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How ADHD and Sleep Are Related

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You want to sleep, you really do. You’re too tired to do anything worthwhile, but not tired enough to just Go. To. Sleep. The more you think about it, the worse it gets. Unfortunately it’s common to suffer from ADHD and sleep problems.

Firstly, our minds race. They fixate. When I’m having insomnia it’s because I’m probably solving some sort of Rubik’s cube in my mind. Most likely, it’s a work issue or something that’s happening in my marriage or child’s life.

Then there are the physiological factors. True story: Even though I know better, I wrote the first draft of this article briefly before I intended to go to bed. This broke 3 rules of my doctor-prescribed sleep regimen: no working, no screen time and no caffeine before bedtime.

There’s also the other kind of sleeplessness, perhaps the more annoying kind. It’s the kind where your mind isn’t fixated on anything. For whatever reason, your body just refuses to sleep.

Whatever the reason, sleep issues are troublesome because adequate rest is a basic building block for our health, especially our mental health. Most of us with ADHD probably have suffered from sleep issues, if we’re not experiencing them right now. We know the what, but what’s the why?

Does ADHD Cause Sleep Problems?

Like our favorite Facebook relationship status: “it’s complicated.” What’s not complicated is that if you’re of the 4 to 5% of Americans with ADHD, you’ve probably played a round or two of Google roulette in your bed to figure it out (again, making it worse with screen time). According to the National Sleep Foundation, ADHD is often linked with mental health issues, substance abuse and/ or poor work or school performance. These same issues are often present in a sleep disorder. As such, there’s frequency a diagnosis overlap among ADHD and sleep disorders such as insomnia. “Sleep problems are also common in adults with ADHD,” reports the NSF. “In one study, researchers compared adults with narcolepsy, idiopathic hypersomnia, and AHDH and found a high percentage of symptom overlap, suggesting the possibility of ADHD misdiagnosis among adults.”

ADHD Comorbidities Linked To Sleep Issues

Here’s a look at some of the most common mental health disorders swirling around the sleep and ADHD conundrum. If you suspect you have ADHD, one of the issues below or a sleep disorder, it’s important to seek the help of a medical professional immediately. If possible, especially for mental health issues, try to find somebody who specializes in your issue rather than a general practitioner. However, even a general practitioner is a good place to start, and often they can give you a referral to a specialist.

Anxiety Disorder

Half of ADHD adults also have anxiety disorder, one of the leading causes of sleep issues. It can complicated treating both, and rule of thumb is to prioritize whichever is causing the largest impairment. Sometimes the fallout from the ADHD is creating the anxiety, while other times the anxiety is happening independent of the ADHD. While stimulant medication can be helpful for treating ADHD, in some cases it may exacerbate anxiety. A common treatment for anxiety is Cognitive Behavior Therapy. “Anxiety disorders and other comorbid conditions may come about as a result of living with ADHD. Having a comorbid anxiety disorder can make treatment more complicated,” reports the Anxiety and Depression Association of America (ADAA).

My ADHD-Anxiety Experience

The ADHD-anxiety relationship is definitely a tricky one for me. My entire life, multiple professionals have left me with the impression that I’m born with anxiety disorder and will always have it. Most of my 20s and 30s have been survived with the assistance of anxiety medication. I’m now learning, however, that the anxiety medication I so relied upon was only supposed to be a fire extinguisher. Not a “maintenance medication” that you take long-term every day.

I’m now in the process of learning how my ADHD informs my anxiety, and that by treating it I also can address my anxiety. Things that have helped include getting on the right ADHD medication for me, nature walks and journaling. Mindfulness and meditation have also played a huge part in gaining control over the anxiety. I’m becoming much more in-tune with how my thoughts create the feelings I experience.

Clinical Depression

While depression in ADHD adults is 2.7 times more likely, it’s also a condition that psychiatrists have a lot of experience in treating. Like anxiety, depression can occur as a result of the ADHD or independent of it. Issues with sleep, motivation and emotions occur in both conditions, which can make diagnosis complicated. Depression joins anxiety as one of the top links to chronic sleep issues. Additionally, just like with anxiety, depression can be a byproduct of your ADHD, related to the challenges in your life that have transpired. While the depression and ADHD link remains a mystery, it’s for certain something that’s commonly passed down by a family member. According to ADAA, “Proper diagnosis relies on a comprehensive clinical evaluation by a health professional, who will take into account personal history, self-reported symptoms, and mental-status testing, as well as  early development problems and symptoms of inattention, distractibility, impulsivity, and emotional instability.”

