Attention Magazine December 2022

Are adults with ADHD more likely to have difficulties with sleep, and in what ways? This research brief examines two studies that investigated the associations between sleep disturbances and adult ADHD.

The first study found that sleep problems were more severe and greater in frequency among adults with ADHD compared to adults without ADHD who had other psychological disorders. These results demonstrate that sleep disturbances may be uniquely associated with ADHD among adults, and that adult ADHD was related to greater severity of sleep problems. The second study reviewed multiple studies on sleep, and showed that adults with ADHD had lower sleep quality, longer sleep onset latency, more night awakenings, more sleep problems, less sleep efficiency, more psychosomatic symptoms during sleep, and more daytime sleepiness.

Overall, these studies indicate that adults with ADHD have greater sleep difficulties compared to adults without ADHD. Sleep is therefore likely to be an area in need of intervention in treatments for ADHD.

Prevalence and severity of sleep disorders

This study explored the prevalence of sleep disorders and their severity in adults with and without ADHD in Italy. These individuals were involved in outpatient services at a hospital. Their diagnoses were evaluated using clinical interviews, and they also completed several questionnaires assessing areas such as sleep and ADHD symptoms.

Forty-four participants were in the ADHD group and 590 were in the non-ADHD group. Across the entire sample, 82% of participants indicated having no or slight sleep problems, 16.7% indicated having a mild or moderate sleep disorder, and 1.3% reported having a severe sleep disorder. Adults with ADHD had more sleep disorders than adults without ADHD. Thirty-four percent of adults with ADHD indicated having no or slight sleep problems, 59.1% indicated having a mild or moderate sleep disturbance, and 6.8% indicated having a severe sleep disorder.

In addition to adults with ADHD having more sleep disturbances, they reported having more severe sleep problems than adults without ADHD. Greater severity of sleep problems was associated not only with having ADHD, but also with other co-occurring psychological disorders as well as prior suicide attempts. However, out of these predictors of sleep problems, ADHD was the most salient one.

Therefore, there appears to be a high prevalence and severity of sleep disorders in adults with ADHD, compared to outpatient adults who do not have ADHD but have other psychological disorders. This result is important given that individuals with other psychological disorders show more sleep problems than those without such disorders. Overall, these findings demonstrate that sleep disturbances are uniquely associated with ADHD rather than due to other psychological disorders.

Valsecchi P, Nibbio G, Rosa J, & Vita A. (2022). Adult ADHD and sleep disorders: Prevalence, severity and predictors of sleep disorders in a sample of Italian psychiatric outpatients. Psychiatry Research, 310, 1-6. https://doi.org/10.1016/j.psychres.2022.114447

Measuring sleep difficulties

This meta-analysis reviewed studies of sleep and adult ADHD using subjective and objective measurements of sleep difficulties. Studies comparing adults with ADHD to adults without ADHD were among the 13 studies included in the review.

The findings showed that adults with ADHD had a longer sleep onset latency, more night awakenings, more sleep problems, lower sleep quality, more psychosomatic symptoms during sleep, less sleep efficiency, and more daytime sleepiness, compared to adults without ADHD. There was, however, no difference between adults with and without ADHD on the restorative value of sleep or sleep duration. Results of objective sleep measures also showed that adults with ADHD had more sleep onset latency and worse sleep efficiency compared to adults without ADHD. The samples of studies included in this meta-analysis varied in terms of co-occurring psychological disorders as well as medication status.

All in all, this review indicates that adults with ADHD report more sleep disturbances in a number of areas compared to adults without ADHD, and also show some differences in sleep difficulties using more objective measurements.

Diaz-Roman A, Mitchell R, & Cortese S. (2018). Sleep in adults with ADHD: Systematic review and meta-analysis of subjective and objective studies. Neuroscience & Biobehavioral Reviews, 89, 61-71. https://doi.org/10.1016/j.neubiorev.2018.02.014

Yuanyuan Jiang, PhD, CPsych, is an assistant professor and registered psychologist in the school of counseling, psychotherapy, and spirituality at Saint Paul University. Her research focuses on studying how attention, behavior, and cognitions interact to learn how to  improve assessments and interventions for children with ADHD.