ADHD and Sleep Disorders
Many children and adults who have ADHD also have a sleep disorder—almost three out of four children and adolescents, and up to four out of five adults with ADHD. Not getting enough sleep, or needing to sleep at times that don’t mesh with school or work obligations, can have significant long-term effects. Those can include physical illness, behavioral issues, and mood changes. While adults may seem obviously tired when they are behind on sleep, fatigue in children often looks like exaggerated ADHD symptoms: hyperactivity and impulsivity—sometimes even aggressiveness and acting out.
Causes of sleep problems
Circadian rhythm disorders. Researchers have repeatedly found that sleep problems are common among people who have ADHD. They think that one reason is because ADHD can mess up what is considered to be a standard sleep-wake cycle, or circadian rhythm. If your circadian rhythm is off, you may have a hard time falling asleep at a standard bedtime, or your sleep may be regularly disrupted, with lots of wakeups throughout the night. Either of those can make it hard for you to wake when your alarm goes off or stay awake and think clearly at work or at school. In general, people with ADHD feel more alert in the evening than they do in the morning. That is the opposite of the way it is for people who do not have ADHD.
For young children with ADHD, it can be difficult to settle down at the end of the day. It may be the child who is wound up from the day’s events can’t stop reliving them and talking about them, or the child who gets so lost in a book or a puzzle doesn’t want to stop reading to brush her teeth and put on pajamas. Although these are not troubling behaviors, when they occur every night, they can frustrate both the child and his or her parents, and in turn further mess with sleep habits.
Caffeine and ADHD medications. Caffeine in soda, coffee, and chocolate, as well as stimulant medications, can also get in the way of a good night’s sleep. Yet even nonstimulant ADHD medications can affect sleep by making people sleepy after taking them—they may need a nap during the day.
Alcohol. Alcohol can make people fall asleep quickly but struggle to stay asleep.
Other conditions. Many conditions that commonly coexist with ADHD, such as anxiety or depression, can have a significant effect on sleep as well.
Electronics. For anyone, too much time on a smartphone, playing video games, or watching television in the evening can mess with the ability to fall asleep and stay asleep.
Common sleep disorders. A number of diagnosable sleep disorders are associated with ADHD.
Breathing disorders. Obstructive sleep apnea, snoring, and other sleep-related breathing disorders are common among children and adults who have been diagnosed with ADHD, though doctors aren’t really sure why. When kids with ADHD and sleep-related breathing disorders have their tonsils removed, they often see an improvement in symptoms of both.
Restless Legs Syndrome. Another common coexisting condition is Restless Legs Syndrome (RLS). People with RLS have an almost uncontrollable need to move their legs. It is especially noticeable in the evenings and when they are in bed. RLS is not common among the general population of children, but many children who have ADHD also have RLS. Researchers aren’t sure why yet. It may just be that the symptoms of the two conditions are very similar and it’s hard to tell them apart when a person is sleeping.
Also in this series:
- ADHD: A 24-Hour Disorder. Psychiatric Times, October 2018.
- Becker SP & Lienesch JA. (November 2018). Nighttime media use in adolescents with ADHD: links to sleep problems and internalizing symptoms. Sleep Medicine 51:171-178.
- Hvolby A. (2015). Associations of sleep disturbance with ADHD: implications for treatment. Attention Deficit and Hyperactivity Disorders 7(1): 1–18.
- Sedky, Karim et al. (August 2014). Attention deficit hyperactivity disorder and sleep disordered breathing in pediatric populations: A meta-analysis. Sleep Medicine Reviews 18(4):349-356.
- Tsai MH et al. (August 2016). Sleep Problems in Children with Attention Deficit/Hyperactivity Disorder: Current Status of Knowledge and Appropriate Management. Current Psychiatry Reports 18(8):76.
- National Institute of Neurological Disorders and Stroke. (2018). Restless Legs Syndrome Fact Sheet.