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. The problem persists in adulthood for the majority of people, although those with ADHD can considerably enhance their quality of life by controlling it carefully.
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A quarter to half of those with ADHD has sleep issues, which can range from insomnia to other sleep disorders. A growing number of doctors are beginning to recognize the importance of treating sleep disorders and the impact this has on both ADHD symptoms and the quality of life for ADHD patients and their families.
What’s the Connection Between ADHD and Sleep?
People with ADHD are more likely to have a shorter sleep time, difficulty falling and staying asleep, and a greater chance of having a sleep disorder as they get older. Children with ADHD, especially those who sleep poorly, are more likely to suffer from nightmares. When it comes to ADHD, sleep problems tend to get worse with age, but they’re also a predictor of later occurrences.
Even those who aren’t usually hyperactive in the daytime can have trouble sleeping at night due to racing thoughts and a surge of activity. Because there are fewer interruptions at night, some people find it easier to “hyperfocus” on a task. A disrupted sleep-wake schedule might result from this, making it difficult to get to sleep. Insomnia may get worse over time if people start to feel anxious about going to sleep.
Many people with ADHD find it difficult to get out of bed in the morning because of a lack of sleep. Others have a hard time getting a good night’s sleep because of their restless, dull sleep patterns and frequent overnight awakenings.
ADHD-related sleep issues tend to vary by kind. It is more common for insomnia to affect people with mostly inattentive symptoms than those with predominantly hyperactive-impulsive symptoms. Poor sleep quality and an earlier bedtime are common occurrences for those with ADHD who are also hyperactive-impulsive and inattentive in nature.
Many of the symptoms of sleep deprivation are similar to those of ADHD. 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. A lack of sleep or ADHD can cause similar symptoms, but it can be difficult to identify. Sleep disorders may go unnoticed or be misdiagnosed as a result of this practice. The asleep study should be done before providing ADHD medication, according to experts.
What’s the Biology Behind the ADHD-Sleep Connection?
Many children with ADHD have trouble sleeping since their brains aren’t able to arouse, alert or regulate themselves properly. ADHD sleep issues may be linked to a delayed circadian rhythm and a later commencement of melatonin production, according to other experts. 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 recommended for ADHD can help some people sleep better at night. Stimulant medicines, on the other hand, can trigger a slew of sleep issues on their own for many people. Poor sleep hygiene and co-existing problems, such as anxiety, depression, or substance addiction, may also play a role.
How Do ADHD Sleep Problems Affect Daily Life??
People who have ADHD and a sleep disorder report worse ADHD symptoms and a lower quality of life, despite the lack of study into this combination. 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 might lead to physical health issues in the long run.
School and employment can be seriously harmed by drowsiness during the day. People with ADHD may be judged for sleeping at the wrong times because they don’t realize it’s a symptom of their condition. In addition to being harmful while driving or engaging in other activities that demand focus, sudden bouts of tiredness can also be dangerous.
Daytime exhaustion might result from a lack of sleep at night. ADHD-related sleep deprivation can make people cranky, irritable, and restless, and it can also make it difficult for them to concentrate at school or work. A mood condition may be confused for these symptoms. Children with ADHD are more likely to experience sleep problems because of their increased levels of worry and behavioral issues.
A person’s family and carers are also affected by these issues. Primary caregivers of children with ADHD and sleep issues are more likely to be unhappy, anxious, stressed, and late to work than those without these conditions.
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. Those who are “night owls,” or those who get a boost of energy when the sun goes down, are those people. 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. Their worries seem to flit from one to the next in a flurry of dread. Due to the common misconception that “racing” thought patterns are indicative of some sort of mood problem, individuals with ADHD are frequently misdiagnosed.
Approximately 10% to 15% of children with ADHD have difficulty sleeping before the age of adolescence. This is twice the rate that is reported in children and adolescents without ADHD. This number rises sharply with increasing maturity: 50% of children with ADHD have difficulties going asleep nearly daily by the time they are 12 12 years old, and by the time they are 30, 70% of people with ADHD report that they spend more than an hour trying to sleep.
2. Restless Sleep with ADHD
When people with ADHD finally go to sleep, it’s usually a restless one. They toss and turn. Noises in the home awaken them. They have such restless nights that their bed companions often opt for a different one. As soon as they wake up, they discover the bed dismantled and the sheets scattered across the floor. When they wake up, they are just as worn out as they were before they went to bed.
3. Difficulty Waking Up with ADHD
More than 80% of people with ADHD in my clinic report numerous arousals till 4 a.m. in the morning. They then enter “the sleep of the dead,” a state from which they are unable to be awoken.
Family members have tried repeatedly to wake them up without success, yet they continue to sleep through at least three alarms. When ADHD sleeper is woken up before they are ready, they are often irritated or even violent. There are a lot of people who claim that they aren’t really awake till noon.
