The connection between ADHD and sleep

You've probably noticed ADHD being discussed everywhere lately - in the media, across social networks, and maybe in your own conversations with friends and colleagues. This surge in awareness has many people curious about ADHD, particularly how it might affect different aspects of health and wellbeing. As a sleep psychologist, one aspect that particularly interests me is the connection between ADHD and sleep.
Whether or not you have ADHD - or have ever considered it - understanding this relationship offers valuable insights for anyone who struggles with sleep. While most people think of ADHD as affecting attention, focus, and energy during the day, its impact on sleep is significant and often overlooked. In fact, what we're learning about how ADHD affects sleep might help explain why some people struggle to get good rest despite following all the usual sleep advice.
So, in this article I want to shed some light on this topic and offer some tips that I hope will be of value to you, whether you have ADHD or not.
Understanding ADHD
Let’s start with an understanding of ADHD. ADHD stands for Attention-deficit/hyperactivity disorder but not all health professionals believe ADHD is a “deficit” or “disorder” in the traditional sense. While it can certainly cause significant problems for many people in certain environments, where skills like organisation, planning and attention are required, a more progressive and neuroaffirming understanding of ADHD is that it's a natural variation in how some brains are wired.
Think of it like having a different operating system with added variations to the “hardware” of the brain. The key difficulties of people with ADHD are problems with attention, hyperactivity, and impulsivity. As an example, while some brains naturally filter out distractions in order to focus easily on a task, an ADHD brain might notice many things occurring simultaneously, such as background noises (e.g. people taking in neighbouring conversations) and other activities going on (e.g. seeing a bird flying past through a window), and inner thoughts and ideas. Processing this information can be overwhelming and can make it more difficult to focus on the immediate task at hand.
While it can be easy to see the challenges of ADHD, this different brain wiring brings with it some valuable strengths. That same ability to notice everything in your environment can make you exceptionally observant and creative, seeing connections that others might miss. Many people with ADHD have an extraordinary capacity for hyperfocus - becoming completely absorbed in tasks that interest them, often leading to innovative solutions and deep expertise. This intense focus, combined with the ability to think outside conventional boundaries, can result in unique problem-solving abilities and creative insights. Many successful entrepreneurs, artists, and innovators credit their achievements to their ADHD traits, noting that their different way of processing information allows them to see opportunities and solutions that others might overlook. The energetic nature of ADHD can also fuel productivity and inspiration, while the tendency to notice subtle details can enhance empathy and emotional awareness.
ADHD and sleep disturbance can look the same!
When it comes to sleep and ADHD, here’s an important fact that anyone exploring an ADHD diagnosis should know: The symptoms of disturbed sleep can look very similar to ADHD. Both can cause difficulty with concentration and attention, forgetfulness, reduced ability to regulate emotions, poorer decision making that can lead to small errors or mistakes, and an overall feeling of brain fog.
Also, some research shows that up to 50% of people with ADHD will have a sleep disorder, with the more common ones being insomnia, sleep apnoea, and restless legs syndrome. There's also an interesting connection with narcolepsy - adults with narcolepsy are twice as likely to have experienced ADHD symptoms in childhood. While researchers are still understanding the exact link, they suspect shared genetic factors or brain chemistry patterns might be at play.
Many adults with ADHD naturally feel more alert in the evening, making it challenging to maintain a traditional sleep schedule. This isn't just about being a "night owl" - research suggests it may be linked to differences in when your brain produces melatonin, the hormone that helps regulate sleep. In fact, up to 78% of adults with ADHD have a delayed biological rhythm also called a delayed sleep phase disorder (DSPD), which can be measured by saliva tests of melatonin levels (Van Veen et al., 2010).
If you're taking ADHD medication, you're probably aware that it can affect your sleep, but this impact isn't as straightforward as you might think. Some people actually sleep better with proper medication management, while others need to carefully time their doses to avoid sleep disruption. This is why working closely with your healthcare provider to find the right balance is so important.
Tip: A sleep assessment should be one of the first steps that health professionals make before making an ADHD diagnosis, and make sure you talk to your doctor about how to screen for all of these conditions so that nothing is missed in your assessment.
ADHD and sleep disturbance: a bi-directional relationship
The relationship between sleep and ADHD is what researchers call bidirectional - each condition can affect the other, in this case making the other worse. Poor sleep worsens ADHD symptoms and ADHD interferes with sleep.
Tip: Getting treatment for your sleep disturbance is essential if you have ADHD, as it can help improve your cognitive skills.
ADHD, sleep disturbance and perimenopause: a multidimensional relationship
Now, if you’re a woman in her 40s or 50’s, this relationship is even more complex due to a third factor added to the mix: perimenopause! Perimenopause, the years preceding menopause, is marked by rapidly changing hormones, which also causes disturbed sleep and cognitive difficulties, and these hormonal changes can amplify ADHD symptoms.
This triple whammy can create the perfect storm for mental and physical health problems in this stage of life, and why getting specialist help with all three factors: sleep problems, perimenopause, and ADHD can be critical to managing this very difficult time in life.
Tip: Read my article specifically focused on this powerful triad, and if you’re in this category, seek the support of a doctor who specialises in perimenopause and menopause to help co-ordinate specialist treatments with ADHD clinicians and sleep professionals, to get the help you may need.
Professional Support and Evidence-Based Solutions
If you're experiencing ongoing sleep difficulties, consider these proven approaches:
Cognitive Behavioural Therapy for Insomnia (CBT-I) This structured program helps you understand and change thought patterns and behaviours that affect sleep. It's particularly effective because it can be tailored to the specific challenges of people with ADHD.
Mindfulness Practices Traditional meditation isn't for everyone, but mindful movement practices like mindful walking or yoga can help quiet an active mind and assist with the evening wind down routine before 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.
And if you have or suspect you have ADHD, sometimes the standard sleep advice needs to be adapted to work with your brain's natural patterns. Here are some strategies that can be particularly helpful in addition to CBT-I and mindfulness.
1) Work With Your Natural Rhythm Instead of fighting against your body's preferences, try creating a flexible sleep window that aligns with your natural patterns while maintaining some consistency.
2) Manage Racing Thoughts Keep a "brain dump" notebook by your bed. Rather than trying to suppress thoughts or ideas that arise at bedtime, quickly jot them down. This gives your active mind permission to rest.
3) Create an Environment That Works for You Some people need complete darkness and silence, while others sleep better with white noise or gentle background sounds. The key is finding what works for your specific needs.
When to seek help
Consider consulting a healthcare provider if you:
- Consistently struggle to fall or stay asleep
- Feel unrested despite adequate sleep
- Notice that sleep problems affect your daytime functioning
- Experience any of the sleep disorders mentioned above
A professional can help determine whether your sleep difficulties might be related to ADHD, another sleep disorder, or a combination of factors. They can also help you develop a personalised approach to improving your sleep.
In summary, whether or not you have ADHD, understanding how your brain works is crucial for developing effective sleep strategies. Rather than trying to force yourself into a one-size-fits-all sleep solution, the key is finding approaches that work with your brain's natural patterns. Remember, the goal isn't perfect sleep every night - it's finding sustainable strategies that help you feel rested and functional. Start with small changes, be patient with yourself, and seek professional support when needed.
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.
References:
M.M. Van Veen et al. Delayed circadian rhythm in adults with attention-deficit/hyperactivity disorder and chronic sleep-onset insomnia, Biol. Psychiatry (2010)
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