Numerous researchers consider sleep essential for establishing stable physical and mental health for everybody. It has an especially great impact on the lives of people with Attention Deficit Hyperactivity Disorder (ADHD). Here is a list of sleep troubles patients usually experience:

hardship with falling asleep, even if the day was exhausting;
keeping a good night’s sleep;
waking up too early without having a proper rest;
feeling tired and refreshed sleep.

Is there a biological connection between attention deficit disorder and sleep? Can one effectively manage their sleep? Does it require any medication?

25%-50% of people diagnosed with ADHD reported having sleeping issues, and that’s why we probe deeper into this connection—to see if there are effective ways to manage sleep problems.

Why Is Sleep So Important for Individuals with ADHD?

Scientists allege that 7-9 hours of sleep is an optimal time for adults to restore the necessary levels of energy. 7 is said to be the lower bound for a stable cognitive function, but those who experience ADHD symptoms are often recommended to stick to the higher number sleeping for 9 hours or even more. Hyperactivity, as well as attention deficit, can be exhausting for the body and, therefore, require more time to restore energy and the ability to focus.

Children, however, need even more hours of sleep depending on their age:

1 to 2 year old kids: 11-14 hours (including naps);
3 to 5 year old kids: 10 to 13 hours (including naps);
6 to 12 year old kids: 9 to 12 hours;
13 to 18 year old teenagers: 8 to 10 hours.

Sleep is a powerful tool for stress management, helping with emotional regulation, better memory function, and other physical issues like reducing the signs of skin aging.

Besides, getting enough sleep is crucial for getting more control over impulsivity and hyperactivity—and these conditions are known to be concomitant to the main ADHD symptoms.

Sleep deprivation, which is a problem for 32.8% of adults, if not managed, carries the threat of getting chronic and developing various sleep disturbances as well as impairing the ADHD condition.

Types of Sleeping Disorders

There are a few common sleep disorders that arise often when one has ADHD. ADHD does resemble some of the symptoms, like concentration problems or irritability, that sometimes get mistaken for a sleeping disorder, so each case has to have careful and precise diagnosing. The research does not show a precise mixture of ADHD sleep problems, but there is a certain list of conditions that are common for people with ADHD.

Insomnia

This sleeping condition is common not only for individuals with ADHD, but it may also result in more health issues like overall exhaustion. Even if the energy levels are regular, a person with ADHD can have trouble falling asleep because the brain works hyperactively. That’s when insomnia hits.

For instance, many find the nighttime more suitable for intellectual work as there are fewer triggers and distractions. The dark time of the day with less fuss and people around allows one to concentrate more easily and be more productive. But, it is also possible that staying up at night is a consequence of circadian rhythms disturbance. This may become the reason for a bad sleeping schedule and more, like overstimulation.

Hyperfocus, as a special brain feature for people with ADHD, can, too, provoke insomnia. This, in turn, makes them lose control over time and ruin their wake-sleep schedule in a bad way.

As a regular bedtime routine often becomes impossible to follow when going to rest early in the morning, the brain simply does not get enough time to stop its active work, making falling asleep harder than usual.

The consequences of a poor sleep-wake schedule can provoke either numerous nighttime awakenings or daytime sleepiness and fatigue in people with ADHD.

The research found that as many as 43% to 80% of adults with ADHD experience insomnia, so the problem is quite typical and widespread.

Restless Legs Syndrome

Restless leg syndrome (RLS) is common for 20% to 33% of adults with ADHD and is even more present in children (11% to 42.9%). The biology behind this phenomenon is dopamine and iron deficiency. It is a condition often concomitant with ADHD that has an impact on brain activity. The brain sends signals to leg muscles, which results in the feeling of tingling or creeping. Also, people with RLS experience an overwhelming urge to constantly move ove’s legs. That, in turn, complicates falling asleep very much.

