Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder with three main behavioral issues, hyperactivity, impulsivity, and inattentiveness. The condition affects 5% to 11% of children and the symptoms usually last into adulthood.
According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), ADHD presentations fall into three self-explanatory categories:
- Predominantly inattentive presentation
- Predominantly hyperactive-impulsive presentation
- Combined presentation
The diagnosis is made if the symptoms are present for at least the last six months. However, diagnosing ADHD is a bit of a challenge, especially in children.
You see, many of the ADHD symptoms can look like typical behavior for kids, for example, being impatient and impulsive, not paying attention, daydreaming, or having trouble sleeping. In fact, many sleep deprivation and ADHD symptoms overlap, such as:
- Difficulty sleeping and/or waking up
- Hyperactivity
- Impulsive behavior
- Low self-control
- Inattentiveness
- Carelessness
- Irritability
- Impatience
Ways ADHD Can Affect Sleep
People with ADHD usually have a hard time getting quality sleep. They often experience trouble falling asleep, and once they do, they find it difficult to stay asleep. On the other hand, when it’s time to get up, most will sleep through many alarms before finally waking up.
The following chart breaks down various ways in which ADHD can be linked to sleep problems.
Let’s explore a few reasons why many people with this mental health condition experience sleep issues.
Time Perception and Management
People with ADHD are often running late. That's because they get easily distracted and, as a result, find it difficult to follow a set schedule. Moreover, their idea of time is abstract. They usually find it difficult to estimate time because their internal clock recognizes only two times, 'now' and 'not now.'
As a result, it can become difficult for people with ADHD to stick to a set sleep/wake time or a regular bedtime routine. Their activities tend to linger on, and they lose track of time. Sometimes, the lack of self-control makes it impossible for them to make the transition to sleep at a regular time daily.
Inaccurate Circadian Clock
Children and adults with ADHD tend to have an inaccurate circadian clock with a delayed sleep-wake cycle. At night our bodies release melatonin to prepare the body for sleep, but in a person with ADHD, melatonin release is usually delayed. If untreated, it can lead to sleep deprivation.
Similarly, high cortisol levels in the morning prepare the body for waking up. But, in people with ADHD, cortisol levels remain low, making it difficult to get up and get ready for the day.
Irregular Arousal and Alertness
According to Dr. Thomas Brown, sleep problems associated with ADHD are due to irregular arousal and alertness. People with ADHD often lack an interest in any activities or sustain that interest long enough to accomplish something.
On the other end, if something grabs their attention, they tend to hyperfocus and are unable to regulate this interest.
When individuals with ADHD go to bed, they are unable to shut down their thoughts and calm their minds. In other words, they are unable to switch off their aroused state of wakefulness and transition to sleep.
Intrusive Sleep
Have you ever experienced a sudden urge to sleep out of boredom? Dr. Marian Sigurdson, an expert on electroencephalography (EEG), noticed a surge of theta wave intrusion in the students with ADHD who suddenly crash to sleep in the classroom.
Intrusive sleep can be fatal if it occurs during long-distance driving on monotonous roads. Contrary to narcolepsy, boredom triggers daytime sleep in ADHD, and some people fight the urge by becoming overly hyperactive.
Use of Stimulant Medication
Many stimulant and non-stimulant medications are used for treating ADHD. Research shows about 30% of kids on stimulants take at least 30 minutes to fall asleep compared to 10% of untreated children.
Insomnia is seen in 65% of the kids on methylphenidate and amphetamines. Stimulants affect kids' sleep more when compared to adults.
Depression and Anxiety
Often people with ADHD struggle with depression, anxiety, or other mood disorders. These mental health issues can have a drastic effect on the sleep habits of individuals with ADHD and the general population.
Some adults with ADHD also fall victim to substance abuse and develop sleep issues subsequently.
Sleep Disorders and ADHD
Sleep disturbances and ADHD often go hand in hand, and their symptoms overlap too. Some sleep disorders occur due to ADHD-related changes in the brain, while others may show ADHD-like signs.
In fact, people with sleep deprivation are sometimes misdiagnosed for having ADHD. That's why researchers suggest compulsory screening for associated sleep disorders when a person comes in with ADHD symptoms.
The following are some of the common sleep disorders associated with ADHD.
