my mind, which makes relaxing or falling asleep incredibly difficult. This ongoing struggle with sleep has honestly been one of the most challenging aspects of managing my ADHD.

In addition to hyperactivity and restlessness, stimulant medications that are often prescribed as treatment for ADHD can also contribute to the disruption of sleep. Irregular routines as well as difficulty maintaining consistent schedules also play a role. Additionally, coexisting conditions such as anxiety, depression, substance abuse, and poor sleep hygiene can further exacerbate sleep difficulties for someone with ADHD. Despite these theories, consistent sleep abnormalities in ADHD patients have not been conclusively identified.

Some researchers also suggest that people with ADHD have a delayed circadian rhythm, which means their internal body clock is shifted later than usual (Petti T et al., 2024). This means that for someone with ADHD, 12 AM might feel more like 10 PM. Consequently, someone with ADHD might feel sleepy later at night and wake up later in the morning. On top of that, researchers have also found that ADHD’ers may produce melatonin, the hormone that promotes sleep, later in the evening than others (Petti T et al., 2024). These circadian rhythm changes can create shifts in the sleep-wake cycle, and  as a result, could make someone more susceptible to various sleep disturbances. 

Some of the most common sleep disturbances that ADHD’ers experience include:

• Insomnia: This includes difficulties in falling asleep, staying asleep and being unable to return to sleep.

• Restless Legs Syndrome (RLS): RLS is characterized by an uncontrollable urge to move the legs, this is often due to uncomfortable sensations.

• Sleep Apnea: A condition where breathing repeatedly stops and starts during sleep, which can also cause disruptions during the sleep cycle. 

• Delayed Sleep Phase Disorder (DSPD): A significant delay in the sleep-wake cycle, typically by two or more hours beyond conventional bedtimes.

• Periodic Limb Movement Disorder (PLMD): Involves repetitive cramping or jerking movements of the legs while being asleep.

Understanding these common sleep disturbances is the first step toward finding effective solutions. Fortunately, there are several treatment options available to help individuals with ADHD improve their ability to fall asleep and achieve better sleep quality.

What Helps Me With My Sleep Disturbances

As I have been struggling most of my life with sleep disturbances, I had to find several strategies to help me achieve a better night's sleep despite having ADHD.

Here are some of my strategies to get a restful night of sleep:

Establishing a Consistent Sleep Schedule: I've made it a habit to go to bed and wake up at roughly the same time every day. This regularity has really helped regulate my body’s internal clock and improve my sleep quality.

Creating a Relaxing Bedtime Routine: I’m personally not a fan of lengthy and extensive morning or nighttime routines as they become difficult for me to maintain. Instead, I have created a simple and relaxing bedtime routine to help me unwind and prepare for sleep. I try to do a brain dump at night where I write down all my thoughts on paper, and always include some form of mindfulness activity. These practices signal to my body that it's time to wind down.

Limiting Exposure to Screens: I avoid using my phone or computer at least an hour before bedtime. The blue light from these screens can interfere with melatonin production, and reducing my screen time has significantly improved my sleep.

Optimizing the Sleep Environment: I've made my bedroom more helpful to rest by investing in a comfortable mattress and pillows, keeping the room cool, and minimizing noise and light.

Using a Weighted Sleep Mask: I use a Nodpod weighted sleep mask. The gentle pressure helps me to relax and fall asleep more easily. Also, I’m very sensitive to light and the darkness from the sleep mask helps me with my sleep as well. When we are in a dark environment, the production of melatonin, the hormone that regulates sleep-wake cycles, is stimulated. This natural response to darkness helps signal to your body that it's time to wind down and prepare for sleep. 

Limiting Stimulants: I avoid caffeine, especially in the late afternoon and evening. I've also become mindful of my medication timing as some ADHD medications can affect my sleep.

Exercising Regularly: Regular physical activity has been super beneficial for me. It helps reduce my ADHD symptoms and improves my sleep. However, I do make sure to avoid any kind of vigorous exercise close to bedtime because intense physical activity can stimulate the body and increase heart rate, making it harder to relax and fall asleep. Vigorous exercise raises body temperature and releases adrenaline, which can interfere with the natural process of winding down for sleep.

Practicing Mindfulness and Relaxation Techniques: Incorporating practices like meditation, yoga, breathing techniques, and progressive muscle relaxation into my routine has also helped me to reduce my stress and anxiety, making it easier to fall asleep.

Resources:

E.J. Brevik et al. Prevalence and clinical correlates of insomnia in adults with attention-deficit hyperactivity disorder. Acta Psychiatr. Scand. (2017)

B.C. Fisher et al. Sex differences and the interaction of age and sleep issues in neuropsychological testing performance across the lifespan in an ADD/ADHD sample from the years 1989 to 2009. Psychol. Rep. (2014)

E. Fuller-Thomson et al. Attention-deficit/hyperactivity disorder casts a long shadow: findings from a population-based study of adult women with self-reported ADHD. Child Care Health Dev. (2016)

Petti T, Gupta M, Fradkin Y, Gupta N. Management of sleep disorders in autism spectrum disorder with co-occurring attention-deficit hyperactivity disorder: update for clinicians. BJPsych Open. 2024;10(1):e11. doi:10.1192/bjo.2023.589