Inattention, hyperactivity, and impulsivity are all hallmarks of ADHD, a condition that typically begins in childhood. It is difficult to perform at school, work, and in social situations because of these symptoms. ADD/HD affects roughly 5% of children, with boys being more susceptible than girls. People with ADHD are more likely to develop the disorder as adults, although effective management can considerably enhance their quality of life.
A quarter to half of those with ADHD has sleep issues, which can range from insomnia to other sleep disorders. They are realizing that addressing sleep disorders can have a significant influence on both ADHD symptoms and the quality of life for ADHD patients and their families.
What’s the Connection Between ADHD and Sleep?
It is common for persons with ADHD to have difficulty falling and staying asleep, as well as a greater chance of having a sleep disturbance at an early age. Nightmares are also common in children with ADHD, especially those with sleeplessness. When it comes to ADHD, sleep problems tend to get worse with age, but they’re also a predictor of later occurrences.
Nighttime racing thoughts and a surge of energy can disrupt sleep for even folks who aren’t typically hyperactive during the day. Because there are fewer interruptions at night, some people find it easier to “hyperfocus” on a task. As a result, falling asleep is more difficult, and a disturbed sleep-wake cycle may result. Insomnia can worsen over time if people begin to feel anxious about bedtime.
As a result of sleep deprivation, many people with ADHD have trouble waking up in the mornings. Multiple overnight awakenings are a problem for some people.
A person’s kind of ADHD appears to influence the severity of their sleep problems. Insomnia is more common in people who have more inattentive symptoms, whereas individuals with more hyperactive-impulsive symptoms are more likely to have a later bedtime. Both poor sleep quality and a later bedtime are experienced by those with combination hyperactive-impulsive and inattentive ADHD.
Many of the signs and symptoms of ADHD might be mistaken for those of sleep apnea. Adult ADHD sleep issues, such as forgetfulness and difficulties concentrating, are among the most common. Children’s hyperactivity and impulsivity might be symptoms of exhaustion. It’s not always easy to identify if these symptoms are the result of ADHD or simply a lack of sleep. This can result in incorrect diagnoses or the omission of sleep problems. Because of this, doctors urge that patients be tested for sleep issues before being prescribed medication for attention deficit hyperactivity disorder (ADHD).
What’s the Biology Behind the ADHD-Sleep Connection?
Impaired arousal, vigilance, and regulatory pathways in the brain may cause ADHD sleep issues as a side effect. ADHD sleep issues, according to some experts, may be caused by a slowed circadian rhythm, which in turn causes melatonin generation to begin more slowly. Research has failed to establish consistent sleep abnormalities in patients with ADHD, despite the fact that some sleep disorders are associated with ADHD symptoms.
Stimulant drugs typically taken for ADHD have a soothing impact that helps some people sleep better. Many people, however, experience sleep issues as a side effect of stimulant medicines. Poor sleep hygiene and co-existing problems, such as anxiety, depression, or substance addiction, may also play a part in sleep issues.
How Do ADHD Sleep Problems Affect Daily Life??
Children and adults with ADHD with a sleep issue report more severe ADHD symptoms and a lower quality of life, despite the lack of research on this topic. Depressive and anxiety disorders, as well as hyperactivity and inattention, are more common in these individuals, as is a greater body mass index. Chronic sleep deprivation puts people at risk for physical health concerns over the long run.
School and employment can be seriously harmed by drowsiness during the day. It is common for people with ADHD to be judged for sleeping at inconvenient times, without realizing that this is a normal feature of their disease. Sleepiness that comes on suddenly can also be problematic when driving or performing other tasks that necessitate focus.
Even if you have a good night’s sleep, you may still be tired during the day. As a result of ADHD-related sleep loss, people with the disorder may be prone to being grouchy, irritable, restless, or exhausted. A mood condition may be confused for these symptoms. Anxiety and behavioral problems in children with ADHD have been linked to an increased incidence of sleep disturbances.
Families and caregivers of people with ADHD suffer as a result of these issues. Primary caregivers of children with attention deficit hyperactivity disorder (ADHD) and sleep problems are more likely to be depressed, anxious, tense, and running late for work, according to preliminary research.
