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While ADHD is a difficult to manage psychiatric disorder, living with it isn’t always a negative experience. ADHD can be a whirlwind of creativity, social frenzies, spells of spinning in a chair staring at the ceiling, and lots of fun. However, it can also mean frustrating report cards, long periods of boredom, and sleepless nights.
Just as soon as you seem to find a good pattern that optimizes productivity and focus, things change and you’re forced to start all over again. To complicate the matter, like many other events in the life of someone affected by ADHD, rest is often elusive and interrupted.
Whether you’re a parent of a child with ADHD, or you experience the disorder yourself, you’ve probably encountered sleep issues first hand and may have found yourself searching for answers on Google at one o’clock in the morning. Don’t worry, you’re not alone. We’ve done the research to bring you the important facts about ADHD and sleep deprivation.
01
What is It?
ADHD stands for Attention Deficit Hyperactivity Disorder. It’s a medical condition that affects brain activity and development, often affecting attention and ability to sit still. While ADHD is often diagnosed in children, it also affects teens and adults of all ages.
Originally differentiated from ADD, or Attention Deficit Disorder, ADHD is now the standard terminology for both disorders, but it can exist with or without hyperactivity. ADHD can take three forms: inattentive, hyperactive or impulsive — or a combination.
This disorder affects the brain in a variety of ways, sometimes causing delayed development of the cerebral cortex in children, or inefficient organization in adults. The brain relies on pathways to communicate between the different centers and in ADHD patients, these pathways are sometimes delayed or inefficient. This makes it more difficult for their brains to use the “off-switch” when it is time to focus or control impulses.
Over the counter sleeping pills are common and inexpensive, but they aren’t always recommended for long-term use. However, some patients with ADHD have found relief in taking them regularly during bouts of insomnia. Other options include prescribed sleeping pills such as Clonidine, or GABA enhancers, as these have been effective in managing hyperactivity by calming brain activity.
02
Why am I so Tired?
Sleep Deprivation and ADHD:
Is There a Link?
If you or someone close to you has ADHD, you probably knew all of this already, but did you know it’s possible that attention deficits and hyperactivity could be caused or worsened by sleep deprivation? In fact, in some cases, the symptoms of these disorders so closely mimic ADHD that scientists can’t always tell the difference between the two.
Studies suggest that sleep is vital to managing ADHD in the realms of neuron function, impulse control, and focus, but those with this disorder also face more obstacles than others in order to achieve restful slumber.
According to a study conducted at the University of Toronto, up to 55% of all patients diagnosed with the disorder experience sleep disturbances, and more recent findings in Australia suggest the number could be higher. Disrupted rest in ADHD patients is so common it used to be a criterion for diagnosing the condition, though presently it’s just listed as a common coincidence.
While these disturbances are likely caused by a variety of factors, proper rest has been shown to dramatically aid in the management of ADHD. In a study conducted by the American Physiological Society, adolescents who slept for eight hours per night were found to perform significantly better in areas of memory, planning, organization, and emotional control than when they slept for an average of six hours.
“Increased sleep may significantly [and positively] impact academic, social and emotional functioning in adolescents with ADHD,” the researchers said. “And sleep may be an important future target for future intervention.”
Though it may seem like an uphill battle, the reward of better management most likely makes the journey to identify and solve the problem worth the effort.
03
Side Effects of Medication
The history of using medication to manage ADHD is as long as it is complicated, and while each doctor may have different recommendations based on their professional experience, stimulants such as Adderall or Ritalin are a common way to treat the disorder, often beginning from a young age.
While some studies suggest that stimulants cause sleeping problems, such as the one conducted at the University of Chicago in 2011, they also have the opposite effect in others, producing a calming reaction, as evidenced by a study from the University of Nebraska in 2005. To better understand this paradox, let’s delve deeper into how stimulants function.
Most stimulants prescribed for ADHD are a derivative of Amphetamine Salts, which work by increasing the release of neurotransmitters like dopamine in the brain. Dopamine is typically associated with pleasurable or happy feelings, but too much can cause feelings of paranoia, nervousness, or irrational fear and hallucinations.
These side effects can make it difficult for some people to fall asleep, especially as, various studies show these symptoms can also constrict blood vessels, increase heart rate, elevate blood sugar, and increase motor activity. Each of these activities send a direct message to the brain that it is not safe to fall asleep.
However, not everyone with ADHD has the same reaction to these medications. If your brain has difficulty communicating between neurons with a higher volume of neurotransmitters like dopamine and norepinephrine allows the brain to communicate more efficiently, resulting in better focus, attention span, and clearer thought processes.
