metrorun ADHD affects about 10% of children and many adults. It was not tested when I was young and, knowing the symptoms, I feel that I probably have this disorder as an adult.
Sleep problems commonly plague individuals with ADHD — particularly during the teen years, when sleep hygiene and patterns go haywire in typical brains and households.
Studies estimate that up to 70 percent of children and adolescents with ADHD have problems with sleep that stem from reasons ranging from racing thoughts to coexisting conditions and even environmental factors that can impact sleep patterns. As we age, ADHD can linger, lasting well into our adult years.
No matter the age nor causes, persistent sleep problems can impact executive functioning and impair quality of life over time. Interventions and practices, however, can significantly improve sleep quality — especially when implemented early in life.
Sleep problems – including restless nights and morning grogginess – are common. ADHD brains don’t know how to fall asleep. They regularly perseverate beyond bedtime; staying awake late, then are foggy in the morning.
If you’re not sleeping well, every aspect of your life suffers. Below are the most common ADHD sleeping problems, why they occur, and how to overcome them to fall asleep – at last.
The ADHD-Sleep Connection: Problems
There’s not one single sleeping problem that afflicts people with attention deficit hyperactivity disorder (ADHD or ADD). Rather, there are many difficulties and disorders including:
- Difficulty falling and staying asleep
- Daytime sleepiness, sleep onset problems, and circadian abnormalities
- Unwillingness to nap even when exhausted
- Increased nocturnal activity/feeling more alert/energized after dark
- Going to bed late (around 2 a.m.)
- Difficulty awakening (regardless of ample sleep)
- Feeling tired despite ample sleep
- Difficulty maintaining alertness during the day
- Sleep talking/sleep walking
- Narcolepsy
- Restless Leg Syndrome (RLS) affect about 25% of those with ADHD
- Bruxism (teeth grinding)
- Sleep paralysis
- Obstructive sleep apnea
Lack of sleep can lead to other health problems, such as weakened immunity, dysregulated appetite and metabolism, and moodiness. Sleep problems may worsen executive functions, like memory, focus, and problem solving, all of which are already weakened by ADHD alone. Hyperactivity and inattentiveness can also worsen with inadequate sleep.
Theories Explaining the ADHD-Sleep Link
Biological Roots of Sleep Problems – Sleep involves neurotransmitters also implicated in ADHD. GABA, for example, is a neurotransmitter responsible for inhibition. Individuals with ADHD typically have less available GABA, which can make surrendering to sleep difficult. Delayed sleep phase syndrome (DSPS), a circadian rhythm abnormality, is also common among many people with ADHD. Delay in melatonin onset, a hormone associated with falling asleep, is another issue seen in people with ADHD.
Behavioral Roots of Sleep Problems – ADHD symptoms can conspire all day long to create less-than-optimal environments for sleep later in the evening. Some with ADHD rely on caffeine and caffeine-containing medication in order to optimize focus, consumption of which can impact sleep duration and quality. Many people with ADHD, however, prefer staying up late because that’s when they focus best.
Genetic Roots of Sleep Problems – Many adults with ADHD exhibit a genetic variation of the COMT gene, which suppresses an enzyme that metabolizes dopamine. This makes it harder for the body to regulate sleep. [This is the Met/Met variation of rs4680, which I have]
How to Fall Asleep with ADHD
Begin by keeping a sleep diary to track the following:
- Actual hours slept each night (not just time spent in bed trying to sleep). The National Sleep Foundation (https://www.thensf.org/) recommends 7 to 9 hours of sleep for adults, 8 to 10 hours for teens, and 9 to 11 hours for 6 to 13 year olds. The more sleep done when the sun is down, the better. Weekday and weekend sleeping hours shouldn’t vary by more than 30 minutes.
- Sleep location (bed, couch, etc.)
- Environment (T.V. on or off? music playing?, ambient light, with partner/pet or not, room temperature)
- Awakenings/nightmares
- Naps during the day
- If and how sleep habits affect others in the household
- How you feel about your sleep or lack of sleep
Consider signing up for a sleep study, a test that studies brain waves, oxygen levels in the blood, breathing, and more to see if any sleep disorders are present. If diagnosed with sleep apnea, a CPAP machine might help with breathing, although there are other solutions that might aid with this condition.
Anatomical issues, like a deviated septum, can also obstruct breathing and be a factor in other sleeping problems. A septoplasty and other procedures can correct the issue.
Best Practices for Sleep and ADHD Brains
That evening glass of wine isn’t easing you into sleep; it’s contributing to your restless nights and warm milk has no evidence of helping sleep. Here are some tips on what to drink and eat instead to get the sleep you need.
- To nap, or not to nap? For some, power naps throughout the day are a must for feeling energized and refreshed. For others, it may mess with sleep later in the evening. Experiment with naps, and note it in the sleep diary.
- 20-minute rule: If you’re trying to change your sleep time, do it in 20-minute intervals to avoid jarring the brain. For example, if 2 a.m. is your current bedtime and your goal is to be asleep by 11 p.m., aim to sleep at 1:40 a.m. the first night, 1:20 a.m. the next, etc.
- Relaxation exercises/deep breathing. These practices can calm and prep the body and mind for sleep.
- Unplug from technology. Have an end time, at least 60 minutes before bed time, to put away your phone, turn off TV shows, or stop playing video games. The light from devices can throw off your sleep cycle.
- Use External cues: A warm bath, stretching, light music (or a sound machine), dim lights, and changing into bed clothes can help shift the mind and body closer to sleep mode. Make sure to have and use daytime cues as well when you want to be alert (bright lights, a cool shower, food, etc.)
- Climate control: Having a cool room offset by a warm, cozy bed grounds the body and makes you more inclined to stay in bed.
- Dark room. Use eye masks, close shades and curtains, and dim lights from clocks and other electronic devices.
- Try breathing techniques or progressive muscle relaxation
- Don’t stay awake in bed too long. If it takes longer than a half hour to fall asleep, it’s better to get out of bed and engage in a non-stimulating activity until sleepiness sets in.
- Keep a regular Bed and Wake time every day of the week
- Engage in daily physical activity and exercise (but not too close to bedtime).
- Using the bed only for sleep to instill a powerful bedtime cue.
- Don’t drink alcohol. Digesting alcohol can affect your ability to stay asleep, and may result in frequent waking in the middle of the night. Alcohol is a diuretic, and will also cause frequent bathroom visits during the night. Try chamomile tea. Chamomile has a mild sedative property, which increases when combined with the soothing effect of a warm liquid.
- Don’t consume anything containing caffeine (including coffee, soda, caffeinated tea and chocolate) less than four hours, or more, before bedtime. In addition to being a stimulant, caffeine, like alcohol, is also a potent diuretic that could cause you to wake up for bathroom trips at night.
- Don’t eat a large meal. It takes about four hours to digest a meal, which can keep you awake so finish eating early.
- Watch intake of certain medications before bedtime. Many over-the-counter medications contain caffeine. Certain asthma medications, migraine and cold preparations, and antidepressants may also contribute to insomnia.
- Get evaluated and/or treated for restless legs syndrome (RLS). The name of this common sleep disorder refers to the “creepy, crawly” sensation in a sufferer’s legs, which causes an urge to move and makes it difficult to get to sleep.
These are solid tips for ANYONE who struggles with sleep.
I’d love to hear your tips on getting better sleep. Let me know!