Insomnia
Insomnia is one of the most common sleep problems seen in people with ADHD. Most children and adults report taking anywhere from 30 minutes to an hour to fall asleep finally. Insomnia prevalence in those with ADHD is 80% compared to 56% in the general population.
Once people with ADHD do fall asleep, their sleep is light, so they tend to wake up from every other disturbance. They often squirm a lot in sleep, and even if they don't wake up, the sleep is unrestful, and they usually feel tired and sleepy the next day.
Sleep Apnea
25-30% of people with ADHD experience sleep apnea and other sleep-disordered breathing issues. By contrast, only 3% of the general population has sleep apnea. That's why when children present with ADHD, they are also evaluated for the presence of any sleep-disordered breathing problems.
Obesity, which often leads to sleep apnea, is also common among kids with ADHD. However, studies show that hyperactivity and irritability related to ADHD can subside when patients get sleep apnea treatment.
Delayed-Phase Sleep Disorder
In Delayed Phase Sleep Disorder, the body's sleep/wake cycle occurs later than a regular night and day cycle. The body produces melatonin late in the night, and therefore, you don't feel sleepy at your bedtime.
However, due to the delayed phase rhythm, people with ADHD also tend to wake up later in the day. This sleep-wake cycle is quite common among adolescents all over the world and results in sleep loss and impaired functioning.
Restless Legs Syndrome (RLS)
About 44% of children with ADHD experience restless legs. The uncontrollable tingling is followed by an urge to move legs to get relief. This unpleasant feeling occurs right when you're about to fall asleep. So it not only disturbs sleep but also makes kids resist going to bed.
Similarly, can occur during the day, but it often looks like hyperactivity. Interestingly 26% of people with RLS also exhibit ADHD-like symptoms, which disappear as you treat RLS. So, it's crucial to assess kids for RLS when they present with ADHD symptoms.
Periodic Limb Movement Disorder (PLMD)
Unlike RLS, PLMD is a jerking movement of legs which occurs mostly during sleep. It usually occurs every 20 to 40 seconds in clusters that may last for a few minutes to a few hours. Most people are unaware of these movements, but sleep studies can record them.
Periodic limb movements during sleep (PLMS) are considered a disorder if they disrupt an individual's sleep. PLMD and ADHD have many common symptoms, and both affect the quality of sleep. The duration and number of PLMS are higher in ADHD.
Treatment Options for ADHD-Related Sleep Problems
Treating sleep issues in individuals with ADHD can resolve or reduce many daytime ADHD symptoms such as excessive sleepiness, inattention, and hyperactivity. Here are a few successful treatment options that are safe for both kids and adults.
1. Stimulants and Sedatives
Determining the exact cause of sleep problems is the best way to solve them. If they’re due to the restlessness associated with ADHD, a stimulant medication 45 minutes before bedtime is enough to shut down their thoughts and let them sleep.
However, about one-third of people with ADHD have comorbid sleep disorders. The best course of action is to visit a sleep specialist and get diagnosed. Besides stimulants, the non-habit forming sedatives commonly prescribed to ADHD are as follows.
Melatonin
Melatonin is a natural hormone produced by our pineal gland. As discussed earlier, melatonin production in people with ADHD is delayed. That’s why melatonin therapy is quite effective in regulating their sleep/wake cycle.
However, melatonin may not act the first night. You may need to take it for a few days to see any improvement in sleep.
Periactin
Periactin acts like Benadryl, the over-the-counter antihistamine with sleep-inducing properties. It is a prescription drug with the added advantage that it counters the stimulants’ effect on appetite. It also suppresses dreams and improves the overall quality of sleep.
Clonidine
Although a drug used for high blood pressure, Clonidine counters hyperactivity induced by ADHD. Its sedative effects last for about four hours only.
Antidepressants
Commonly used for their sedative effect, antidepressants such as Desyrel and Remeron are used in low doses, but even then, their effects last till the next day and make getting up in the morning difficult.
Side Effects of Pharmaceutical Treatments
Like all medications, sedatives used for ADHD also have their side effects. For example, high doses of melatonin can increase seizure risk in kids. Only 0.5 mg in kids and 1 mg in adults is sufficient to induce sleep, but it's usually available on the shelves as 3 to 6 mg doses.