The spike in these neurotransmitters may not result in anxiety or increased heart rate in this case, but rather calms the patient as the brain doesn’t need to work as hard to function. If you are concerned about how introducing medication may affect your rest, talking to your doctor and keeping a journal could help you determine the risks of long-term use.
Adderall is generally a fast-acting drug that lasts for less than six hours in the body, however, when used continuously, it can cause some serious concerns. Many doctors do not recommend taking the drug after a certain point in the afternoon to avoid interfering with sleep. If you feel you need the medication to get your work done, it may be beneficial to plan your day so you accomplish the important tasks earlier in the day.
This is because some ADHD medications contain Norepinephrine, which is associated with the body’s adrenaline fight or flight response, making users feel hyper-aware and more alert. While this aids brain function, it also interferes with the body’s ability to wind down and prepare for rest.
This phenomenon doesn’t affect all patients equally, and some even report that their use of stimulants allows them to calm their minds and fall asleep easier. This could be because, with a clearer mind anxiety may not be as severe.
According to Psychology Today, many patients combine ADHD medication with an anti-anxiety medication to combat some of the effects of stimulants such as increased anxiety and heart rate, which could account for the discrepancy of the results.
Not everyone with ADHD experiences hyperactivity or impulsivity. For those who do experience it, studies show these symptoms aren’t a result of too much energy, but rather a difficulty in brain communication. For these patients, the stimulant may help them to control their impulses by making brain communication more efficient.
04
Sleep Disorders Commonly Associated with ADHD
According to a study conducted at McGill University in Quebec, the following disorders are often diagnosed concurrently with ADHD but aren’t necessarily caused by it or vice versa. Many studies have linked sleep deprivation to ADHD-like symptoms, but scientists haven’t concluded what the exact nature of the relationship is between the two.
Insomnia
Insomnia is characterized by difficulty falling and staying asleep. Difficulty sleeping doesn’t need to be chronic to be classified as insomnia, it can happen intermittently or even occasionally, according to the Mayo Clinic. While there are a variety of causes for insomnia, those with ADHD tend to experience it more often than others. This could be due to side effects from medication, but could also be from difficulty calming racing thoughts when the condition isn’t being adequately treated.
Narcolepsy
According to the National Association for Psychiatric Disorders and Stroke, this condition affects the body’s ability to control sleep and waking cycles. Though you may picture people falling asleep while driving, during a conversation, or in the middle of the meal, Narcolepsy also means increased drowsiness throughout the day, waking up frequently during the night, and sometimes muscle weakness triggered by emotional responses.
These muscle weaknesses are called cataplexy and are often misdiagnosed as seizure disorders. Narcolepsy with cataplexy is most commonly caused by the shortage of a chemical called hypocretin, which is often associated with brain auto-immune disorders.
According to the study at McGill University, people with Narcolepsy were much more likely to be diagnosed with ADHD as a child due to the symptoms of fatigue that mimic inattention and hyperactivity. As these symptoms respond well to stimulants, which are also used to treat narcolepsy, it’s possible that these diagnoses are false, or that they result from the same neural pathway problems.
In either case, the treatment is the same, and as more studies follow, we may learn more about the relation between the two disorders.
Sleep Apnea
This disorder occurs in three forms: obstructive, where muscles in the throat block breathing during sleep; central, where the brain doesn’t properly regulate breathing during rest; and complex, which is a combination of the two former types.
A study conducted by Duke Medical Center found a correlation between obstructive sleep apnea (OSA) and ADHD. While up to 30% of full-syndromal ADHD patients were found to have OSA, over 95% of OSA patients were found to have attention deficits. Once the OSA was treated, both groups saw an improvement in their attention deficits. There is some speculation that the similarities between these symptoms could mean some people diagnosed with ADHD may just suffer from extreme fatigue due to this condition.
Though the condition is dangerous, once diagnosed there are a variety of effective treatment options based on the situation that have been shown to drastically improve symptoms of inattention. While some may require a CPAP machine to regulate breathing during sleep, others may need to lose some weight or wear a specialized oral device.
Circadian Rhythm Disorder
This disorder affects the ability of the body to properly time sleep onset and often results in sleepiness at odd or irregular times of day. A Montreal study found that behavioral problems and circadian irregularities were both found to contribute to problems with sleep onset in children with ADHD.
