ADHD and Sleep: A Comprehensive Guide
ADHD, or attention deficit hyperactivity disorder, is one of the most commonly diagnosed childhood disorders in the United States. To date, 6.4 million children ages 4-17 have been diagnosed with ADHD, and 4 percent of adults over the age of 18 deal with it, as well.
Studies have long linked ADHD to sleep problems such as restless legs syndrome, sleep-onset delay, sleep-disordered breathing, and shorter overall sleep times. 25-50% of children and adolescents diagnosed with ADHD experience clinically reported sleep problems.
Because quality sleep is key to so many other fundamental processes in the body, finding solutions to these sleep problems is a top priority for many ADHD sufferers and their parents.
The optimum amount of sleep your body needs depends on your age, but the Mayo Clinic recommends adults get 7-8 hours of sleep every day. Unfortunately, the symptoms of sleep deprivation and ADHD are very similar, so distinguishing between the two can be tricky. Additionally, many ADHD symptoms are considered normal behavior for children.
In order to be diagnosed with ADHD, a child must have experienced symptoms for at least 6 months, and they have to meet the requirements of hyperactivity-impulsivity or inattentiveness. ADHD is sometimes misdiagnosed as a sleep disorder and vice versa, so it’s worth examining the connection between the two.
Importance of Sleep
Sleep isn’t just something we like to do when we’re feeling a little tired— it’s just as vital to our well-being as breathing or drinking water. Understanding different stages of sleep and the processes our bodies go through during each phase can put their vital importance into perspective.
Stage 1 of Sleep
During the first stage of sleep, we start to drift off; the first symptoms of fatigue begin to set in, like heavy eyelids, a slowed heart rate, and relaxed muscles. Our brain releases GABA, a neurotransmitter that initiates these calming processes.
Some studies have found that GABA release is inhibited in ADHD sufferers, preventing them from relaxing and winding down for sleep.
Stage 2 of Sleep
When our bodies reach phase 2, NREM, or non-REM sleep begins. Like its name implies, it’s much harder to wake somebody up once they’re in the non-REM sleep phase. During Stage 2, the brain begins to produce brain waves that convert our short-term memories to long-term ones.
These brain waves are called sleep spindles, and some evidence suggests children with neurodevelopmental disorders such as ADHD, are more vulnerable to abnormal spindle generation. Abnormal spindle generation results in poor intellectual performance and a low attention span— both symptoms prevalent in ADHD patients.
Stage 3 of Sleep
Stage 3 is the most restorative phase of sleep— missing out on this phase consistently can lead to long-term health consequences. During this stage is when deep sleep occurs, your body repairs muscles, improves your immune function and clears your brain of plaque that can lead to brain diseases like Alzheimer’s or Parkinson's if it builds up over time.
Children and adults with ADHD sometimes struggle to fall asleep and stay asleep, thus increasing their risk of skipping Stage 3. A study published in the journal Sleep concluded that while adults and children with ADHD don’t necessarily sleep less, their sleep quality is greatly diminished because they are so restless.
Stage 4 of Sleep
REM, or Rapid Eye Movement, occurs during the final stage of sleep. Most of our dreaming takes place during REM, and waking up during this phase can result in a lethargic, groggy feeling.
A study measuring sleep patterns in children with ADHD discovered that REM time for children with ADHD was almost 20 minutes less than it was in children without ADHD. The same study concluded that poor sleep does not cause ADHD, but it can exacerbate the symptoms.
Sleep Deprivation and ADHD
Sleep duration is only one part of the equation— a full night of sleep is pointless if the sleep is not high-quality. As we mentioned above, missing out on any phase of the sleep cycle is linked to poor cognitive performance, including inattentiveness and short-term memory loss.
Common symptoms associated with both sleep deprivation and ADHD include the following:
- Impulsive behavior
- Difficulty waking up
- Difficulty falling asleep
- Poor reaction time
- Low self-control
Sleep Disorders Related to ADHD
Because poor sleep quality is so common among ADHD patients, they suffer from other symptoms associated with sleep deprivation, and some develop more serious sleep conditions as a result. While treating sleep deprivation can help, other interventions may be required for these conditions.
Restless Legs Syndrome (RLS)
Restless Legs Syndrome is characterized by twitching or uncontrollable movement in the legs, often accompanied by numbness, tingling, or crawling sensations. To alleviate this constant discomfort, RLS-sufferers have to move their legs constantly, keeping them awake all night.
RLS is one of the most common sleep disorders linked to ADHD, especially in children. Restless Legs Syndrome is related to Periodic Limb Movement Syndrome (PLMS), which occurs when legs jerk or cramp during sleep. 80% of people with RLS also have PLMS— both are known to negatively affect sleep quality.
To help children sleep better with these two disruptive conditions, parents can massage the affected limbs when they are in pain, stretching, establishing a consistent bedtime routine, and getting regular exercise.
Sleep Apnea and Sleep-Disordered Breathing
Snoring, sleep apnea, and other breathing issues during sleep are commonly linked to people with ADHD. Sleep apnea and snoring occur when the airways are obstructed, either by a deviated septum (one nostril smaller than the other), large tonsils, or the tongue.
People with sleep apnea or disordered breathing can get “stuck” in the first one or two stages of their sleep cycle, thus missing out on some of the most restorative sleep stages and inhibiting cognitive performance during the day.