Similarly, Benadryl, Periactin, and antidepressants are long-acting drugs and can make it difficult for people with ADHD to wake up the next morning. Moreover, they can also cause excessive sleepiness the next day.
Clonidine is quite effective against insomnia, but its effect is short-lived, so if you wake up in the middle of the night, it's effect might have worn off by then. Interestingly, high doses of clonidine are less effective at inducing sleep than the lower doses.
2. ADHD Supplements for Sleep
Many people prefer natural supplements to medications, especially for kids. No matter how effective and safe ADHD medications are, it's always a difficult decision to put your three or eight-year-old on drugs.
On top of it, every medicine has some potential side effects, and not every drug acts the same way in every child.
Some of the common supplements used by people with ADHD are as follows.
Omega 3 Fatty Acids
Omega 3 fatty acids are considered super brain food for people with ADHD. In low amounts, it decreases sleep disturbances and facilitates melatonin release. However, high amounts of fish oil can interfere with sleep, so moderation is the key.
Iron
Iron studies in kids with ADHD show ferritin levels at 22 compared to 44 in neurotypical kids. Iron deficiency has a strong link with RLS, and around 68% of persons with iron deficiency anemia show sleep problems.
Iron supplements are often a part of the ADHD regimen, but before taking any on your own, it's crucial to measure iron levels because high levels are life-threatening.
Zinc
Dietary zinc improves sleep onset and sleep quality. In fact, sleep problems are one of the most prominent signs of zinc deficiency. Since our body absorbs only 30% of zinc from our diet, these supplements are crucial for maintaining optimum levels.
Zinc supplements also decrease the requirements of stimulant medications by 40% for the same level of relief from ADHD symptoms.
Ginkgo Biloba
Ginkgo improves sleep by reducing anxiety symptoms, of which sleeplessness is one of the most common. It also improves cognitive functions and attentiveness by 35% when used with stimulant medication. However, it has little effect on impulsivity or hyperactivity.
Therapies for Sleep
Medication alone is not enough for long-term management of ADHD symptoms. People with ADHD thrive in a structured environment, and non-drug therapies are usually based on set routines.
As a result, individuals with ADHD learn to manage their symptoms, including sleep problems and life skills like time management. These therapies include:
Stimulus Control Therapy
It's a part of cognitive behavior therapy for insomnia (CBT-I) in which the person is asked to restrict the bed only for sleep. You follow a strict sleep/wake up time, avoid naps, and leave the bedroom if you're not asleep within 20 minutes.
You should return to bed only when you feel sleepy again.
Sleep Restriction
Sleep restriction involves partial sleep deprivation to build up sleep drive. The actual sleep duration is calculated over a week before the therapy. Next, the time in bed is restricted to this calculated sleep duration.
So for example, if you stay in bed from 11:00 pm to 8:00 am but sleep only for six hours, your bedtime will be restricted to 12:00 to 6:00 am. Sleep quality and the number of nighttime awakenings are measured for next week.
You can increase your sleep duration gradually once you start sleeping through the night without waking up.
Light Therapy
If sleep problems are due to delayed sleep phase disorder, light therapy is quite effective in regulating the circadian rhythm. The first bright light exposure session begins right after you wake up, at the time you naturally wake up without any obligations whatsoever.
Wake up time is then advanced in increments of 15 or 30 minutes. Similarly, dim the lights at least one hour before bedtime and do not lie in bed awake. Follow stimulus control therapy instructions for nighttime awakenings.
So, if you usually wake up at 9:00 am, your light therapy schedule might look something like this:
Sleep Management Tips for Children with ADHD
While medications and therapies are quite effective, you can make peace with your child over nighttime struggles by following these simple yet effective sleep management tips.
1. Follow a Bedtime Ritual
Most people with ADHD have difficulty transitioning from one activity to another. Following a bedtime ritual every night makes this transition smoother. After repeating the same routine enough times, it will become a conditioned reflex inducing calmness and sleep.
You should move from energetic to calmer activities. For example:
- You can start by brushing teeth, having a warm bath, and changing into pajamas.
- Next, you can read a book together or do night yoga, whichever your kid prefers.
- Finally, tuck your child in bed at least 15 minutes before bedtime so you and your child can spend some relaxing one-on-one time.
Sprinkle in lots of hugs and kisses to make nighttime all the more rewarding. You can use a timer and charts so that the child can follow the bedtime ritual independently after some time.
