ADHD and Sleep

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental condition characterised by persistent patterns of inattention, hyperactivity, and impulsivity. While much of the focus tends to be on the behavioural and cognitive aspects of ADHD, people often overlook a crucial issue - the impact of ADHD on sleep. Many people with ADHD experience significant sleep disturbances, which not only impacts their overall wellbeing (and sanity!) but can also exacerbate the symptoms ADHD, making management so much more challenging.

The Sleep Struggles of ADHD

Of course, you don't need to have ADHD to have sleep issues. But ADHD folks make up a large representation of sleep sufferers - with an estimated 25% to 50% experiening sleep problems, ranging from insomnia to secondary sleep conditions. We can categorise these sleep issues here:

1. Difficulty Falling Asleep: Many individuals with ADHD find it challenging to wind down and fall asleep at night. This can be due to racing thoughts, restlessness, or an inability to relax.

2. Irregular Sleep Patterns: Those with ADHD may have inconsistent sleep schedules, often staying up late and struggling to wake up in the morning, leading to a condition known as delayed sleep phase syndrome.

3. Restless Sleep: Even if they manage to fall asleep, people with ADHD often experience restless sleep, characterised by frequent awakenings and poor sleep quality.

4. Sleep Apnoea: There is a higher prevalence of sleep apnoea among individuals with ADHD, which involves repeated interruptions in breathing during sleep and significantly impacts sleep quality.

5. Difficulty Waking Up: Waking up can be particularly challenging for those with ADHD, leading to prolonged grogginess or "sleep inertia" that can affect daytime functioning.

Why Does ADHD Affect Sleep?

Several factors contribute to the sleep disturbances commonly seen in ADHD:

Neurobiological Factors

ADHD is associated with dysregulation of neurotransmitters such as dopamine and norepinephrine, which play crucial roles in regulating attention, behaviour, and sleep-wake cycles. Imbalances in these chemicals can lead to difficulties in maintaining regular sleep patterns.

Hyperactivity and Restlessness

The hyperactive component of ADHD can make it difficult for individuals to relax and settle down for sleep. The constant need for movement and activity can persist into the night, preventing restful sleep.

Emotional and Cognitive Factors

People with ADHD often experience heightened levels of stress, anxiety, and depression, which can interfere with the ability to fall and stay asleep. Additionally, the tendency for racing thoughts and an overactive mind can make it hard to transition into sleep.

Co-existing Conditions

ADHD frequently co-occurs with other conditions such as anxiety disorders, depression, and sensory processing issues, all of which can further disrupt sleep patterns. For instance, sensory sensitivities might make individuals more susceptible to disturbances from light, noise, or even the texture of bedding.

Impact of Poor Sleep on ADHD Symptoms

The relationship between ADHD and sleep is bidirectional. Not only does ADHD contribute to sleep problems, but inadequate sleep can also worsen ADHD symptoms. Poor sleep can lead to increased inattention, hyperactivity, and impulsivity during the day, creating a vicious cycle where each condition exacerbates the other. Additionally, lack of sleep can impair executive functioning, affecting memory, decision-making, and emotional regulation, all of which are already areas of difficulty for those with ADHD.

Strategies for Better Sleep

Despite the challenges, there are several strategies that individuals with ADHD can employ to improve their sleep:

Establishing a Routine

Creating a consistent sleep routine can help regulate the body’s internal clock. Going to bed and waking up at the same time every day, even on weekends, can improve sleep quality over time.

Creating a Sleep-Friendly Environment

Optimising the sleep environment can make a significant difference. Make sure the bedroom is dark, quiet, and cool. Using blackout curtains, an eye mark and/or earplugs can help minimise disturbances. Sometimes, apps with brown noise (low frequency sound) can really help quiet the mind of an ADHDer. Consider shopping around for comforting bedding that suits your needs, e.g. a weighted or really soft blanket.

Limiting Phone Time

Note that I didn't say 'screen time'. This is deliberate. Some have suggested that watching a comforting TV show can assist in relaxation and prepare the body for sleep. So, big screen + comforting show = good. But little screen (phone) doom-scrolling on short videos and stimulating content = bad. Having your phone charger in the kitchen is a good way to keep devices out of the bedroom and helps remove that scroll-temptation. Need the alarm clock function though? Go buy an alarm clock, set it to radio and thank me later.

Addressing Co-existing Conditions

Treating co-existing conditions such as anxiety or depression can have a positive impact on sleep. Cognitive-behavioural therapy (CBT) is particularly effective for managing these issues and improving sleep quality.

Physical Activity

Regular physical activity can promote better sleep by reducing anxiety and improving overall health. It's ok to train after work, just make sure than any vigorous exercise is finished at least 3 hours before bedtime, as it can be stimulating.

Dietary Considerations

Paying attention to diet can also support better sleep. Reducing caffeine intake, particularly in the afternoon and evening, and avoiding large meals close to bedtime can help.

Sleep problems are a significant concern for individuals with ADHD, affecting not only sleep quality but also daytime functioning and overall quality of life. It's important to understand that if you have ADHD, your brain is wired a little differently and you might need to take a bit more care with your sleep. Honestly, this translates to the day as well - your ADHD brain has you mentally working overtime, and ADHDers are not good at resting. Your super-brain is hard to switch off, and being aware of this can be the first step in listening to what your body needs. Finding the right combination of strategies may take time and experimentation, but with persistence and support, better sleep is an achievable goal for those with ADHD.

If sleep problems continue, please seek professional guidance from healthcare providers who specialise in ADHD and sleep disorders. Don't go it alone.