The four most common sleep disturbances associated with ADHD are:
1. Difficulty Falling Asleep with ADHD
As many as three-quarters of individuals with ADHD say they have difficulty “turning off my mind” at night so they can get some shut-eye. Many people describe themselves as “night owls” who are energized when the sunsets. Some people say they are tired all day, yet their minds come back to life as soon as they lay their heads on the pillow. It’s as though they’re always switching back and forth between concerns. Although many of these adult ADHD sufferers are prone to describing their thoughts as “racing,” this is nothing more than the mental restlessness associated with ADHD.
In youngsters under the age of puberty, between 10% to 15% have problems falling asleep. This is twice the rate that is reported in children and adolescents who do not have attention deficit hyperactivity disorder. Age has a big effect on this number: By the age of 12, half of all children with ADHD have trouble getting asleep. By the age of 30, more than 70% of adults with ADHD report that they spend more than an hour each night trying to fall asleep.
2. Restless Sleep with ADHD
Restless sleep is a common occurrence for those with ADHD. They are restless. Any sound in the house wakes them up. It is fairly uncommon for bed partners to prefer to sleep in a different bed because of their restless nights. They frequently wake up to discover their bed ripped apart and their sheets tossed to the ground. When they wake up, they are just as worn out as they were before they went to bed.
3. Difficulty Waking Up with ADHD
In my practice, more than 80% of adults with ADHD report frequent awakenings until about 4 a.m. For the rest of their lives, they are unable to rouse themselves from this “sleep of the dead.”
These people sleep through two or three alarms and even family members’ attempts at getting them up. When ADHD sleeper is woken up before they are ready, they are often irritated or even violent. Many of them claim that they aren’t really awake until the midday hours of the next day.
4. Intrusive Sleep with ADHD
Paul Wender, M.D., a 30-year veteran of ADHD research, links the condition to interest-based performance. ‘ People with ADHD did not show symptoms of the disease as long as they were engaged in or challenged by what they were doing. (Some refer to this as “hyperfocus,” and it is frequently associated with ADHD.) An individual who suffers from attention deficit hyperactivity disorder (ADHD) is more likely to give up on a task if he or she becomes bored. Sometimes this disconnection is so abrupt that it causes significant drowsiness, even to the point of passing out.
As noted by EEG expert Marian Sigurdson, Ph.D., brain wave tracings at this time demonstrate a sudden appearance of theta waves in the alpha and beta alertness rhythms. The student in the back of the classroom who suddenly falls to the floor, having “fallen asleep,” is a classic example of “theta wave intrusion.” Most likely, this person had attention deficit hyperactivity disorder (ADHD) and was losing consciousness rather than going asleep. It is extremely dangerous to drive when suffering from this condition; long-distance travel on straight, boring roads is a common trigger. EEG negative narcolepsy is a common misdiagnosis for this illness.” We don’t know how common intrusive “sleep” is since it only occurs under specific circumstances that are difficult to replicate in a lab.
What Sleep Disorders Commonly Occur in People With ADHD?
People with ADHD are more likely than the general population to suffer from a variety of sleep difficulties. ADHD may go undetected if its symptoms are mistaken for those of one of these sleep disorders. As a result of their inability to express themselves, children may be misdiagnosed with ADHD when they are actually suffering from a sleep condition. It’s also possible that they’re suffering from ADHD and a sleep condition at the same time.
- Circadian Rhythm Sleep Disorder: Those with ADHD, especially adolescents, tend to be more awake at night. Due to the irregularity of this schedule, it may be difficult to fulfill obligations at work or school. People with ADHD may have a smaller pineal gland, anomalies in clock genes, and delayed melatonin production, all of which may contribute to their sleep problems. In order to modify your schedule, melatonin tablets or strong light treatment may be helpful.
- Sleep-Disordered Breathing: Snoring and sleep apnea affect up to a third of people with ADHD who suffer from sleep disorders. Disrupted sleep patterns and excessive daytime sleepiness are hallmarks of SDB, as are other symptoms associated with attention deficit hyperactivity disorder (ADHD). The good news is that treating SDB may lessen the requirement for stimulants in children who have been diagnosed with ADHD. While removing the tonsils may alleviate the symptoms of ADHD and sleep apnea in youngsters, it is more effective for adults.
- Restless Legs Syndrome: As a result of tingling feelings in the legs, those with restless legs syndrome (RLS) find it difficult to fall asleep. Nearly half of those with ADHD may suffer from RLS or another sort of periodic limb movement disorder. Children with ADHD and RLS appear to spend more time in stage one light sleep, which is not as restorative, than those without these conditions. Lack of iron and dopamine is thought to be the cause of RLS, just as these nutrients are implicated in ADHD. It is possible to cure RLS by taking iron supplements or dopaminergic medications.
