ADHD and Insomnia

Sleep is essential to healthy brain function. Unfortunately, those living with ADHD can struggle to sleep soundly, which makes focusing during the day challenging.

About 75% of those diagnosed with ADHD exhibit physiological sleep phases that are 1.5 hours late due to issues in their circadian rhythm and an incorrect sense of timing; these factors could contribute to time being perceived as “not yet”.

Symptoms

Trouble sleeping is an unfortunate aspect of ADHD. Sleep loss may contribute to many of its symptoms such as difficulty paying attention, impulsive behavior and forgetfulness. Children with ADHD can have trouble falling and staying asleep; some experience anxiety-provoking night terrors that prevent restful rest; while others have medical conditions like sleep apnea or asthma that prevent restful restful slumber; those who do fall asleep frequently often wake up early due to breathing interferences waking them during the night — while even when sleeping comes they frequently awake to racing thoughts when tossing and turning all night.

Late Sleep Phase Syndrome, or DSPS, is the most frequently reported sleep condition associated with ADHD. This occurs when your biological clock falls out of sync with its usual wake/sleep cycle; people suffering from this disorder tend to go to bed later than others without it, and wake up later too. Other sleep issues reported by children and adults living with ADHD include night terrors, nightmares, disordered breathing patterns and daytime fatigue.

Researchers conducted two studies which demonstrated that ADHD symptoms increase sleep disturbances among kids diagnosed before age 12. This suggests that ADHD symptoms might have some influence over when these problems first appear and their severity. Another research paper indicated that children diagnosed with ADHD more often experience irregular, low-periodic movements of both their upper and lower bodies during sleep than non-ADHD children, though such movements may not register on polysomnographic indices of periodic leg movement during sleep; such disturbances interfere with reseting circadian rhythm (Hansen et al. 2006; Cortese et al. 2009).

Sleep is essential to everyone, and people with ADHD must especially prioritize getting enough of it. Along with regular physical exercise, those living with ADHD must avoid caffeine, alcohol and stimulants in the hours leading up to bedtime; aim for regular bedtimes in dark and quiet surroundings with comfortable mattresses — no TVs, smartphones or electronic devices in the bedroom should be seen while asleep!

Causes

Sleep difficulties can be a significant problem for those living with ADHD. Aiming for seven to nine hours of quality rest per night is essential to their daily function; especially important if one struggles to focus, perform or make social connections due to fatigue. Furthermore, many with adhd have trouble sleeping; often finding it hard to fall asleep at night and when waking too early in the morning are unable to go back to rest again — these disruptions may have severe implications on health, mood and daily function.

There are various theories as to why those with adhd have difficulty sleeping at night. One explanation could be they do not get enough deep sleep — whether this be due to difficulty falling or staying asleep, disrupted dreams, or just not getting enough restorative shuteye in general. Another possibility could be they don’t follow a regular sleeping cycle that leads to problems with internal clock and circadian rhythm issues; further complicating matters further are delayed sleep phase syndrome (DSPS), restless legs syndrome (RLS), or periodic limb movement disorder (PLMD).

ADHD and sleep issues share an intricate connection. Studies comparing sleep in people with ADHD to that in those without have produced mixed results, with wide disparity among objective measures (polysomnography, actigraphy and the multiple sleep latency test) versus subjective measures such as diaries or questionnaires administered to parents or individuals themselves. ADHD has been linked with various sleep disorders, including obstructive sleep apnea and peripheral limb movements seen on polysomnographic studies; nocturnal motricity on actigraphic studies; and decreased sleep duration from subjective research studies. Treating RLS or DSPS disorders successfully has shown to reduce ADHD symptoms for some patients.

Some researchers believe the relationship between ADHD and sleep is tied to abnormalities in how the brain releases chemicals that regulate mood and activity. If these chemicals become disrupted, this could result in concentration and focus issues as well as altering natural rhythms within the body — these disruptions are even more noticeable among those diagnosed with adhd.

Treatment

ADHD has long been linked with sleep issues. Research suggests that people with ADD or ADHD often have delayed circadian rhythms, making it harder for them to fall asleep at night and wake up in the morning. Furthermore, others with ADHD struggle with regulating arousal states — meaning their engines keep running even when trying to sleep — which might explain why so many of my ADHD patients report feeling tired even after getting adequate rest each night.

Studies have demonstrated that both children and adults with ADHD show greater impairment on objective (polysomnography and actigraphy) and subjective measures of sleep problems than people without ADHD (including architecture, duration and efficiency measures; subjectivity includes parental ratings of disturbances/symptoms/diaries/questionnaires etc). These assessments can take place either in a laboratory setting or at home with monitoring equipment such as electroencephalography/electrocardiography/polysomnography/actigraphy etc (Cortese et al 2013a; Owens 2008).

Many individuals with ADD and ADHD also suffer from other sleep disorders, such as insomnia, periodic leg movement disorder (PLMD), restless legs syndrome (RLS), narcolepsy and obstructive sleep apnea. Sleep disorders tend to be more prevalent among those who also have ADHD than without it, although there may be differences between groups due to comorbid disorders and medication usage.

Implementing healthy sleep practices may help alleviate some of these difficulties, including keeping to a regular sleeping schedule; avoiding caffeine, large quantities of liquids and naps before bedtime; not engaging in physical activities that engage alerting activities shortly before sleep time; keeping bedroom dark and quiet with no activities happening nearby before sleep time; using bed only for sleeping purposes and limiting screen time before and during rest (Cortese et al. 2012).

ADHD and sleep disorders should be discussed with their physician or specialist in order to establish how best to address them. For example, in some instances nocturnal polysomnography tests are done which measure heart, lung and brain activity while sleeping as well as movement and breathing patterns.

Prevention

Sleep deprivation can contribute to physical health problems such as obesity, high blood pressure and depression. A regular bedtime routine that eliminates caffeine, heavy meals and alerting activities shortly before sleeping may help alleviate ADHD and insomnia symptoms; failing that, medical examination could uncover other sources of disruptions such as sleep apnea or depression causing night sweats in women over 40.

Oxford PharmaGenesis Ltd. 2014. All rights are reserved by Shire. Shire provided funding to support writing, fact checking, editing and formatting of this publication; its author declares no potential conflicts of interest and it is not endorsed by the American Academy of Pediatrics; rather it was created purely for educational purposes.

Originally published in The Sleep Loft — Online Mattress Showroom NYC