Autism Spectrum Disorder (ASD)

Autism and ADHD have many similarities and also are prone to co-exist, although researchers aren’t yet sure why. Up to 80% of children with autism suffer from sleep issues, and adults suffer as well. Like ADHD, lack of sleep can worsen symptoms and cause issues at work or in school. Adults with undiagnosed ASD can have difficulty getting diagnosed, particularly because of the lack of reliable screening options available, as most are designed for children. The difference between autism and ADHD can be tricky, but ASD typically refers to a range of neurological conditions that impact social skills, thinking, communication, and repetitive behaviors. ADHD, meanwhile, is a singular neurological condition associated with focus and impulsivity. While ADHD isn’t a spectrum disorder like ASD, it still has a wide range of symptoms. “With ADHD or ASD, brain development has been affected in some way,” explains CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder).  “Most importantly, that includes the brain’s executive functioning, which is responsible for decision making, impulse control, time management, focus, and organization skills.”

Bipolar Disorder (BD)

While those with ADHD have mood fluctuations, those with bipolar have severe mood fluctuations that alternate between extremes of depressive and manic. Not only can this be confusing to diagnose, but having both conditions occur together can be downright dangerous. About 70 percent of those with bipolar also have ADHD. Conversely, 20% of those with ADHD are known to develop bipolar disorder. Not surprisingly, sleep problems and bipolar are commonplace. “It is understandable that doctors confuse bipolar symptoms for those of ADHD,” reports ADDitude magazine, “Both conditions involve impulsivity, irritability, hyperactivity, emotional dysregulation, sleep problems, a racing brain, and problems with maintaining attention.” While bipolar disorder is very common, the cause is unclear and there is no cure. There are, however, treatments that can help. These are commonly needed for life and include a combination of medication and psychotherapy. BD patients typically experience both manic and depressive phases that last weeks or months at a time.

ADHD and Substance Abuse

While ADHD medications carry a lot of stigma, those who are properly diagnosed and treated with it are less likely to suffer from substance abuse. Those with ADHD are three times as likely to suffer from substance abuse, particularly alcohol and marijuana. In his study on the issue, Harvard professor Timothy Wilens, M.D. discovered that most of his subjects weren’t trying to get high – they were trying to feel better by self-medicating. “ADHD medication is not a gateway drug,” ADDitude explains. “In fact, teens and adults who seek treatment for their ADHD symptoms are much less likely to abuse drugs and alcohol than are their undiagnosed, untreated counterparts.” Those with addiction issues are 5 to 10 times more likely to have sleep issues as well. In some cases, substances are initially used to help with sleep and addiction surfaces. Those with sleep issues may also fall into drug addiction because they are trying to stay awake after a restless night. Ever still, the long-term effects of the patient’s substance abuse (unrelated to a sleep disorder) can change the body in a way that makes it hard to get sleep.

Does Lack of Sleep Make ADHD Worse?

Because sleep deprivation is linked to lack of focus and problems with motor skills, not getting enough sleep absolutely can make ADHD worse. ADHD coach Dana Rayburn points to a study in Sleep journal, in which children without ADHD with a sleep deficit demonstrated ADHD symptoms. Even though the study was on children, she urges adults to take heart if they’re ADHD sufferers. Lack of sleep will jack up anybody; if you have ADHD you’re pouring grease into the fire. “Just for kicks, I went back and checked the intake forms for my last ten new clients,” Rayburn said, “Guess what? Only one of them claimed to get the amount of sleep she needs! It’s that old self-care thing I’m always yammering about. If you don’t give your body the care and support it needs you’re asking for a runaway case of ADD / ADHD.”

How Do You Fall Asleep With ADHD?

The first step in better sleep is seeing a medical professional. Not only can they help sort out the complexities of your sleep issues and concurring issues (such as comorbid conditions), they also can help you establish positive sleep hygiene.