RLS is strongly associated with ADHD, but is not a type of hyperactivity; it is a different kind of moving discomfort that also leads to sleep deprivation.

Sleep-Disordered Breathing

The most widespread breathing disorders connected with sleep are snoring and apnea. While snoring can have an exclusively physical basis, obstructive sleep apnea is common in people with ADHD. The research from 2021 claims that 9.5% of children with ADHD suffer from apnea, while another one suggests this disorder is more common for adults.

In children, sleep apnea causes hyperactivity or difficulty concentrating, while for adults it always results in daytime fatigue and sleepiness. The treatment also depends on the patient.

patients’ age: adults have to undergo Constant Positive Airway Pressure (CPAP), while children require surgery.

Narcolepsy

Narcolepsy is one of the common sleep disorders causing a bad night’s sleep. Still, it is rich with other special symptoms, like excessive daytime sleepiness (EDS), which is much stronger in this sleeping condition than in any other one.

Also, there can be cataplexy—the loss of muscle control. It can vary from the light forms where an individual feels significantly weak, to the severe ones, where the total collapse happens.

Narcolepsy is often accompanied by sleep paralysis. In this state, an individual feels like they cannot move any part of their body, but feel awake and see everything around them. It usually happens right before or after falling asleep and is a temporary state lasting for a few minutes. About 75% of sleep paralysis cases include hallucinations: it can be a feeling of dangerous presence in the room, chest pressure, or out-of-body sensations. Any kind of sleeping paralysis experience can cause emotional exhaustion and affect the quality of sleep.

In accordance with the research conducted in 2020, 33% of people diagnosed with narcolepsy also experience the symptoms of ADHD. There is no proven causal link, but the correspondence exists.

Circadian Rhythm Sleep Disorders

These are a whole group of conditions that are based on the atypical sleep schedule. People with a Circadian rhythm sleep disorder can’t fall asleep at the biologically natural resting hours. Hence, they have a hard time waking up in the morning, and it often leads to a schedule of life and activity that significantly differs from the usual cycle of night and day.

Usually, it may be caused by jet lag or night working shifts, but ADHD can sometimes have a direct impact on sleeping patterns.

Many individuals diagnosed with ADHD have notably higher energy levels in the evening, right before regular bedtime, but cannot concentrate and be productive in the morning hours, which is considered biologically correct for people without such a diagnosis.

Delayed sleep phase syndrome (DSPS) commonly moves the regular sleeping schedule for two hours or more, which, if developing steadily, can cause massive tiredness, cognitive hardships, and low energy levels. It is good to know that DSPS is a chronic condition (often of a genetic origin) that impacts the synchronization of circadian rhythms.

All of the disorders listed above can bother people diagnosed with ADHD, and an individual can even develop a few sleep problems at once if the fatigue and stress levels grow with time. That’s why it is so vital to carefully examine one’s state in order to prevent any further exhaustion. There are some conditions that can be fixed by simply implementing a healthy sleeping routine, knowing what sleep-and-wake schedule suits one best, and taking care of the right room setting that would improve your sleep quality.

However, for some severe cases, prescribing medication would be necessary.

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Cognitive and Behavioral Implications of Sleep Disturbances

Reduced sleep time does not only lead to physiological consequences like headaches, joint pain, hormonal imbalance, obesity, or even diabetes. All kinds of sleep dysfunctions also refer to certain cognitive and behavioral implications that can start developing as the sleep deprivation proceeds. All of them can be managed effectively if recognized by a specialist.

Cognitive Implications

These deteriorations can be mistakenly underestimated by patients as their impact on overall health can’t be recognizable at first. Yet, as time passes, it becomes obvious that such conditions no longer classify as temporary difficulties and require close attention of both the medical practitioner and the patient, especially if this patient is diagnosed with ADHD. Here are the basic conditions that are worth paying attention to if you have experienced any type of sleep disturbance lately.

