An Introduction to ADHD and Sleep
The majority of individuals with ADHD report some type of difficulty with sleep. The relationship between ADHD and sleep is complex and is multidirectional, meaning sleep issues can impact the intensity of ADHD traits and ADHD traits can impact sleep.
Let’s review some common sleep issues related to ADHD:
Delayed Circadian Rhythms
Many ADHDers report that they have a hard time getting out of bed in the morning regardless of how many hours they’ve slept. They also may have a tendency to stay up later at night compared to others. One explanation for this is having a delayed circadian rhythm, which is more common for ADHDers. This is the body’s internal sleep/wake cycle that recurs every 24 hours. This can also be referred to as Delayed Sleep Phase Syndrome (DSPS). Having a delayed circadian rhythm isn’t inherently problematic, but we live in a world that has expectations about when one is awake and sleeps and it’s often necessary to follow these social norms. If you are an ADHD parent with children in public school, you may need to get them to school before 8:00 am even though your body’s natural wake up time may not be until 9:00 am. It’s important to recognize this is a common experience for many ADHDers. Often medical professionals and well meaning other humans will often make assumptions and judgments about the ADHDer or their efforts to sleep. However, if the person has a delayed circadian rhythm they are likely to continually struggle with sleeping at the normative times despite trying “all the things” simply because they aren’t following their body’s natural rhythm.
Revenge Bedtime Procrastination
Revenge Bedtime Procrastination is a somewhat newer term that has been used to describe the experience of sacrificing time sleeping because you want to take time to meet your own needs with no external demands on you. While this can occur for anyone, it’s particularly common for parents of young children. There are often many demands placed on us by others or society, so we may consciously decide to put off sleep by staying up later in order to engage in activities just for ourselves. Wanting to have some “me time” is entirely valid. Dare I say it’s even essential to our wellbeing. Ideally though, we can review our daily schedule and problem solve ways to build in “me time” that does not require sacrificing sleep.
Sleep Disorders that Co-Occur with ADHD
There are a few sleep disorders that commonly co-occur with ADHD. One of these is restless leg syndrome (RLS) a condition marked by uncomfortable sensations in the legs and an irresistible urge to move them. It can cause difficulty falling asleep and disrupt sleep throughout the night. One study stated it occurs in approximately 2-15% of the general population compared to around 44% of children with ADHD and 20-33% of adults with ADHD.
Sleep apnea, characterized by interrupted breathing during sleep, can lead to fragmented and poor-quality sleep, resulting in daytime fatigue and impaired cognitive function. Sleep apnea occurs in about 3% of the general population compared to estimates of 25% or higher in those with ADHD. Given all of this, if someone with ADHD is noticing difficulties of restless sleep or feeling tired even after getting a full night’s sleep, it’s best to get a sleep study.
Role of Stimulant Medications
Stimulant medications taken to help manage ADHD traits can impact sleep for some individuals. ADHDers who take stimulant medications generally report feeling more calm and focused when medicated when on the proper dosage, as opposed to non-ADHDers report feeling extra energy and less of a need to sleep when they take stimulant medications illicitly. For ADHDers taking stimulant medication as prescribed, while most may not feel a sense of stimulation, some do experience difficulty initiating sleep if they have a body that is extra sensitive, or if the medication is taken too late in the day. This is different for everyone. There are also some individuals with ADHD that find taking stimulants later in the day actually helps them sleep because their brain is able to slow down instead of having multiple thought trains racing at once.
Sleep Issues Can Mimic ADHD Traits
Lack of sleep in and of itself is known to cause difficulty with many brain functions. In a recent interview I listened to with a doctor, he stated that if someone has many presenting concerns and only one could be addressed, that he would choose to prioritize sleep above all the rest as it has the largest impact on all other health factors. Individuals may have sleep disorders that disrupt sleep. Sleep deprivation is known to cause symptoms such as:
Difficulty sustaining attention
Distractibility
Decreased ability to engage in executive functioning skills such as planning, problem solving, decision making
Emotional dysregulation
irritability
Restlessness
Impulsivity
Memory difficulties
Increased anxiety and depression
Sounds familiar, right? All of those items listed sound a lot like ADHD. Thorough assessment is necessary when considering a possible ADHD diagnosis. Sleep patterns and quality should be included in any ADHD assessment process. Another factor to consider in differentiation is that ADHD is neurobiological, so we can expect the symptoms to be present regardless of whether the individual is sleeping well. It is to be expected in individuals who do have ADHD, that the symptoms will be more pronounced when the individual is sleep deprived. If the above mentioned symptoms are not present at all when sleeping well, a sleep study may be worth considering.
As you can see the relationship between ADHD and sleep is a complex one. ADHD causes difficulty with sleeping. ADHDers are more likely to have co-occurring sleep problems, and sleep issues can mimic ADHD traits. Once one has gained clarity on whether they have ADHD, sleep disorders, or both, then they can begin seeking ways to manage any sleep challenges.
Check back soon for our next article on Managing Sleep Difficulties with ADHD.
Reference:
https://link.springer.com/article/10.1007/s12402-014-0151-0
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The content provided in this article is intended for informational purposes only and should not be considered as a substitute for professional medical advice, psychotherapy, or diagnosis. While efforts have been made to ensure the accuracy and reliability of the information, it is crucial to recognize that every individual is unique, and their situations may vary. Readers are encouraged to consult with qualified healthcare professionals.