A good sleep routine may require a combination of things, and it may require some trial and error. “A regular nightly routine helps the body recognize that it is bedtime,” explains the NSF.  “This could include taking warm shower or bath, reading a book, or light stretches. When possible, try to avoid emotionally upsetting conversations and activities before attempting to sleep.” Most solid sleep routines have the following things in common:

Caffeine

Caffeine can have positive effects such as keeping you alert and focused. In fact, ADHD patients pre-treatment often find that they have been relying on stimulants to get stuff done for years. However, if you overdo it or drink it too close to bedtime, it can be detrimental to your sleep hygiene. Caffeine takes about 30 to 60 minutes to take effect in your body and has a half-life of 3 to 5 hours. Especially before bed, cutting back on caffeine can help you sleep better. While times vary on when you should limit your caffeine, the general advice ranges to cutting yourself off 3 to 6 hours before bedtime. Sleep studies have found that caffeine intake can mess with your body’s internal clock and can cost you an hour of lost sleep when ingested within 6 hours of bedtime. “Caffeine works best when you take it on an intermittent, off-and-on basis,” explains the American Academy of Sleep Medicine. “Higher doses can have much more potent effects. A dose of 500 mg or 600 mg of caffeine can affect you much like a low dose of an amphetamine. When you consume caffeine daily, it is less effective as a stimulant. Your body builds up a tolerance to it.”

Bedtime Routine

If you’re a parent, you know this one all to well. For adults, the American Heart Association (AHA) recommends setting a reminder to begin the routine, preparing for the next day briefly, releasing stress through something like meditation or journaling, and reading while dimming the lights. “Don’t lie in bed tossing and turning if you’re restless,’ recommends the AHA. “It’s better to get up and reset. Try some of the activities above for a short time before getting back to bed. Ten minutes of meditation or reading might save you hours of staring at the ceiling.” These tips are a good start, and the same things won’t work for everyone. For example, when I saw a doctor for insomnia, he actually advised me not to read right before bedtime; everyone’s different. Also be sure you’re going to bed early enough to get enough sleep. Give yourself about least 30 minutes to wind down for sleep, and make sure you’re getting 7 to 9 hours a night.

Screen Time

Screen time in the evening has been found to disrupt the circadian rhythm and cognitive function. Your circadian rhythm is your body’s internal clock, a 24-hour sleep and wake cycle that can be influenced by things like sunlight and temperature. It’s generally recommended that you shut down screen time sometime between 30 minutes and 2 hours before bed. You may have seen a blue light filter on your phone and wondered if that would help. These filters decrease the amount of blue light your eyes receive, which can inhibit your body’s production of melatonin (which promotes a good night’s sleep). “The frequent use of LED sources could have ramifications on human behavior, since light is the most important synchronizer of our biological clock,” explains Swiss researchers whose work on the subject appeared in the American Physiological Society.

Don’t Work or Read Where You Sleep

As a doctor once told me, the bedroom should be for two things only: sleeping and sex. This strengthens your association between the bedroom and sleep. When it is finally time for bedtime, dark and cool environments are typically the best for most people. And, of course, no screens. “A quiet, dark, and cool environment can help promote sound slumber,” recommends the Division of Sleep at Harvard Medical School. “To achieve such an environment, lower the volume of outside noise with earplugs or a “white noise” appliance.”

“Use heavy curtains, blackout shades, or an eye mask to block light, a powerful cue that tells the brain that it’s time to wake up. Keep the temperature comfortably cool—between 60 and 75°F—and the room well ventilated. And make sure your bedroom is equipped with a comfortable mattress and pillows.”

Common Sleep Solutions

Here are some common solutions to getting a better sleep.

Melatonin Supplements

This hormone plays a vital role in your sleep cycle, and if you’re having sleep issues it may be time to consider melatonin supplements. While some people may suffer grogginess the day after taking melatonin, others find that it’s the best thing for sleep since the invention of the mattress. When shopping for melatonin supplements and other natural sleep aids for ADHD, make sure you are purchasing from a well-reputed source. If you don’t have a word-of-mouth recommendation, check out online reviews and stick to brands that you trust. Here are some melatonin options. 