Short attention span

An attention span is a period of time one can dedicate to a task without getting distracted. It can naturally differ from person to person, but the average human attention span is now only 8.25 seconds. Lack of sleep makes it almost impossible to effectively concentrate and complete the given tasks—it is equally fair for both children who have to attend school and adults who have work commitments.

Memory issues

Both short- and long-term memory suffers as an individual gets sleep-deprived. The human brain uses sleep to form connections that have an impact on the process of storing, analyzing, and remembering new information. When the healthy sleeping schedule is ignored, the human ability to learn significantly decreases. Also, people who are diagnosed with sleep disorders like sleep apnea are actually likely to experience memory loss as the brain does not get enough oxygen to function normally, and that is when memory issues may come up.

Decision making

Although some individuals tend to be more impulsive than others in general, a lack of sleep can noticeably highlight and increase this trait, as well as negatively influence the executive brain function. Also, it has been proven that sleep deprivation, even if partial and not total, leads to ill-judged risk-taking, which can result in all kinds of health issues later.

Mood changes

Although the name of this implication hints at the changes (often constant and rapid) in emotional states, it is actually more about negative moods that arise after the person wakes up and last for a significant period of time, appearing again and again during the day. The following include:

irritability;
sadness;
anger;
frustration;
overwhelmingness.

Simultaneously, positive emotions tend to decrease and give place to the feelings that are often characterized as mental health issues, if they last long enough. Some research claims that sleep deprivation can even cause depression.

Increased stress responsivity

When a person sleeps for 7-9 hours and gets enough rest for their body, their cortisol levels decrease. Cortisol is also known as a stress hormone, so it is easy to guess that it is responsible for how our body reacts in critical situations. An important point to consider here is also emotional response: if an individual is in distress, it may be hard for them to control their feelings.

The research has found a direct link between the quantity of sleep and the level of cortisol. Although the cortisol level is naturally high in the morning and varies during the day, chronic stress or lack of sleep keeps the hormone constantly high, which results in emotional issues.

Poor planning

The ability for planning sufficiently drops as sleep deprivation develops, the research claims. As well as the organizational skills, planning loses in quality because it depends on the quality of rest like all other executive functions of the brain. Problem-solving also implies a good night’s rest and normal energy levels, so feeling sick after sleep deprivation or overexcited and hyperactive due to ADHD can significantly affect cognitive functions in a negative way.

Alzheimer’s Disease

The US National Institutes of Health claim that there are risks for people in their 50s and 60s to develop dementia if they have slept for 6 hours or less per night.

The information given in the research is primarily an assumption based on the survey and measuring sleep time of the participants with accelerometers, so the link between Alzheimer’s disease and sleep problems is not causal but correlative. Hence, to keep the brain healthy it is vital to stick to a good night’s rest.

Behavioral Implications

Behavioral implications often follow the cognitive ones and can be even more noticeable for the people around. They tend to be easier to identify, and it is still important to deal with them for better emotional and physical state.

Sleep anxiety

This condition often appears in individuals who have already had sleeping disorders for a significant time. It can also develop in those suffering from nightmares or having experienced any trauma linked to going to sleep. Sleep anxiety is often characterized by the fear of falling or staying asleep. It develops quite fast if a person has had numerous experiences of sleep disturbances. One of the most popular reasons for sleep anxiety is sleep paralysis as the hallucinations can cause severe emotional distress.

Parasomnia

Sleepwalking and -talking (parasomnia) can be a sign of overexcitation and hyperactivity, which is common in people with ADHD and sleep problems. Parasomnia is a popular diagnosis for children mostly, but some adults can experience this kind of sleep disturbance too.

Low productivity

Generally speaking, lack of sleep can even influence state economics. Employees who experience bad sleep tend to make mistakes more often and, therefore, perform worse. E.g. Sleep loss can be crucial for healthcare and result in an increased number of medical errors.