2. Cultivate Desire to Go To Sleep
Kids with ADHD usually follow their hearts. So, if you can make them want to go to sleep, they will be more inclined to follow through. Some of the best ways to do that include:
- Make bedtime fun and give the child your undivided attention so he/she will look forward to it.
- Talk to kids about the benefits of sleep so they can understand why it’s essential.
- Reward them every time they go to bed and/or wake up on time.
A little encouragement goes a long way with kids with ADHD and otherwise.
3. Try Meditation and Mindfulness
Our bodies are programmed to follow routine tasks without having to focus much. But in people with ADHD, this natural tendency leads to impulsive behaviors. That’s why coaching your child to be mindful in everything they do can go a long way at helping them control their impulsiveness.
You can make meditation a part of their bedtime ritual. There are many kid-friendly guided meditation videos available on Youtube for free. Meditation can not only make your child more compliant but also frees their minds of the million thoughts going on in an ADHD brain.
4. Make Bed and Bedroom Relaxing
Make the bedroom and bed as relaxing as possible. You can diffuse calming essential oils in the room or apply them on their clothes or pillows. However, be careful when applying on their skin as not all essential oils are safe for kids.
When buying a mattress for your kid with ADHD, make sure to take him/her with you to the mattress showroom. Have them test the mattresses so they can choose the firmness or texture that helps them relax.
5. Remove Distractions from The Bedroom
Kids with ADHD can easily get distracted. They tend to act on impulse, so remove any toys, books, computers, TV, or any other irresistible activity that's not a part of their bedtime ritual.
This is all the more important if your child has any underlying sleep disorders.
6. Limit Screen Time Before Bedtime
Screen time during the evening can have a dire effect on your child's sleep. Since people with ADHD usually already have a delayed-phase sleep, blue light exposure can increase the risk of poor sleep quality.
Blue light can also make them more inattentive to their sleep needs. They might lose track of time spent on games, texting, and watching videos. So, restrict screen time to 30-minute to one hour and impose reasonable rewards and consequences for following these rules.
7. Avoid Stimulant Foods Before Bedtime
Avoid any high-sugar foods right before bedtime. Chocolates, cakes, and donuts are all a big no as they stimulate the mind with a surge of energy. Interestingly, cinnamon is also a potent stimulant, and it's found in many kinds of cereal.
If you give your child any ADHD supplements for cognitive activation such as Ginseng or Ginkgo, you might want to use them in the morning or early in the evening.
8. Spend an Active Day
Spending a day full of activities that exhausts your child both physically and mentally is a sure way to help them transition to sleep smoothly as night approaches.
An active day also improves sleep quality. It increases the duration of slow-wave sleep, also known as deep sleep. It also improves mood, making kids more willing to comply with the bedtime schedule.
9. Monitor Naps
Naps can be an excellent way to structure young kids' day. It also helps them rest and recollect themselves. However, make sure the naps are time-limited and occur at a consistent time daily, including weekends.
Older kids should avoid naps as they can disturb their sleep patterns and most often delay their bedtime. Prolonged sleep onset issues can lead to all sorts of problems, especially restless legs syndrome. If they must, they can take a power nap of 20-30 minutes.
10. Cultivate Time Management Skills
Time management is one of the most challenging tasks for people with ADHD. But, if you start at a young age, you can help your kids manage their schedule effectively, including their sleep routine.
Break down the day into manageable chunks and reward them when they stick to the time limits. Gradually, time management will become a habit, and transitioning from one task to the other won't be that big of a struggle for them.
Sleep Management Tips for Adults with ADHD
Adults with ADHD also find it challenging to transition to sleep. But, these tips will help them overcome the resistance within themselves.
1. Avoid Engaging Tasks Before Bedtime
Most adults are so engrossed in their activities that they miss their bedtime altogether. Others are just unable to control the impulse to carry on with the task at hand.
You can make the transition easier by not engaging in any tasks that might be too difficult to leave. For example, don't start watching your favorite movie when you know it won't finish before bedtime. Or, don't work on that critical assignment or exciting project in the late evenings.
2. Follow a Strict Sleep Routine
Establish a bedtime ritual and follow it religiously at a set time daily. You should start your bedtime ritual at least an hour before bedtime. It can include having a warm bath, a cup of calming tea, reading a book, or writing a journal.