A Good Mattress

According to the Better Sleep Council, you should get a new mattress every 7 years or when all signs point to replace. The firmest mattress isn’t necessarily the best mattress – it all depends on your favorite sleeping position. Knowing your budget ahead of time and studying online reviews are the best ways to ensure you’ll find the best mattress for you. While it used to be necessary to go to the mattress store and battle salespeople, now you can shop from the comfort of your own home. Some companies will even be happy to take your old mattress away while they’re bringing your new one (and it’s typically returnable if it’s not quite the right fit). Here are some mattresses you can buy on Amazon.

Alarm Clocks for Heavy Sleepers

If your smartphone or digital alarm clock isn’t doing the job anymore, it’s time to break out the big guns. There are various types of alarm clocks for those who need a little more help than usual, including alarm clocks for heavy sleepers, programmable alarm clocks and projection alarm clocks. Here are some alarm clocks for heavy sleepers

CBD Oil for Sleep?

The jury’s still out on whether there’s enough scientific benefits to back the use of CBD oil for sleep. However, those who use it swear by it. One of the reasons may be because CBD oil is also said to relieve anxiety and pain as well, which sounds very sleep-inducing. As states continue to loosen their grip on the cannabis industry, only time will tell if the medical claims add up. When shopping for CBD oil, ensure that you are purchasing from a reputable company that has a product that is lab-tested. Look out for sellers who will share certificates of authenticity from independent labs to back up their products. Here are some options on Amazon

Headphones for Sleep

When earplugs just won’t cut it anymore or if you need special sounds delivered via earphones, consider finding a pair of comfortable earbuds for sleep. Not only can you find relaxing sounds such as white noise, there are also meditations available that can help you find your way to sleep. Here are some headphones for sleep. 

Sleep Apps

Your mileage may vary, but there are a variety of sleep apps out there. Some help you track your sleeping habits, while others help you wake up when it can feel impossible. Do you ever have trouble with math early in the morning? Try having to solve a math equation in order to turn off your obnoxious ringtone – there’s an app for that (many!).

Sleep Masks

While all sleepers are different, I find that the best sleep masks are cushioned without being too hot. Not only are they more effective at blocking out light, they’re more comfortable as well. I’m not a fan of the ones what are paper thin, but they are so common that somebody’s buying them. Like most things, it’s just going to depend on your individual preferences. Pro tip: Like any good ADHD’er, I actually always have two of these at a time in my home. Inevitably, I’m always misplacing one of them so it’s always nice to have another readily available. This is especially true right before you’re going to bed and aren’t in the mood to play “Find the Sleep Mask”. Here are some sleep masks.

Sleep Monitoring Devices

While the jury’s still out on the accuracy of these, unless you’re submitting a study to a medical journal, you’ll probably get what you need out of it. Typically associated with tracking exercise, these devices also capture how long you sleep and how often you toss and turn. Here are some fitness devices that also track sleep. 

Tea for Sleep

When drinking tea for sleep, your best bets are chamomile, valerian, oatstraw, and passionflower. One of my all time favorites is the wellness version of Sleepytime Tea, which you can get at any grocery store. Or, if you’re feeling fancy, the original Sleepytime is available in K-cup. Here are some tea options that promote sleep. 

Weighted Blankets

Weighing up to 30 pounds, these blankets contain weighted beads or pellets. Benefits include improved sleep and relieved anxiety. You can typically find them at places like Bed Bath & Beyond, and depending on your weight you may have difficulty finding something heavy enough. If you’re having trouble finding a weighted blanket heavy enough for you, be sure to check out these plus size weighted blankets. Here are some weighted blankets on Amazon.

Frequently Asked Questions

Do people with ADHD get tired easily?

It’s definitely possible. Some reasons may be the fatigue of having hyperfocus, the associated sleep problems and the constant effort required to stay focused.

Do adults with ADHD sleep a lot?

Typically, the sleep issues for ADHD adults center around getting to sleep, getting enough sleep and getting restful sleep. However, for those who aren’t getting enough sleep at night, it can seem from the outside that they’re sleeping too much if they’re trying to catch up on sleep during the day.

Is insomnia a symptom of ADHD?

It’s hard to say whether a patient’s insomnia is a byproduct of the ADHD or if it’s a coexisting condition independent of ADHD. That said, it’s true that many people with ADHD also suffer from other sleep issues such as insomnia.