While this may indicate that some children’s sleep issues could stem from symptoms of ADHD rather than additional disorders, parent reports indicated that the two are not necessarily mutually exclusive, and could coincide with the same result.
Restless Leg Syndrome
Restless Leg Syndrome (RLS) is a sensorimotor disorder that results in an irresistible compulsion to move the legs, which often keeps patients up at night. According to a Paris Study, up to 44% of ADHD patients experienced RLS, and around 26% of patients with RLS had ADHD.
This conclusion led researchers to speculate that once again, symptoms of restlessness and fatigue could be mistaken for ADHD. Alternatively, it is possible that the two disorders could have something to do with the function of neural pathways and affect each other. According to the researchers, preliminary studies show that dopamine-producing drugs may be effective in treating both disorders concurrently, though research is limited.
05
Why is Improving Rest so Important?
Better rest has been shown to drastically improve symptoms of ADHD and hyperactivity, whether or not additional disorders were present. When the disorders were present, research showed that treating the disorder directly improved ADHD symptoms of inattention and hyperactivity.
Whether you or your child with ADHD has been diagnosed with an additional sleep disorder or not, it is never a bad idea to optimize bedtime habits to maximize its effect on managing ADHD.
06
Treatment Options
Melatonin
This hormone is naturally produced and is used to tell the body it’s time to start preparing for sleep. Melatonin is only produced at night, and for those with circadian rhythm disorders, this can help tell the body that the sun is down, and it’s time to rest. Though this supplement doesn’t cause or facilitate rest, it’s a key step in the process.
A European study has shown that some people with Circadian Rhythmic Disorders may produce a decreased amount of the hormone, and increasing its volume with a melatonin supplement could help sustain sleep.
Other Sleep Medications
These medications should be used only when consulting a doctor, as they can produce powerful side-effects such as depression and suicidal thoughts in some patients.
Weighted Blankets
Though weighted blankets is a new trend has gained popularity on the internet, it’s not a solution to brush aside. Various studies have found that sleeping with evenly distributed weights amounting to 10% of the user's body weight results in better rest for patients with insomnia or anxiety.
The idea is that feeling snugly wrapped up, like we are in the womb, has a natural calming effect according to Harvard Medical School. Dr. Cristina Cusin, an assistant professor of psychiatry at Harvard Medical School says these blankets are often used in a psychiatric ward for children with behavioral issues or autism.
Dr. Gaby Badre, M.D., Ph.D., a co-author of a weighted blanket study at the University of Gothenburg says the result could be due to a deep-pressure sensation. “The pressure provides a reassuring and cocooning feeling,” she says.
Cognitive Behavioral Therapy
This type of treatment focuses on resolving the underlying psychological problems that cause cognitive and behavioral issues. This therapy is especially useful for those with PTSD, ADHD, and other psychiatric disorders, but has been found to improve rest for those with insomnia as well.
By identifying and resolving beliefs and behaviors that contribute to poor sleep, therapists can help those with insomnia retrain their thoughts and actions to be conducive to rest. The training may include limiting time spent in bed during the day, keeping a sleep diary, and talk therapy to process worries, according to the patient's needs.
Light Therapy
For those with Circadian Rhythm Disorders, light therapy can help improve sleep patterns by sending signals to the areas of the brain that keep time. According to a study conducted at the University of North Carolina, light therapy is a viable alternative to medications in many patients.
In this type of therapy, patients are subjected to lightboxes or high-powered desk lamps for hours at a time while they work or go about other activities. For those who attend school or work in an office with poor lighting, these boxes can help the body keep time and be more prepared for rest at night.
CPAP Therapy
Continuous Positive Airway Pressure, or CPAP for short, is a common treatment for some types of sleep apnea. These machines facilitate a gentle flow of air through the lungs of patients who struggle to breathe regularly throughout the night.
This treatment has been shown to improve mental function, attentiveness, and depression in patients who used the CPAP machine to manage their sleep apnea according to a study conducted at the University of Edinburgh.
07
Help for Children Struggling With Sleep
While most of these sleep-enhancing treatments are widely recommended by doctors, some may not be a good fit for everyone. If you’re still looking for a solution to help your toddler get to sleep, don’t worry. There are certain standard practices doctors recommend for helping them drift off.
Develop a Regular Routine
One of the most common recommendations during Cognitive Behavioral Therapy is to create a regular sleep routine. For kids with behavioral problems, this may be a challenge, but persistence in this endeavor will likely help their bodies to adapt to a schedule. According to a study reported by the American Academy of Pediatrics, regular schedules are linked to good behavior in school.
