Does ADHD Affect Sleep?

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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.

Why Does ADHD Affect Sleep?

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:

  • Predominantly Inattentive
  • Hyperactive-Impulsive
  • Combined

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.

Common ADHD Sleep Problems

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:

Difficulty falling asleep:

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 waking up:

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.

Intrusive or restless sleep:

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.

Alertness and Sleep: A Scientific View

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.

Getting to Sleep With ADHD

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.

  • Avoid caffeine in the evening: Caffeine can have a heightened stimulating impact on someone with ADHD, particularly when consumed in the evening as lack of sunlight will usually prompt our bodies to start winding down. To try and avoid increased alertness, racing thoughts and frequent visits to the toilet, avoid caffeinated drinks after 6pm.
  • Avoid associating bed with other things: Your bed should be for sleep and sex only. Try not to use your bed during the day for other activities such as reading or video games to avoid your brain associating bed with being stimulated. If you have another room or piece of furniture (such as a sofa or chair) that you can do these other activities in, then do them there. It is much more helpful to use this than to associate your bed with alertness.
  • Stick to a routine: Over time, a strict routine can have a significant impact on how well you sleep, as your brain will associate certain times with winding down and waking up. It may take several weeks to put this in place, but if the routine is stuck to rigorously it will likely change your sleep hygiene for the better.
  • Having an evening and bedtime routine can help your brain to cue the release of melatonin and bring on sleep. For example, at 9pm every evening you might dim all the lights around your home, put on some relaxing music, stop using your phone, or have a hot bath or warm glass of milk. These behaviours, if engaged with routinely, can start to indicate to your brain that you are beginning to relax and that you are getting ready for bed.
At Psymplicity Healthcare we offer ADHD assessments in addition to diagnosis and specialised treatment plans for ADHD and other conditions. If you have recognised that yourself or a loved one is struggling with ADHD symptoms, do not hesitate to get in touch with one of our experts.
Contact us now to speak with one of our ADHD specialists and begin a personalised treatment plan.
Mavish Sikander

Mavish Sikander

Mavish is a BABCP Accredited CBT and EMDR Therapist and CBT Clinical Lead at Psymplicity.

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