Does ADHD medication help with sleep?

If trouble sleeping is a byproduct of ADHD, then treating the ADHD can very well help with sleep issues. The same is true about ADHD-related anxiety. On the flip side, if ADHD medication isn’t timed correctly, it can actually make it more difficult to sleep. This is especially the case with extended release medications, which last longer.

Can ADHD cause sleepiness?

This is an issue definitely being studied by researchers, including this 2015 French study and this 2013 Canadian study. Both echo the difficulty of fully understanding the relationship between ADHD and sleep issues, particularly daytime sleepiness. “The links between attention-deficit hyperactivity disorder (ADHD) and sleep disorders remain unclear,” explains the French researchers. “ It may thus be difficult for clinicians to differentiate the diagnosis of ADHD comorbid with a sleep disorder from sleep disorders with ADHD-like symptoms. This distinction could be important for the appropriate management of patients with dual complaints of trouble maintaining attention and daytime sleepiness.”

Does ADHD get worse when you’re tired?

Yes, ADHD symptoms are known to worsen when the patient hasn’t had enough sleep. The ability to focus and motor skills are particularly impacted.

Why does caffeine make me sleepy?

According to Death Wish Coffee, there are a few reasons coffee can seem like it’s making you tired. One is the flood of adenosine that hits your brain after coffee wears off. This is a neurotransmitter that induces sleepiness, which is blocked by caffeine. “While preventing your brain from receiving adenosine, your body is still producing the neurotransmitter,” explains Death Wish. “Because of this, once the caffeine wears off, you have a build-up of adenosine that comes over your body all at once making you sleepy.” Caffeine is also a diuretic, and being dehydrated can make you feel sleepy. And if you’re adding sweeteners to your coffee, you could be having sugar crashes.

Why do I fall asleep when I’m bored?

According to a 2017 Japenese-Chinese study, the part of the brain associated with motivation and pleasure, the nucleus accumbens, also can produce sleep. Much like we may forgo sleep when engaged in something, the study poses the possibility that the opposite may be true when we are bored. “As humans, we often defy sleepiness and stay awake when attention is necessary, but also experience an inescapable desire to sleep in boring situations,” explain the researchers. “The brain mechanisms governing the regulation of sleep by cognitive and emotional factors are not well understood.”

Why do I always fall asleep during the day?

Sleep deficit, caffeine wearing off and boredom can all make us sleepy. However, if you experience intermittent and uncontrollable episodes of falling asleep during the daytime that can’t otherwise be explained, you may have narcolepsy. In fact, French researchers discovered in 2017 that a drug used to treat narcolepsy also helped ADHD symptoms.

ADHD & Sleep Resources for Women

Here are some fantastic resources for ADHD and sleep if you still want to learn more:

  • Better Than Counting Sheep! Your Free Guide to Sleeping Better, ADDitude Magazine – A comprehensive collection of resources from the ADDitude team. Be sure to check out the list of top sleep apps!
  • How to Get Sleep When You Have ADHD, How to ADHD – Intel on the fabulous Jessica McCabe on this very common topic. The description section of the video has an incredible collection of even more resources on ADHD and sleep.
  • A New Theory About ADHD And Sleep– Sleep Doctor – Dr. Michael Breus discusses new research that ADHD could actually directly impact circadian rhythms. Dr. Breus us particularly interested in “the relationship between ADHD and sleep, and particularly in the risk of misdiagnosis of ADHD for what may be sleep problems.
  • Academic research about ADHD and sleep in adults, Google Scholar – A collection of available scientific research on the subject.
  • Getting Better Sleep with ADHD, Taking Control: The ADHD Podcast – ADHD coach dedicates an entire podcast episode on the topic of adult ADHD and sleep. The 33-minute episode introduces “a modest suggestion of a single strategy, and what you need to do to implement this strategy toward becoming a better sleeper.”
  • Basics About Sleep, Centers for Disease Control and Prevention – A full guide on the basics of sleep, including how to get it and what to do if you’re not getting enough of it.
  • Sleep Tips When You Have ADHD, The A.D.D. Resource Center – Handy list to keep on-hand from one of the leading information sources on ADHD online.
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