Limit Distractions in the Bedroom
In order to facilitate a proper routine, you may try limiting distractions in the bedroom so the child understands that sleeping is the main activity for that space. Consider creating rules that prohibit the use of electronics in their room, and remove distracting T.V.s or toy boxes. That way when it’s time for bed, there is nothing stimulating to keep them awake.
Limit Screen Time
Before bed, you may try engaging in activities that naturally wind the body down, like reading an unexciting or short story, having a light snack of protein and complex carbs, or talking. This may be a struggle for children and teens who use their smartphones or iPads frequently, but cutting down on screen time has been shown to prepare the body for sleep, as the blue light that emanates from these devices stimulates the brain, suppressing melatonin production, and keeping it awake, according to Harvard Medical School.
Increase Exercise
If you find your child is bouncing off the walls at bedtime every night, consider helping them get more exercise to burn off that excess energy and help trigger their body’s need for rest. According to an Australian study at Monash University, for every hour a child is sedentary a day, it takes them three extra minutes to fall asleep.
08
Sleep Routines for ADHD Adults
Each of the recommendations for children is just as applicable to adults. Maintaining a regular sleep schedule, minimizing distractions in the bedroom, exercise, and blue light reduction all play an important role in improving sleep duration and quality.
However, as we get older there seem to be more and more factors affecting rest and more pressure to ignore them. Though it may be a challenge to improve your sleep hygiene, studies show that implementing the following measures can improve rest, which directly improves the manageability of symptoms of ADHD.
Limit Caffeine
Caffeine is one of the most widely used drugs in the world, and probably one of the least understood by its users. Many of us can’t remember the first time we took a swig of caffeinated soda, coffee, or even our first bite of chocolate. We grow up with it, but don’t often take time to evaluate its impact.
Caffeine is a stimulant that works by attaching to adenosine receptors in the brain. Adenosine is a neurotransmitter that facilitates sleep and when it can’t attach, we don’t get mentally tired. While this is good news on long road trips or during late nights at the office, when it's inevitably time for us to rest, the caffeine is often still active in our system.
This is because its half-life is about five to six hours, meaning the afternoon cup of joe is probably still working in your system when you’re trying to get some shut-eye. The better you can limit caffeine during the day, the better you should be able to get to sleep when you want to. At the very least, doctors recommend having your last dose of the drug earlier than six hours before bedtime.
Put a Limit on Email Checking
With how accessible employees are today through smartphones and laptops, it can sometimes feel like we never leave work. No matter how much you want your next promotion, try to turn off email or work notifications when you get in bed. Checking work emails while not at work can disrupt sleep and contribute to daytime anxiety according to a study conducted by the Cleveland Clinic.
So before you mark as read, consider that you the best thing for your career is to snooze the notifications for a few hours.
Avoid Alcohol
A study conducted by the National Institute of Alcohol Abuse and Alcoholism suggests that alcohol interacts with sleep deprivation to exacerbate sleepiness and inhibit performance across a variety of measures. For those with ADHD, this effect can both worsen already existing problems, and daytime performance.
Additionally, frequently drinking alcohol before bed has been shown to disrupt REM cycles, and inhibit restful sleep.
More Exercise
Exercise has long been shown to improve sleep but for those with ADHD, it can help increase dopamine, which contributes to alertness, mental function, and clear thinking. When exercise can be used as an alternative to stimulants, it may help improve rest by reducing the complicating factors.
When it comes to using exercise to improve sleep, studies show that moderation over an extended period of time yields the best results. Though it may be tempting to initiate a workout frenzy to wear yourself out, long term sustained exercise habits have the power to increase your rest by one hour per night after a few months.
09
Conclusion
While some studies indicate that it’s possible for ADHD to be confused with or misdiagnosed for sleeping problems, it can’t be denied that ADHD and rest are closely tied together. Studies show that sleep deprivation worsens ADHD, and ADHD worsens sleep, making good habits and proper understanding vital in order to manage the symptoms.
The good news is the opposite is also true. Good sleep improves ADHD symptoms, and proper management of ADHD symptoms improves rest in some cases. By recognizing the signs of common disorders, and combining doctor's recommendations with personalized habits, sleep deprivation associated with ADHD doesn’t have to be impossible to overcome.
Katie Harris
Katie is a content writer and serial hobby collector who enjoys naps almost as much as her pets do. When she isn't writing, she likes to ride her motorcycle, catch Pokemon with her hubby, and practice yoga with her dog.
