ADHD, Sleep, and Hormones in Perimenopause

If you follow social media, you might have noticed that ADHD is a hot topic lately, with many people reporting new diagnoses, especially among women in their 40s and 50s. This surge in diagnoses isn't random; factors like increased awareness, advances in our understanding of the condition, and the complex interactions between hormones, brain function, and sleep all play a role.
For women facing the combined challenges of perimenopause, ADHD, and sleep issues, daily life can feel overwhelming. But with the right support, insights and strategies, you can learn to navigate this difficult life stage and find the light at the end of the tunnel.
Why Are ADHD Diagnoses Rising for Women in Midlife?
There are a few reasons why more women than men are being diagnosed with ADHD in midlife, and the first lies in perimenopause, a natural life stage for women typically in their 40s and 50s, where fluctuating estrogen levels start to impact cognitive functions—memory, concentration, and planning. These cognitive changes closely mimic ADHD symptoms, leading some women to seek support and, through the assessment process, uncover an ADHD condition they may have managed unknowingly for years. When these hormonal shifts intensify, they bring previously masked ADHD traits into sharper focus.
Secondly, this timing often coincides with a particularly demanding life phase. Many women in this age group are balancing career peak responsibilities, managing small or teenage children, and caring for aging parents. While some have successfully compensated for attention and focus challenges through careful routines and coping strategies (a phenomenon known as "masking"), perimenopause and added life stressors make these strategies less effective. As a result, hidden ADHD struggles become impossible to ignore.
And thirdly, females often present with the "inattentive" ADHD subtype rather than the "hyperactive" subtype more typical in males. Since inattentiveness doesn’t usually lead to disruptive behaviour, ADHD symptoms in girls have often been overlooked in childhood. Many women only recognise similarities in symptoms after their children are diagnosed with ADHD due to its strong genetic link, prompting them to seek help.
The Role of Sleep in ADHD and Perimenopause
Another crucial, often overlooked, factor is sleep. Sleep disruption is common during perimenopause and can amplify cognitive and attentional difficulties. Poor sleep can make anyone feel foggy and unfocused, but for women with underlying ADHD traits, the combined effects of hormonal changes and disrupted sleep can create a "perfect storm" of cognitive challenges—a triple whammy of declining estrogen, poor sleep, and ADHD, making daily tasks feel overwhelming.
The relationship between perimenopause, ADHD, and sleep is deeply intertwined, with each factor amplifying the effects of the others.
Common Sleep Disorders in ADHD and Perimenopause
If you’ve been diagnosed with ADHD and are also navigating perimenopause, be aware that sleep disorders are common in both conditions. Research has shown that up to 55% of individuals with ADHD and up to 47% of perimenopausal women experience sleep disturbances, with this figure rising to 60% in post-menopause.
ADHD can interfere with the brain’s sleep-wake cycles, causing many adults with ADHD to feel more alert at night, making it challenging to stick to a traditional sleep schedule. This isn't just about being a "night owl"—research suggests it may be tied to differences in when the brain produces melatonin, the sleep-regulating hormone. Up to 78% of adults with ADHD experience delayed biological rhythms, making it hard to fall asleep before their brain naturally reaches a sleepy state.
Additionally, adults with ADHD have higher rates of sleep apnea, restless legs syndrome, and teeth grinding. There’s also a curious link between ADHD and narcolepsy, with narcoleptics twice as likely to have shown ADHD symptoms in childhood. While the exact connection is still being studied, it’s believed that shared genetic or brain chemistry patterns may play a role.
Medication management is another important consideration. While ADHD medications can affect sleep, proper timing and dosage adjustments can help some people sleep better, making collaboration with your healthcare provider essential.
Strategies for Better Sleep with ADHD in Perimenopause
So, how can you improve sleep when dealing with both ADHD and perimenopause? There’s good news! Just as ADHD, sleep problems and perimenopause interact to create challenges, treatments for each area can have positive effects on the others.
For example:
- Hormone Therapy: Estrogen and progesterone treatments can alleviate perimenopausal symptoms and improve sleep, while also potentially reducing ADHD symptoms and improving ADHD medication effectiveness.
- ADHD Management: Proper ADHD management can lead to better sleep quality and indirectly benefit perimenopausal symptoms.
- Sleep Therapy: Treating sleep disorders can improve cognitive function, mood, and overall energy, easing some of the distressing symptoms associated with ADHD and perimenopause.
Fortunately, there are effective sleep therapy strategies available:
1) Cognitive Behavioural Therapy for Insomnia (CBT-I)
Cognitive Behavioural Therapy for Insomnia (CBT-I) is particularly beneficial for individuals with ADHD, as it not only addresses the cognitive distortions and maladaptive behaviours that can exacerbate sleep difficulties, it can also assist with managing sleep schedules that are best suited to a potentially delayed ADHD circadian rhythm type.
2) Mindfulness Practices
Mindfulness practices are invaluable for individuals with ADHD and those navigating the challenges of perimenopause who have sleep problems, as they promote emotional regulation and stress reduction. During perimenopause, many experience heightened anxiety and mood fluctuations, which can lead to racing thoughts that interfere with sleep. Mindfulness encourages a non-judgmental awareness of these thoughts, allowing individuals to acknowledge and release them without becoming overwhelmed. Techniques such as mindful breathing, body scans, or gentle yoga can help calm an overstimulated nervous system, creating a more conducive mental state for sleep. Furthermore, regular mindfulness practice can enhance focus and attention, addressing some of the core symptoms of ADHD while also fostering a sense of calm and relaxation that is crucial for managing sleep disturbances often encountered during perimenopause.
In summary, the interplay between ADHD, perimenopause, and sleep challenges can make midlife an especially demanding time for many women. Understanding how these factors impact each other—and knowing that there are effective ways to manage each—can be empowering. Whether through hormone therapy, ADHD management, improving sleep skills, or practicing mindfulness, small changes can make a big difference. By taking steps to address each area, it’s possible to regain a sense of balance, energy, and wellbeing. Remember, you’re not alone in this journey, and support is available to help you find your way through these unique challenges.
Please check out our other articles and blogs on all things sleep, including our evidenced-based online sleep program A Mindful Way to Healthy Sleep.
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