Many people with ADHD like to keep a diary for a brain dump before bedtime to free up their mind for sleep. Follow a strict sleep and wake up time, and gradually it will become a habit that you can follow impulsively.
3. Daytime Activity and Sleep Hygiene
Exercise daily for at least half an hour in the morning to regulate your energy and improve cognitive functions. However, don't do any strenuous exercise later in the evening. Instead, do light yoga as a part of your bedtime ritual.
Similarly, eat sleep-inducing food in the evening. At the same time, avoid stimulating foods such as coffee, chocolates, or anything which contains lots of sugar.
4. Be More Mindful About Sleep
People with ADHD tend to self-sabotage or act impulsively due to habit or uncontrollable desire. Practice mindfulness during routine activities throughout the day and during your bedtime ritual.
You can meditate to train your mind to be more present so you can make conscious decisions. You should also set some cues or prompts to enter into a mindful state. Counting to 10 is the easiest way to delve into mindfulness.
5. Two-Alarm System
If waking up at a set time is a struggle for you, try out the two-alarm system. It works for those on stimulant medication.
Put your medicine with a glass of water by your bedside. Set two alarms, 30 minutes to one hour apart. When the first alarm goes off, manage to wake up yourself enough to take your medicine. By the time the second alarm goes off, medicine's effect makes getting up and out of bed easier.
Helpful Sleep Products for Those with ADHD
If you experience sleep issues due to ADHD, you're not alone. That's why you can find many products on the market that aim to make sleep more manageable for people with ADHD.
1. Anti-Snoring Devices
If snoring or sleep apnea are the culprits of your sleep problems, you can use anti-snoring mouthpieces and dental devices. Nasal dilators are also quite useful. However, if you snore too loudly, your sleep specialist may recommend a CPAP machine to keep the airways open.
2. White Noise Machine
White noise masks sudden sound changes in the environment that may disturb your sleep. You can also use white noise if the absence of sound unsettles you. White noise machines produce a static, calming sound. They also drown irritating sounds in the room like the whirring fan or the ticking clock.
4. ADHD-Friendly Alarms
If you, like many other adults with ADHD, regularly sleep through multiple alarms no matter where you place them, then you should invest in an ADHD-friendly alarm. Some people benefit from high-pitched sounds like the Screaming Meanie while others prefer progression alarms like the Zen Alarm Clock and Philips Wake-up Light.
5. Interactive Nightlights
When kids with ADHD toss and turn in bed and cannot fall asleep, you can use interactive nightlights to distract them. Two great examples are the Twilight Turtle or the OK to Wake! Owl.
The Twilight Turtle projects glowing stars on the ceiling and around the room to distract and soothe the child. Similarly, Ok to Wake! is a cuddly owl that teaches kids to stay in bed if they wake up in the middle of the night. When you hug it, it glows and sings lullabies. If it glows green, it means you can get out of the bed.
6. Body Pillows and Weighted Blankets
Gentle yet firm pressure also called deep touch stimulation, is a form of therapy that can help people with ADHD self-soothe and feel calmer. When individuals with ADHD use weighted blankets or squish a body pillow, they can feel more peaceful and relaxed.
7. A Comfy Mattresses
If you want to sleep better, you need a comfy mattress, more so if you have trouble sleeping. Mattresses come in many comfort levels from soft to firm and many firmness levels in between. Whether a firm or a soft mattress is comfortable for you depends on your sleep preferences, dominant sleep position, and body type.
Additional Resources
Check out the following resources if you need more information about ADHD, it's symptoms, and management.
Sleep Resources for ADHD
Parents Guide to ADHD
Adult ADHD
ADHD Knowledge Base
Support Groups
Making your bed and bedroom comfortable is central to improving your sleep quality. Even if you follow all the tips and tricks to help you or your child fall asleep, if your mattress isn’t suitable for you, you won’t be able to get a restful snooze.
That’s why you should select your mattress carefully, keeping in mind ADHD and the sleep issues related to this neurodevelopmental disorder. Also, visit our mattress comparisons page to pit your top choices against each other. The side-by-side analysis will help you figure out the best mattress that meets your sleep needs.
Resources
>> How Much Sleep Do Kids Need
>> How Long Can A Baby Sleep In A Bassinet
>> Insomnia In Children
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