4. Intrusive Sleep with ADHD
Paul Wender, M.D., a 30-year veteran of ADHD research, links the condition to interest-based achievement. The symptoms of ADHD did not appear in people with ADHD as long as the activities they were engaged in or challenged them. (Some refer to this as “hyperfocus,” and it is frequently associated with ADHD.) A person’s neurological system disengages if he or she loses interest in a task, however, because of ADHD. Sometimes this disconnection is so abrupt that it causes significant drowsiness, even to the point of passing out.
EEG expert Marian Sigurdson, Ph.D., says that theta waves suddenly enter the alpha and beta rhythms of wakefulness at this point in the EEG recordings. Everyone has observed “theta wave incursion” in a pupil who abruptly falls to the ground because he or she “fell asleep.” This was most likely the result of a person with attention deficit hyperactivity disorder (ADHD) becoming disoriented rather than falling asleep. Long-distance driving on straight, monotonous roads is a common trigger for this life-threatening illness. EEG negative narcolepsy is a common misdiagnosis. This “intrusive sleep” is difficult to study in a laboratory since it occurs only under certain conditions that are difficult to replicate.
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 disturbances, in addition to chronic generalized insomnia. Sleep disorders may go misdiagnosed due to the similarity of ADHD symptoms to these diseases. As a result of their inability to express themselves, children may be misdiagnosed with ADHD when they are actually suffering from a sleep condition. They may also have a sleep issue and ADHD.
- Circadian Rhythm Sleep Disorder: Adolescents, in particular, who suffer from ADHD tend to become more alert at night. It can be challenging to keep up with work or school obligations due to this unusual schedule. It is possible that people with ADHD have a smaller pineal gland, anomalies in the clock genes, and delayed melatonin release. Bright light treatment or melatonin tablets may help you modify your sleep routine.
- Sleep-Disordered Breathing: Snoring and sleep apnea are common symptoms of SDB, which affects up to one-third of people with ADHD. SDB can produce sleep disturbances and daytime drowsiness, as well as ADHD-like symptoms. Good news for children suspected of ADHD: addressing SDB may lessen their need for stimulant medications. Children with ADHD and sleep apnea may benefit from having their tonsils removed, while adults should use CPAP equipment.
- Restless Legs Syndrome: As a result of tingling feelings in the legs, those with restless legs syndrome (RLS) find it difficult to fall asleep. There is a 50 percent chance that people with ADHD will develop RLS or other periodic limb movement disorders. Stage one light sleep, which is less restorative, is more common in children with ADHD and RLS. RLS may be caused by iron and dopamine deficiency, both of which are linked to ADHD, according to researchers. RLS can be treated with dopaminergic drugs or iron supplements.
- Narcolepsy: Those who suffer from narcolepsy are prone to waking up in the middle of the day, unable to get back to sleep, or both. ADHD is twice as common in adults with narcolepsy as in those without the condition. Despite the lack of evidence, researchers believe that narcolepsy-induced sleepiness may be a contributing factor in the development of ADHD symptoms. A comparable underlying reason, such as a malfunctioning gene or an issue with neurotransmitters, could explain the occurrence of both illnesses. Medications are typically used to combat narcolepsy.
Treating the underlying sleep difficulties of people with ADHD is an essential step in improving their ability to sleep at night. Ask your doctor for a sleep study to rule out any secondary sleep disorders that may need to be addressed in addition to your ADHD treatment plan. 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
Many medical professionals are cautiously optimistic that sleep interventions can help people with ADHD and the side effects of their medication sleep better and feel more in control of their symptoms. 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.
Children, adolescents, and adults with ADHD can benefit from a consistent bedtime routine and proper sleep hygiene practices. To create a system that works best for you, begin by making little adjustments and tracking your progress. Here are a few pointers:
- Remove sugar, caffeine, and alcohol from your diet before going to bed.
- Before going to bed, limit your screen usage to an hour.
- In the evening, stay away from mentally taxing pursuits and projects that necessitate intense concentration.
- Make the bed a place where you can relax and have sex without any worries.
- During the day, get some exercise and some sunlight.
- Create a nightly ritual you’ll look forward to, such as reading a beloved book or spending time with your pets.
- Keep the room dark, cool, and silent, if required, by employing a white noise machine to mute any unwanted noises.
- A realistic and age-appropriate time to go to bed and wake up each day is the best way to ensure that you are getting the recommended amount of sleep for your age.
- For added comfort, use a stuffed weighted ball blanket.
As a result, many people with ADHD have difficulty getting out of bed in the morning. Get out of bed by employing light therapy or planning a fun activity for when you get out of bed, such as an enjoyable workout or a hearty breakfast
It is recommended by the Children and Adults with ADHD organization to use a reward-based strategy for children with ADHD who are having sleep issues. By often checking in on your youngster, you may be able to provide some reassurance. People with ADHD, regardless of their age, may find it easier to fall asleep if they speak with a trusted confidant, keep a worry notebook, or use relaxation techniques such as guided imagery.
Talk to your doctor about adding vitamins or changing your prescription schedule so that you get the best night’s sleep possible. People with attention deficit hyperactivity disorder (ADHD) may benefit from taking their medication an hour before they wake up. Cognitive-behavioral therapy for insomnia can help adolescents and adults who are having trouble sleeping (CBT-I).