- Narcolepsy: Those with narcolepsy may find it difficult to sleep at night since they tend to fall asleep unexpectedly throughout the day. It’s twice as common for an adult with narcolepsy to have had ADHD as a kid. Despite the fact that the connection between the two isn’t entirely evident, researchers believe that the excessive sleepiness caused by narcolepsy could trigger symptoms of ADHD. Other than genetics or neurotransmitter malfunctions, it’s possible that the two conditions are linked. Drugs are commonly used to treat narcolepsy.
Treating the underlying sleep disturbances of people with ADHD is an essential step in improving their quality of sleep. Ask your doctor for a sleep study to rule out any secondary sleep disorders that may need to be treated in addition to your ADHD. A skilled doctor should be on the lookout for signs of sleep disorders on a regular basis.
Sleep Tips for Children and Adults With ADHD and Sleep Problems
ADHD symptoms, as well as the effects of ADHD medication, may benefit from sleep interventions, experts believe. According to early research, behavioral sleep therapies help with sleep, symptoms of attention deficit hyperactivity disorder (ADHD), quality of life, day-to-day functioning, behavior, and memory.
Consistent bedtime routines and good sleep hygiene can assist children, adolescents, and adults with ADHD make the connection between bed and sleep. It’s best to make little adjustments and track your progress to find a system that works for you. Among them are:
- Before going to bed, limit your intake of sweets, caffeine, and alcoholic beverages.
- Before going to bed, limit your screen usage to an hour.
- Avoid engaging in high-intensity tasks and projects in the evening.
- Sleep and sex should be the only activities permitted in the bedroom.
- During the day, get some exercise and some sunlight.
- Spend time with your dogs, read a favorite book, or take a warm bath before going to sleep.
- Make sure the space is dimly lit, chilly, and silent; if required, use a white noise machine to mute outside sounds.
- Set a bedtime and wake-up time that is reasonable and age-appropriate so that you can obtain the required amount of sleep for your age.
- Use a weighted blanket
The inability to get out of bed in the morning is a common symptom among those who suffer from ADHD. If you’re having trouble getting out of bed in the morning, consider employing light therapy or making a special treat for yourself when you finally do get up.
A rewards-based method is recommended by the Children and Adults with ADHD organization when dealing with sleep issues in young children. By often checking in on your youngster, you may be able to provide some reassurance. A trusted confidant, maintaining a worry notebook, or practicing relaxation techniques such as guided imagery may help alleviate the tension of bedtime for people with ADHD of any age.
You may not be able to take sleep medicine if you have ADHD, but your doctor may be able to prescribe vitamins or adjust your medication regimen to help you sleep better. Some patients with ADHD find that taking their medication an hour before waking up improves their attentiveness. Cognitive-behavioral therapy for insomnia can help adolescents and adults who are having trouble sleeping (CBT-I).
How to Get to Sleep with ADD
There is a treatment for sleep disorders known as “sleep hygiene,” which takes into account all of the factors that contribute to the onset and maintenance of sleep. This particular mix of circumstances is particularly unique to each individual. Silence is a necessity for certain people. White noise, such as the sound of a fan or radio, can help some people fall asleep. Having a snack in the hours leading up to bedtime is necessary for some people, but not for others. There are a few universal guidelines for good sleep hygiene:
- Don’t use the bed for anything other than sleeping or sex.
- Have a set bedtime and a nighttime routine and stick to it — fiercely.
- Stay away from daytime snoozes.
Two more elements of good sleep hygiene seem obvious, but they should be stressed for people with ADHD.
- Get in bed to go to sleep. Those who suffer from attention deficit hyperactivity disorder (ADHD) often perform their best at night. Their mental clarity and energy levels peak when the sunsets. Distractions are few and far between in this place. They are most prolific at this period. Due to their professions and families, they must get up early the next day, which is made more difficult by a lack of sleep.
- Avoid caffeine late at night. Caffeine can make an ADHD brain more agitated and prone to impulsivity. Caffeine is also a diuretic, but not as effective as previously assumed, and may disrupt sleep due to the need to go to the toilet, which is a side effect of caffeine. Avoiding beverages right before the night is a smart idea.
Treatment Options for ADHD-Related Sleep Problems
There are many symptoms of ADHD, but one of the most common is an inability to sleep at night because the patient’s mind is racing and his body shakes. A dose of stimulant-class medication taken 45 minutes before bedtime is the most effective treatment. Patients who have trouble sleeping may find it challenging to accept this treatment plan. As a result, I ask them to take a nap one hour after they have taken the second dose of their prescription.
