ADHD often disrupts sleep, leading to insomnia and restless nights. Photo / 123rf
Many people with ADHD have ‘delayed sleep phase disorder’, meaning falling – and staying – asleep can be difficult. Here’s how to treat it.
With minds that whir away at night as soon as their heads hit the pillow, people with ADHD often struggle to get to
Clinicians estimate that between 50-75 per cent of people with ADHD will suffer from debilitating sleep disorders.
“Sufferers often call it “perverse sleep” — when they want to be asleep, they are awake; when they want to be awake, they are asleep,” says Dr William Dodson, a US-based psychiatrist and leading specialist in ADHD in adults.
Yet treating ADHD can help with sleep problems, and getting a better night’s sleep can also reduce ADHD symptoms.
Medication for ADHD will also treat sleep problems, but certain non-medication-based therapies can also be useful. Read on for everything you need to know about ADHD and sleep.
People with ADHD often have difficulties:
Dr Helen Read is a consultant psychiatrist who worked in the NHS, and now runs a private practice, The ADHD Consultancy. She also has ADHD herself. “Falling asleep can be a big issue as many people with ADHD have what is known as a delayed sleep phase disorder. Come 9pm their brains come alive, and they might stay up until the early hours of the morning and wake up at midday, but of course, society doesn’t have that timetable.”
Another factor is the common mental health issues that go alongside ADHD. “Anxiety or mood issues often come on strongly at night. So that’s when we worry or suddenly remember that super embarrassing thing we did 20 years ago, and it feels like yesterday,” she says.
Insomnia
It is estimated 50-75 per cent of people with ADHD struggle with insomnia. They often find it hard to fall asleep at night as their minds are racing. They have disturbed sleep and multiple wakings and may struggle to rouse themselves in the morning. They may begin to dread bedtime and that can increase anxiety about sleep and make the problem worse. Mood disorders often occur alongside ADHD which can worsen insomnia.
Circadian rhythm sleep disorders
People with ADHD sometimes struggle with a delay in their internal circadian rhythms or clock and are often characterised as “night owls” who come alive in the evening. They are out of sync and their internal clock is set too late. Sometimes light therapy or melatonin can help.
Sleep-disordered breathing
Sleep-disordered breathing, which includes sleep apnea and snoring, affects up to one-third of patients with ADHD. Sleep apnea is when you stop and start breathing through the night. “A lot of people have trouble with sleep apnea and snoring in my clinic,” says Dr Helen Read.
Restless legs syndrome
Restless legs syndrome is when uncomfortable sensations in the legs cause an overwhelming desire to move them. Around 44 per cent of people with ADHD have restless leg syndrome (RLS) which may make it hard to fall and stay asleep.
Narcolepsy
Narcolepsy causes excessive sleepiness, where people can suddenly fall asleep without warning. Adults with narcolepsy are two times as likely to have had ADHD as a child, and up to 30 per cent of people with narcolepsy also meet the criteria for ADHD.
Intrusive sleep
Intrusive sleep is less extreme than narcolepsy but can cause people with ADHD to fall asleep during the day, in boring meetings or lectures, for example. “If an individual with ADHD loses interest in an activity, his nervous system disengages, in search of something more interesting. Sometimes this disengagement is so abrupt as to induce sudden extreme drowsiness, even to the point of falling asleep,” says Dr William Dodson.
Lack of sleep can affect everything from being able to focus and perform at work, to your mental and physical health. For people with ADHD, it can significantly worsen their symptoms, or make them less able to manage them.
“Long before I was diagnosed with ADHD I always had this problem of falling asleep in the daytime if things got boring. I’d fall asleep in management meetings and it did affect my career. I went to a sleep clinic, but they didn’t diagnose ADHD. It wasn’t until the ADHD was treated that my sleep improved,” says Dr Helen Read.
Sometimes ADHD insomnia can get worse with age. “I see a lot of women in my clinic who are menopausal and their fatigue conditions have worsened, they are no longer able to power through and they’ve just ground to a halt,” says Dr Helen Read.
According to experts, the standard sleep hygiene measures are not always effective for people with ADHD.
“When you’ve got a brain that is too active at night, actually taking away everything and shutting you up in the dark can be torture and make things worse. In the clinic I advise people to gradually wind down with a level of stimulation that is right for them,” says Dr Helen Read.