Currently, there is not enough research to definitively link sleep apnea to ADHD, but there is an interesting correlation— a literature review published in the Annals of Clinical Psychiatry found that attentional deficits have been reported in up to 95% of obstructive sleep apnea patients. Additionally, standard treatments for obstructive sleep apnea have shown positive effects on ADHD symptoms.
Children and adults with parasomnias experience frequent interruptions to sleep in the form of sleepwalking, night terrors, nightmares, and confusion causing the sleeper to wake up. Studies examining the relationship between parasomnias and ADHD find that treating parasomnias can lead to an improvement of ADHD symptoms.
Managing Sleep Deprivation in ADHD Patients
As many as 50% of children with ADHD deal with sleep issues of some kind and almost 75% of adults with ADHD suffer from insomnia. Even though no definitive link between the two has been established, there is enough of a correlation that suggests improving sleep hygiene can potentially alleviate symptoms of ADHD.
Sufferers of ADHD often don’t have a set concept of time; essentially, their circadian clocks are off. One of the best treatments for insomnia or sleep deprivation is to establish a consistent bedtime routine, and this tactic works for people with ADHD, too.
As soon as it gets dark outside, your body naturally starts to prepare itself for sleep. However, for people with ADHD, this process can be inhibited by racing thoughts, elevated heart rate, and muscle spasms.
Many ADHD sufferers report having anxiety, which is one of the primary precursors to insomnia. Forcing yourself to adopt a bedtime routine can be difficult at first, but after a few consistent days, you may find your body begins to follow suit. Go to bed at the same time every night, even on the weekends, and avoid sleeping in.
If you deal with racing thoughts, try writing them down before bed to clear your mind.
Avoid Late Naps
Taking naps too late in the day can disrupt your circadian rhythm— avoid naps later than 3 pm, since this will most likely keep you awake. If you need a nap, aim for one that’s 20-30 minutes long and sleep in a comfortable place (i.e. not in a chair or on the couch).
Adults dealing with ADHD should avoid caffeine at least 6 hours before bedtime. Too much caffeine exacerbates ADHD symptoms. If you need an energy boost, try a healthy, sleep-promoting snack like whole wheat crackers and cheese.
Create an Ideal Sleeping Environment
One of the best ways to improve your sleep hygiene is to make your room for sleep only— that means keeping any screens out of your room (TVs, phones, e-readers, and so on). Set your thermostat to a comfortable temperature; studies show the ideal room temperature for sleep is around 67 degrees. Your body will naturally cool down for sleep, so maintaining this temperature is key.
Some people who have trouble falling asleep like using blackout curtains to keep out any bright light. Taking a warm bath before bed can relax your muscles and kickstart your body’s natural cooldown process it needs before you go to sleep.
Upgrading to the best mattress and pillow for your sleep needs can lead to better rest, as well. Depending on your sleep position, you will probably prefer a specific firmness. If you tend to sleep hot, choose mattresses made with cooling technologies, and choose bedding made of natural fabrics like bamboo, Tencel, or 100% cotton.
Regular exercise is an effective tool for treating ADHD symptoms and it usually leads to more restful sleep, as well. Studies have shown aerobic exercise enhances brain function. What’s more, people with a regular exercise habit report it helps calm anxiety or racing thoughts— essentially, it provides an outlet for pent-up energy or hyperactivity.
If you don’t have a regular exercise habit, start small— go on walks or a bike ride.
Eat Sleep-Promoting Foods
Certain foods can interrupt sleep because they irritate the digestive system or stimulate the nervous system, like spicy foods, caffeine, fatty foods, and just too much food in general. Your last meal should be a few hours before bed, but if you need a snack, try the following foods:
- Low-fat milk and cheese (contain tryptophan which promotes deep, restful, sleep)
- Turkey (contains tryptophan)
- Yogurt (contains calcium and magnesium, which promote release of GABA)
- Cherries (contains melatonin, which regulates the sleep-wake cycle)
- Kiwi (promotes serotonin, which affects mood)
A note about medication: some ADHD medications can cause insomnia and other sleep issues. Talk to your health professional for more info about the medications you may be prescribed.
More Sleep Help
Children and adults with ADHD can use other sleep devices or tools to achieve better sleep. Patients with an ADHD diagnosis are more likely to have snoring or breathing problems, so treating snoring with a lofty pillow or an adjustable bed can help keep the airways open, leading to a good night’s sleep.
Light therapy is a popular treatment for patients with delayed sleep phase syndrome or other circadian rhythm disorders (common in ADHD sufferers). Patients use a box that emits artificial light, which in turn synchronizes their circadian rhythm.
Sleep restriction is a more extreme but effective form of sleep therapy— it involves going to bed and waking up at a precise time each day and avoiding all naps.
Thousands of Americans deal with ADHD and its consequences every day. ADHD is characterized by inattention, mood disorders, hyperactive behavior, and of course, sleeplessness. What’s more, sleep deprivation can exacerbate symptoms of ADHD, perpetuating a never-ending cycle of poor sleep.
It seems these problems are only increasing (according to the CDC, the diagnosis of ADHD has risen 42% in the past 8 years). Thankfully, fixing sleep issues without medication is entirely possible.
To ensure you get better sleep, establish a consistent bedtime routine, avoid foods that interrupt sleep and eat foods that promote it, manage your time, and try exercising. All of these things can improve your mental health and boost your sleep habits, thus improving symptoms of ADHD.