ADHD and Sleep
The symptoms and medication for ADHD can contribute to difficulties falling asleep or staying asleep, issues waking up in the morning, and the development of sleep-related breathing disorders.
The symptoms and medication for ADHD can contribute to difficulties falling asleep or staying asleep, issues waking up in the morning, and the development of sleep-related breathing disorders.
Attention deficit hyperactive disorder (ADHD) usually occurs when a child is about to hit puberty and sometimes continues into adulthood. Recent research has shown that roughly two-thirds of the children who are diagnosed with ADHD also have another medical condition of some sort; epilepsy, autism spectrum disorder (ASD), sleep disorders, obsessive-compulsive disorder (OCD), Tourette’s syndrome, intellectual disabilities and anxiety disorders are just some of the most common conditions that comorbid ADHD.
Some of these are topics for debate among professionals because of their controversy. For instance, studies show that people who have ADHD often score lower on intelligence quotient (IQ) tests compared to people without this disorder. It is possible, however, that this is due to distractibility or restlessness that comes with ADHD, and not necessarily due to lower intellectual capacity of the individuals undertaking these tests.
Sleep is a common issue among people with ADHD. Because of the symptoms and medication for ADHD, many people with this disorder experience difficulties falling asleep or staying asleep, have issues waking up in the morning, develop sleep-related breathing disorders, etc. Sleep deprivation and excessive daytime sleepiness are common results of ADHD-related sleep issues, further exacerbating the ADHD symptoms already present in an individual. However, in the other direction, sleep deprivation itself can cause very similar symptoms to those of ADHD, including hyperactivity, impulsivity, being distracted and unable to focus, not paying attention, irritability, etc. It makes it harder to differentiate between the two and diagnose ADHD in children. Persistent sleep issues often develop into sleep disorders. If not addressed, the combination of these two disorders can quickly turn into a big downwards-headed spiral, impairing all areas of a person’s life.
But let’s start from the beginning.
According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, attention deficit hyperactive disorder is a neurodevelopmental mental health disorder, whose main diagnostic symptoms fall under three categories:
This disorder first occurs before a child hits puberty and potentially continues into adulthood. Depending on the dominant symptom group that an individual with ADHD might display, they can be classified into one of the following categories:
From their names, we can gather which category matches which group of symptoms. The root cause of this disorder remains unknown, although it is believed to be connected to certain substance (like alcohol, lead, and tobacco) consumption during pregnancy, premature birth, abnormalities in the brain and genetics. Environmental and social factors have been ruled out of the question, along with high sugar intake.
Because of the nature of their symptoms, people with ADHD are prone to problematic behavior in all aspects of their lives. Compared to people without this disorder, people with ADHD have about 20% higher incidence rate for substance abuse, an over 45% higher rate for teen pregnancy, over 20% more of them repeat a grade in school and roughly 40% more get arrested at some point. Children with ADHD might get in trouble with other kids or do poorly in school; adults have difficulties cultivating and maintaining relationships, keeping jobs and regularly fall behind on their responsibilities.
As mentioned in the introduction of this article, ADHD and sleep issues often occur simultaneously, and it is no surprise since both the ADHD symptoms and medications for managing this disorder can potentially cause sleep disturbances. Half of the children who have ADHD also experience sleep issues and heightened daytime sleepiness; common issues include bedtime anxiety, sleep onset and/or maintenance problems, difficulty waking up early, and occasional parasomnias (like nightmares or sleepwalking).
Some of the most common sleep disorders affecting people with ADHD are listed here:
Medication used to subside the symptoms of ADHD can be short-lasting (4-6 hours) or long-lasting (6-12 hours), and both often have an adverse effect on sleep and appetite, the latter of the two being worse. Because of the more consistent results and the ease of dosing them less frequently than the short-lasting pills, longer-lasting pills are regularly favored none the less.
Stimulant drugs and antidepressants are among the commonly used medications for ADHD; Adderall, Ritalin, Dexedrine, Aventyl, and Norpramin are some of the widely recognized drugs for treating this disorder, but they all have side-effects such as:
Most importantly, they can all cause insomnia.
The first option for a large portion of people with sleep issues or disorders is cognitive behavioral therapy (CBT). This treatment method doesn’t involve any medications in itself and can’t damage the patient no matter their sleep issue. That’s why CBT is often suggested even if it’s not certain whether a particular sleep disorder is present or not. It works by setting up a set of sleep-related “rules” to form a nighttime pattern which will minimize harmful behaviors and promote a healthy relationship with sleep. One such requirement is to avoid spending time in bed for anything barring sleep, in order to reassociate the two and shorten the time spent in attempts to relax and fall asleep.
For people with ADHD, another good treatment option is sleep restriction. It involves setting up the exact time when the patient will go to sleep and wake up every day. Whether the patient manages to fall asleep at the set time isn’t important; he/she is not to break from this schedule even if not fully rested in the morning, and additional rest is not allowed. Over time, this treatment trains the brain to prepare for sleep at bedtime, relieving sleep onset issues commonly reported among people with ADHD.
Light therapy can also be suitable for people with ADHD who have delayed sleep phase syndrome or other circadian rhythm disorders. The name of this treatment is quite explanatory; the patient uses a bright light at certain times of the day to reset or adjust the circadian rhythm, which is known to respond to light, among some other external stimuli. It helps to synchronize the patient’s sleep timing with the light-dark cycle of the day.
Sleep medication might be used to help with especially persistent sleep problems. However, these pills are not to be taken lightly, as they come with plenty of side-effects and often carry a dependency risk. Before opting for any medication, particularly if already using ADHD or some other type of medication, please make sure to discuss it carefully with a specialist.
Melatonin is a relatively safe way to achieve the sleep pill effect; it supplements the sleep-regulating hormone regularly secreted by the pineal gland in our brain. It doesn’t carry dependency risks and is preferable to sleep medication, especially for children. However, if taken in higher than the usual recommended dose (which is sometimes advised for children with ADHD), a potential side-effect is the increased risk for seizures; again, something to discuss with a doctor before taking any action. Don’t supplement without supervision!
Michael is a professional writer based in Boston and someone who has always been fascinated with the mysteries of sleep. When he’s not reading about new sleep studies and working on our news section, you can find him playing video games or visiting local comic book stores.