That might include:
Many people with ADHD reach for caffeine, sugar and alcohol to try and manage their condition. “Because ADHD is a dopamine disorder we do a lot of things to try and get dopamine and make our brains work better, like sugary foods or drinking a lot of coffee,” says Dr Read.
People with ADHD are also more likely to drink to excess, with approximately 25 per cent of adults being treated for alcohol and substance abuse diagnosed with ADHD.
Yet sugar, caffeine and alcohol can all make ADHD insomnia worse, so it’s best to limit them. Cutting down to 2-3 cups a day, however, can be challenging as many people with ADHD use coffee to help them focus. If that’s the case, experts advise not drinking it after lunch to reduce its impact on sleep.
Exercise
Exercise is a good strategy as it makes dopamine in the brain in a healthy, sustainable way, and can help with sleep.
Studies have shown that aerobic exercise outdoors like running, swimming and brisk walking can help with ADHD, as well as mind and body routines like martial arts, yoga, dance and gymnastics. Some people even find that they can manage their symptoms with extreme mind and body exercises like rock climbing, mountain biking and high-level martial arts.
That said, many people with untreated ADHD find that they are tired and overwhelmed and therefore struggle to stick consistently to an exercise routine.
Limiting screen time
“Standard sleep hygiene measures like limiting screens and meditation can be very difficult for people with ADHD,” says Dr Mike Smith, consultant psychiatrist and clinical lead of the Leeds NHS Adult ADHD service.
However the blue light from screens can inhibit melatonin production so switch it to dark mode, find something soothing to listen to like an audiobook or gentle music, or watch or read something absorbing but calming.
Regular bedtime
People with ADHD can struggle with their internal circadian rhythms so setting a regular bedtime and wake time can help reset their internal clocks. They mustn’t feel under too much pressure, however. “People with ADHD can fight this a little bit, so although I advise a regular bedtime, I do say to my clients that when it’s the weekend to give themselves a night or two off,” says Dr Read.
Light therapy
Many people with ADHD find it difficult to wake up in the morning due to circadian rhythm disorders, and using a natural light box can help with that.
“When it’s dark you secrete melatonin that makes you sleepy, that’s why turning off the lights and limiting screens can be helpful.
If you’re out of sync and your system is set too late, using a light box first thing in the morning can help reestablish your circadian rhythm. Go for a walk outside, but if you don’t have time for that, or it’s the winter, you can use a light box while having breakfast or put it on your office desk,” says Dr Mike Read.
White noise machine
White noise is a steady background sound like constant rainfall, radio static or a vacuum cleaner; pink noise is also steady but a little lower in tone. Brown noise is characterised by deep low-frequency noise like waves, thunder or wind. Many people with ADHD find these noises helpful when it comes to calming their minds for sleep, you can find them on Youtube, Spotify or download an app.
Medication
Experts agree that the best thing you can usually do for ADHD sleep disorders is to treat the ADHD with medication
Stimulants
The standard treatment for ADHD is stimulants which will work in most cases. “People are anxious that stimulant medication might make their sleep worse, but we can proceed carefully, by taking medication in the morning, or building up a dose gradually,” says Dr Helen Read. Magnesium supplements can also help with jittery side-effects.
“Patients are afraid of stimulants if they can’t sleep, but paradoxically a small dose of a stimulant can work surprisingly well for sleep disorders as it can calm the mind down,” says Dr Mike Read.
Clonidine
This medication was originally approved to treat people with high blood pressure, but because of its calming effects, it is often used for ADHD. “I prescribe this to about 70 per cent of my clients at night. It calms the busy, ruminating mind of ADHD,” says Dr Helen Read.
Melatonin
Given that ADHD often disrupts the circadian rhythm, and therefore the production of the melatonin that makes us feel sleepy, supplementing with melatonin can be effective for some people. Melatonin is available over the counter in the US, but in New Zealand you need a prescription from your GP.
Cannabis
“A lot of people tell me they use cannabis to help with their sleep. They either get hold of it illicitly or at specialised clinics. However, it can come with other detrimental effects like problems with attention and concentration during the day,” says Dr Mike Read.