ADHD Weekly, January 6, 2022

One in three adults are not getting enough sleep. Among adults who have ADHD, that number jumps to two in three adults—about 67 percent—struggling to sleep.

“ADHD adults are chronically sleep-deprived,” says William Dodson, MD, an author and adult ADHD specialist. “The typical person will be wide awake at 3 or 4 AM and has to get up at 7 to go to work.”

Adults need an average of seven hours of sleep. Getting fewer hours than your body needs can lead to several chronic conditions, including heart disease, diabetes, and depression.

Lack of sleep can also make ADHD symptoms worse.

Sleeplessness and ADHD symptoms

Just one night of sleeplessness or shortened sleeping hours can impair a person’s executive functions—the brain’s ability to begin a task, organize information, account for possible consequences of one’s actions, and to manage information effectively from inside themselves and from the outside world.

When humans sleep, the brain becomes active in ways different from wakefulness. Excess hormones and waste products from burning glucose for fuel are swept away. Memories are consolidated in the mind. Nerve cells begin a series of communications that don’t happen while the person is awake. They reorganize, creating new connections and pruning unneeded ones. At other points, we dream—a process important to our health even though science doesn’t clearly know why. In addition to this flurry of brain activity, our bodies physically rest and repair.

Sleeplessness or frequently waking up during the night interrupts this activity and executive functioning suffers.

Making the sleepy situation worse, ADHD is known to make it harder to fall asleep and stay asleep. Many adults get caught in a cycle of symptoms preventing healthy sleep, and lack of sleep increasing the severity of symptoms.

“The ADHD brain is wired in a way that makes sleep difficult,” says Roberto Olivardia, PhD, a member of CHADD’s professional advisory board. “Sleep difficulties or not wanting to go to bed isn’t about being obstinate or oppositional.”

The risks of under-sleeping

Chronic under-sleeping can also increase the risk for age-related memory loss and other chronic brain-based conditions. More readily, it makes the short-term memory struggles more difficult, for both adults who have ADHD and those who don’t. It decreases motor function, so people move more clumsily, while increasing the tendency toward making mistakes.

Waking up to better days

Working with your ADHD specialist to fine-tune your treatment plan is the first step to improved sleep. This may include changing the timing of when you take medication, since some people find an evening dose actually allows them to fall asleep more easily.

“Exactly why it works is unclear, but maybe it activates a part of the brain whose main function is to filter [sleep-impeding thoughts] that come in,” says Michael Coates, MD, an adult ADHD expert and past chair of family medicine at Wake Forest Baptist Medical Center in North Carolina.

Some adults include melatonin, a lab-made hormone similar to the body’s own sleep-inducing chemical, as part of their evening routines. It is suggested to use melatonin as a short-term supplement while creating a sleep routine that works for you. As always, discuss this and any other supplements with your healthcare providers before including it.

You’ll want to try out a few evening routines before find the right ones for you. Some ideas for settling in:

Create a sleep schedule. Make sleep a priority and set a fixed bedtime and wake-up time. Don’t skimp on your scheduled sleeping hours, but also don’t indulge in naps that can make evening sleep more difficult.

Use the brain’s own sleep triggers. Human bodies are made to respond to daylight when it comes to sleep, but our modern world has adapted to artificial daytime hours. At least an hour before your bedtime, dim the lights, put away cellphones, tablets, and turn off the computer. If you can, find a good book or a favorite magazine in print and take some time to read rather than watch TV. All of this signals to your brain that day is ending and to produce natural sleep-inducing hormones.

Create a sleep sanctuary. Pick out a favorite comforter or weighted blanket for your bed, a nice set of sheets, lower the bedroom lights and temperature, and remove electronics that trick your brain into thinking it’s daytime. Some people find a white-noise generator or soft music is helpful for easing into sleep.

Don’t fight sleeplessness. Most people need about twenty minutes to fall asleep. If you’re still awake after a half an hour, turn on a dim light, get out of bed and do something quiet and soothing—read a book, get a light snack—and break the association between being in bed and not sleeping. Once you feel sleepy again, or perhaps after a brief time you’ve set, such as fifteen or thirty minutes, return to bed. You may have to do this more than once in a night, but your body will soon learn the routine you’ve created to settle into sleep.

Seek help from professionals. Sleeplessness is very common and often expected with ADHD. Talk with your healthcare provider and rule out other health conditions that could make sleeping difficult. There are medical and therapeutic interventions that can help.

“It’s taken years of trial and error to reach this point, but on the whole, my sleep is getting better,” says Reid Payne, a CHADD volunteer, who struggled for years to sleep well. “Like everything in life, it’s a journey. I work on what I can and don’t worry about what I can’t. That’s all you can do in the end. Hey, it’s not worth losing sleep over!”

Still awake and looking for more?

• ADHD and Sleep Disorders
• My Quest for That Elusive Good Night’s Sleep
• Sleep Is Not Always Easy When You Have ADHD
• Optimizing Executive Functions Through Sleep
• How Can We Help Children with ADHD get a Better Night’s Sleep?
• ADHD Never Sleeps (But Children and Adults with ADHD Can)

Join the discussion: What is your favorite part of your evening routine?