How to Get to Sleep with ADD
No matter how a doctor explains sleep disorders, the treatment usually involves a concept known as “sleep hygiene,” which takes into account all the factors that contribute to a healthy sleep cycle. There is a great deal of variation between people with this particular collection of health issues. Absolute silence is required by some people. The sound of a fan or radio can help some people get a good night’s rest, while others prefer white noise. Having a snack in the hours leading up tonight is necessary for some people, but not for others. There are a few general guidelines for a good night’s sleep:
- Don’t use the bed for anything other than sleeping or sex.
- Be sure to establish a regular bedtime and ritual, and then adhere to it religiously.
- Stay away from daytime snoozes.
People with ADHD should pay special attention to two additional aspects of proper sleep hygiene that may seem self-evident to the average person.
- Get in bed to go to sleep. The nighttime hours are the most productive for many people with ADHD. After the sun goes down, they become their most energizing, clearest-thinking, and steady selves. Distractions are scarce and the house is serene. 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 might heighten the irritability and hyperactivity of an ADHD person. Because of the frequent awakenings caused by the urge to use the restroom, caffeine is a diuretic that should be avoided if possible. Avoiding beverages in the hours leading up tonight is a smart move.
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. Because of this, I ask them to take a nap an hour after the second dose of medication in order to ensure that they are taking the correct dosages.
Many discover that the “paradoxical impact” of the drug reducing their restlessness is enough to help them sleep. In most cases, a nap works because most adults are so sleep-deprived that it is a viable option. People are more ready to test drugs before bed if they can witness for themselves, in a “no-risk” environment, that they can help them shut down their brains and bodies and fall asleep. In order to get them to sleep at night, almost two-thirds of my adult patients take their ADHD medicine in its entirety.
What if the patient has a history of the opposite? An estimated quarter of those with ADHD reports no sleep disturbances at all, while the other half report having a normal amount of trouble drifting off to sleep. They do not benefit from taking stimulant-class medications before going to bed. One hour before going to bed, Dr. Brown advises taking 25 to 50 mg of Benadryl. Benadryl is an over-the-counter antihistamine that is not addictive. Some people may experience tiredness lasting up to 60 hours as a result of taking this medication. Benadryl causes significant paradoxical agitation in about 10% of ADHD patients, who therefore never take it again.
There is a wide range of possible causes for sleep problems in adults who have been diagnosed with attention deficit hyperactivity disorder (ADHD). In some cases, patients with ADHD also have a sleep disturbance as a co-morbid condition. The cause of a patient’s sleep disturbance may be determined by doing a sleep study. A Polysomnogram, a Multiple Sleep Latency Test, or a Home Sleeping Test may be recommended. Additional treatment options may be used if there are secondary sleep difficulties.
Prescription drugs are the next stage in the therapeutic process. Because of their potential to become habit-forming, sleeping medications are generally avoided by doctors. Tolerance to them is quickly built and requires ever-increasing dosages. Non-habit forming medications with considerable sedative effects are therefore the next best bets. They’re:
- Melatonin. The brain releases this naturally occurring peptide in reaction to the sun setting, and it may play a role in regulating the circadian clock. Most pharmacies and health food stores carry it without a prescription. There is a tendency for the dosages to be too large. Melatonin has been studied extensively at doses of less than one milligram, however, the dosages currently on the market are either three or six milligrams. Using doses higher than one milligram has little benefit. In order for Melatonin to work, it may take a few nights of use to see results.
- Periactin. Cyproheptadine (Periactin), a prescription antihistamine, works similarly to Benadryl while also suppressing dreams and restoring appetite suppression caused by stimulants.
- Clonidine. In some cases, it is recommended to take 0.05 to 0.1 mg an hour before going to sleep. 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, the sedative effects of drugs like trazodone (Desyrel), 50-100 mg, or mirtazapine (Remeron), 15 mg, are reasons why some doctors prescribe them. Since mirtazapine’s mechanism of action is so complex, it is more sedating at lower doses than at larger ones. In this case, more is not necessarily 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 methods to handle issues with waking up and being completely alert. A two-alarm system is the simplest to set up. 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. It is set to go off an hour before the individual intends to get out of bed in order to avoid any disruptions. 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 individual has a fighting chance to get out of bed and start his day with a dose of medication.
The second technique is more high-tech and is based on evidence suggesting a circadian rhythm disorder is to blame for problems waking up in the morning. Delaying sleep phase syndrome sufferers may be able to set their internal clocks by using sunset/sunrise-simulating lights. Once their internal clock is properly adjusted, many people claim that they have a better awareness of time and how to better manage their time. However, the lights are experimental and costly (about $400).
Disruptions in sleep are widespread in people with ADHD, but the existing diagnostic system and ADHD research tend to overlook them. 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. When it comes to treating ADHD, stimulant-class drugs are often the best option, rather than treating the underlying problem of insomnia.