Driver sleepiness

This could probably be called one of the most alarming consequences of sleep deprivation as, according to the statistics, nearly 20% of car crash injuries in the general population are linked to driver sleepiness precisely. Interestingly, the alcohol effects don’t influence this number, and the problem wholly lies in the field of sleep deprivation, the reasons for which may be various, including bad sleep and ADHD.

Neurochemical Systems Involved in Sleep and ADHD

Molecularly, there are a few neurotransmitter systems that regulate the sleep course and take part in revealing ADHD symptoms. Here is a list of the key neurotransmitters and how exactly they affect human body functioning:

Dopamine. Takes part in the sleep-wake cycle regulation. Sleep deprivation provokes excessive dopamine production, which negatively affects learning and memorizing abilities, as well as focus and motivation.
Norepinephrine. This neurotransmitter in the brain and spinal cord constricts blood vessels and works as a blood pressure regulator. It plays a role in stress resistance and can increase alertness and attention levels in an individual who is experiencing a tough situation.
Serotonin. This chemical influences mood, sleep, digestion, bone health, wound healing, and quite a few other body processes. Serotonin is important for the prevention of Rapid Eye Movement (REM) which is known to disturb sleep as well as the mentioned sleep conditions. As serotonin production is a precursor to melatonin, the main sleep hormone, the lack of serotonin may result in insomnia or depression.
Gamma-Aminobutyric Acid (GABA). This amino acid reduces the activity of brain cells and lets the human body rest for the night. In case GABA receptors are not activated, one may have a hard time trying to fall asleep and feel overwhelmed—that is what a normal level of GABA usually prevents.
Cortisol. Another name for it is a ‘stress hormone’ as cortisol levels rise in the human body when a person is undergoing some hard situations. High cortisol suppresses melatonin and does not let the sleeping cycle begin smoothly. It may also be the reason for rapid heart rate and breathing, which, in turn, makes it physically hard to relax and fall asleep or calm down. Besides, it plays a role in metabolism regulation, which can also affect the sleep.

Some of the neurotransmitter levels can be corrected with the help of medications, while the other way to influence the chemical norms is taking care of nutrition and a healthy routine, which is often recommended by doctors, too.

How do ADHD medications affect sleep quality?

ADHD medications are mainly aimed at lowering hyperactivity and impulsivity, and, technically, they simply increase the levels of necessary chemicals, like dopamine and norepinephrine, in the blood.

The medications for ADHD can be stimulant and non-stimulant, and have a short or long action. The prescription has to be made by a qualified specialist only and depend on the careful examination of a patient; the doctor’s order should also include behavioral therapy and proper sleep hygiene.

These drugs are certified to cure ADHD symptoms:

Name of medicine	Type	Possible side effects
atomoxetine	non-stimulant medication	nausea, appetite loss, abdominal pain, dizziness, tiredness, heartburn
guanfacine	non-stimulant medication	weakness, headache, dry mouth, irritability, appetite loss, abdominal pain, low libido, nausea
dexamfetamine	stimulant medication	headaches, dizziness, nausea, mood swings, restlessness, insomnia, appetite loss
lisdexamfetamine	stimulant medication	dizziness, headaches, dry mouth, constipation, diarrhea, weight loss, sleepiness, insomnia
methylphenidate	stimulant medication	irritability, headaches, abdominal pain, insomnia, nausea, restlessness

All of the mentioned medicines normalize energy levels regulating the activity levels.

It is obvious that the described effects can improve sleep quality. However, the prolonged result would still be impossible without a well-established sleeping schedule. It is vital to consult a medical specialist before taking therapy as stimulants sometimes can make the insomnia situation worse.

