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Attention Deficit Hyperactivity Disorder, commonly known as ADHD, is a behavioural and neurological disorder usually characterised by distractibility, impulsivity and hyperactivity. ADHD can have a significant impact on one’s day to day life, often affecting relationships, educational and professional development and general mood. However, while many of the concerns related to ADHD are widely recognised, there is still some uncertainty around whether problems with sleep could be directly related to the disorder.
Sleep deprivation has been overlooked as a key characteristic of ADHD for a number of years. This is because difficulties with sleep often develop in adolescence, leading it to being missed as a sign of autism in younger children, in some cases. Due to sleep problems becoming more apparent with age, these difficulties may not be included under the DSM-6’s (diagnostic and statistical manual) criteria for ADHD diagnosis, which states that all symptoms of ADHD must be present by the age of 7. Recently, studies on adolescents and adults with ADHD have confirmed that the disorder can have an impact on a person’s brain functionality during sleep – thus leading to sleep disturbances.
Several ADHD symptoms are similar to those of sleep deprivation in neuro-typical individuals, including forgetfulness, difficulty concentrating and impulsiveness. However, this is not to be confused with how ADHD and sleep disturbances are directly related to one another. For people with ADHD, sleep may be affected by the delayed circadian rhythm (commonly known as internal body clock cycles) or impaired regulation circuits in the brain that are often recognised in those with ADHD. This contrasts to what may cause sleep difficulties in neurotypical individuals – stress, anxiety or narcolepsy (which is genetic).
The kinds of sleeping problems that people with ADHD face will likely depend on the type of ADHD they have. The DSM-6 lists three presentations of ADHD:
Those with the predominantly inattentive presentation of ADHD will likely have difficulty sticking to a regular sleep schedule, and may use their bedtime as an opportunity to hyper-focus on a project. Those who are hyperactive-impulsive may experience bursts of energy late in the evening, which could also lead to a poor sleeping pattern and even insomnia. Over time, this can also result in a build up of stress and anxiety around sleeping and can therefore worsen the effects of ADHD on sleep. A combined presentation refers to when both predominantly inattentive and hyperactive-impulsive traits can be recognised in one individual.
A lot of people have difficulty sleeping for a number of different reasons. Issues can be stress induced, puberty related or based on unhelpful habits and comfort. For those with ADHD, however, there are key concerns that researchers recognise:
As previously mentioned, bursts of energy during downtime in the evening can result in those with ADHD experiencing difficulty ‘winding down’. For some, several hours’ worth of racing thoughts can pass before sleep finally takes over.
Difficulty getting to sleep can naturally have an impact on how people with ADHD respond to being woken up. Many of those with ADHD have reported not feeling fully alert until noon, and can also appear agitated if woken before they are ready. This could be due to delayed circadian rhythm, as previously mentioned.
Sometimes falling asleep is only half the battle – many people with ADHD have difficulty staying asleep, and will often toss and turn in the middle of the night or wake up to find themselves fully alert. On the other hand, some experience ‘intrusive sleep’ or sudden disengagement in an activity, causing them to feel suddenly drowsy or fall asleep completely. This phenomenon is described by researcher Marian Sigurdson as “a sudden intrusion of theta waves into the alpha and beta rhythms of alertness” and can be extremely dangerous in some situations. As our brain waves communicate our thoughts and behaviours, a sudden change in the types of brain waves being used may cause erratic impulses. Thankfully, intrusive sleep is very uncommon.
ADHD researcher Thomas Brown views problems with sleep as “a developmentally-based impairment of management functions of the brain”, meaning that functions such as alertness, awareness and control are more difficult to regulate. He explains that many adolescents and adults experiencing sleep difficulties are likely to also be struggling with managing their levels of alertness day-to-day. This control difficulty therefore impacts sleep hygiene (management of sleep schedule and quality) as the affected person maintains unhelpful alertness during what is usually the time for the brain to rest.
Sleep problems are likely to occur due to impaired regulation of alertness and arousal that is commonly found in those with ADHD. However, there are a number of other theories that researchers are looking into that may explain why some people with ADHD experience heightened sleep difficulties compared to others. For example, some people will experience differences in the production of melatonin in their bodies (a hormone that contributes to us feeling tired in the evening), which could also have an impact.
As well as seeking professional support or trying medication, there are some techniques you can try at home to help you manage your sleep hygiene better if you think you might have ADHD.
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