Many discover that the “paradoxical impact” of the drug reducing their restlessness is enough to help them sleep. Adults are so sleep-deprived that a nap is typically a good idea. People are more ready to test drugs at bedtime if they can see for themselves that they can help them fall asleep in a “no-risk” environment. The majority of my adult ADHD patients take their entire nightly ADHD medication dose to help them sleep.
It is possible that a patient has a medical history in the opposite direction. One-fourth of people with ADHD either don’t have any sleep disturbances or have normal difficulty falling asleep, as is the case for most of the population. They do not benefit from using stimulant-class drugs before going to bed. One hour before going to bed, Dr. Brown advises taking 25 to 50 mg of Benadryl. Benadryl is a non-addictive antihistamine available over-the-counter. The drawback is that it has a long half-life, lasting up to 60 hours in certain people. The Benadryl paradoxical agitation experienced by 10% of persons with ADHD is so severe that they avoid using it again.
If you’re diagnosed with ADHD, you’re more than likely to have sleep issues, but experts say they’re not usually the result of ADHD-related issues. In some cases, persons with ADHD also suffer from a sleep disturbance. The cause of a patient’s sleep disturbance may be determined by doing a sleep study. A polysomnogram, multiple sleep latency tests, or a home sleeping test may be recommended. Doctors may utilize additional therapy options to deal with sleep troubles if there are secondary sleep issues.
Prescription drugs are the next stage in the therapeutic process. Because of their potential to become habit-forming, sleeping medications are generally avoided by medical professionals. People rapidly become accustomed to drugs and need ever-increasing doses. Non-habit forming medications with considerable sedative effects are therefore the next best bets. These are the names of the individuals:
- Melatonin. When the sun sets, the brain releases a naturally occurring peptide that has a role in regulating circadian rhythms. Without a prescription, it can be purchased at nearly all pharmacies and health food establishments across the country. Most of the time, the available dosages are far too large. There is almost no published research on Melatonin doses greater than 1, although the amounts that are now available on the market are 3 and 6 milligrams each. Using doses higher than one milligram has little benefit. It is possible that Melatonin will not work the first night, thus it may take a few nights of use to see results.
- Periactin. Cyproheptadine (Periactin), a prescription antihistamine, performs similarly to Benadryl while also reducing nightmares and restoring appetite suppression caused by stimulants.
- Clonidine. One hour before going to bed, some doctors advise taking a dose of 0.05 to 0.1 milligrams. The hyperactive component of ADHD is treated with this medicine, which is also used to treat high blood pressure. For around four hours, it has a substantial sedative effect.
- Antidepressant medications, A few doctors may prescribe trazodone (Desyrel), 50 to 100 mg, or mirtazapine (Remeron), 15 mg, for its sedative effects. Lower doses of mirtazapine are more sedative than higher doses because of a complicated mechanism of action. More is not always better. These medications, like Benadryl, might cause drowsiness the next day and make getting out of bed more difficult than it already was.
Problems Waking Up with ADHD
There are two approaches to deal with difficulties in awakening and feeling fully awake. A two-alarm system is the most straightforward. A glass of water and the first dose of stimulant-class medication is placed on the patient’s nightstand next to his or her bed. Set an alarm for one hour before the person intends to get out of bed. Patients wake up when the alarm goes off, take their medication, and then go back to sleep. An hour after the first alarm goes off, the medication’s blood level is nearing its maximum, giving the patient a fighting chance to get out of bed and start his day.
Second, a high-tech technique based on findings suggesting a circadian rhythm disorder is to blame for problems waking up in the morning is being used. Anecdotal research suggests that persons with Delayed Sleep Phase Syndrome can set their internal clocks with the use of sunset/sunrise-simulating lights. After setting their internal clock, many people say that they have a sharper awareness of time and better time management. The lights, on the other hand, are experimental and costly (about 400 dollars).
People with ADHD often have sleep disturbances, although our current diagnostic system and ADHD studies pay little attention to this issue. As we grow older, these tendencies only worsen. The inability to fall asleep has been mistakenly attributed to stimulant-class pharmaceutical side effects, making it difficult to detect sleep disturbances in ADHD. Because of this, stimulant-class drugs can be used to address sleep issues rather than the underlying cause of them, as was once thought.