Tips for Managing ADHD and Sleep Disorders

Optimize a good sleeping routine. It has to be adaptable and easy to follow in case your conditions change and you have to sleep in a new place, or your schedule gets temporarily disturbed. Think of the rituals that work best for you before bed, organize your space the way it helps you get enough darkness, and regulate the temperature. Make everything around you get you into a resting mood so that anxiety can’t rise.
Reduce screen time. There is a link between the time a person spends using a gadget and the vividness of ADHD symptoms. So, it would be a good idea to put all the screens away from the bedroom for at least 60 minutes before bedtime. The blue light from the gadget screens prevents melatonin production as the human brain indicates it as daylight and, hence, gives the brain a signal to not fall asleep. It’s important to start relaxing mentally to calm down and prepare your body for a proper rest.
Establish a schedule. Try to wake up and sleep at the same time every day for at least a couple of weeks. This way, your brain gets used to a new routine and signals to rest in the evening, reminding you of its necessities.
Decrease caffeine use 4 hours before bedtime. Coffee is a well-known stimulator and can interrupt sleep, artificially increasing the energy levels at the time of the day when the body biologically tends to rest and restore. Substitute coffee with herbal teas: chamomile, for example, has a soft tranquilizing effect.
Watch your medications. If you have been prescribed any stimulants, remember to take them as early as possible to avoid getting overstimulated before bedtime.
Move your body. Physical activity has a huge positive effect on sleep quality and mental stability. The more you get tired, the stronger your body signals your brain that it requires rest—hence, you fall asleep faster and rest better.

Final word

ADHD sleep issues share some significant common symptoms, but there are not any specific causal links recognized.

To encourage people diagnosed with sleep disturbance and ADHD to improve their condition management, it is important for their family and friends to follow the same routine and provide a healthy example—but as a support and not in a preaching way. It is also vital to not shame the patients for their diagnosis as the sleeping conditions and hyperactivity issues are caused by a chemical imbalance in the body and have nothing to do with laziness, stubbornness, or some other accusations one can mistakenly throw at those who disclose their symptoms.

Establishing a working sleeping schedule and routine is a key factor for improving an overall state and reaching the necessary level of tranquility.

References:

Wajszilber, D., Santiseban, J. A., & Gruber, R. (2018). Sleep disorders in patients with ADHD: impact and management challenges. Nature and science of sleep, 10, 453–480. (https://pubmed.ncbi.nlm.nih.gov/30588139/ )

Gamble, K. L., May, R. S., Besing, R. C., Tankersly, A. P., & Fargason, R. E. (2013). Delayed sleep timing and symptoms in adults with attention-deficit/hyperactivity disorder: a controlled actigraphy study. Chronobiology international, 30(4), 598–606. (https://pubmed.ncbi.nlm.nih.gov/23445512/ )

Lunsford-Avery J. R., & Kollins S. H. (2018). Editorial Perspective: Delayed circadian rhythm phase: a cause of late-onset attention-deficit/hyperactivity disorder among adolescents? Journal of Child Psychology and Psychiatry, and Allied Disciplines. 59(12):1248-1251. (https://pubmed.ncbi.nlm.nih.gov/30176050/ )

Children and Adults with Attention-Deficit/Hyperactivity Disorder. (2020, June). How can we help children with ADHD get a better night’s Sleep? (https://chadd.org/attention-article/how-can-we-help-children-with-adhd-get-a-better-nights-sleep/ )

Sedky, K., Bennett, D. S., & Carvalho, K. S. (2014). Attention deficit hyperactivity disorder and sleep disordered breathing in pediatric populations: a meta-analysis. Sleep medicine reviews, 18(4), 349–356. (https://pubmed.ncbi.nlm.nih.gov/24581717/ )

American Academy of Sleep Medicine. (2014). The International Classification of Sleep Disorders – Third Edition (ICSD-3). Darien, IL. (https://aasm.org/)

Winkelman JW. Overview of the treatment of insomnia in adults. In: Benca R, Eichler AF, eds. UpToDate. UpToDate Publishing; 2023. (https://www.uptodate.com/contents/overview-of-the-treatment-of-insomnia-in-adults)

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Sleep and ADHD Connection & Tips for Better Sleep Management

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