ADHD and Sleep: Twelve tips to facilitate a better night's rest

Are my ADHD symptoms impacting my ability to sleep? Are my struggles with sleep contributing to my ADHD symptoms? Which problem emerged first?

This line of questioning can seem like a chicken/egg scenario and unfortunately, we do not conclusively know the answer.

It has been reported that sleep disorders and disturbances affect up to 80% of people diagnosed with ADHD,[1] making this one of the biggest comorbidities that we face. The biological cause for this is still poorly understood. However, after over a decade of research into the topic, there have been significant observations made that may lead us to the answer.

Does ADHD affect sleep?

Sleep research measures sleep quality in two main ways. One way is through subjective measures, such as data collected via self-report questionnaires. The other is through objective measures, such as data collected via sleep studies. Some research has found that, despite high subjective measures of sleep disturbance, the objective measures showed no significant difference compared to the control group.[2] If you have ever been through a sleep study and the doctor said that they had not found a distinct cause for your struggle, this might be why.

Sleep difficulties commonly observed among the ADHD population include trouble falling asleep, not feeling tired at the ‘right’ time, frequently waking up at night,[3] restlessness, and an increased number of sleep stage shifts.[4]

A partial explanation for difficulties falling asleep could be delayed melatonin onset. Our bodies naturally make and release melatonin, which is part of what causes us to feel sleepy. Many of us with ADHD have a delayed release of this hormone, causing us to feel sleepy later than is considered normal. At the start of one study, 77% of subjects with ADHD had a melatonin release after 9 pm.[5]

Does sleep affect ADHD?

In contrast, it has been clinically demonstrated that poor quality of sleep can have a detrimental effect on many ADHD symptoms.

Consistent lack of sleep can significantly increase the prevalence of inattentive and oppositional behaviors,[6][7] and impair the ability to emotionally self-regulate.[8] This leads to a decrease in overall school/work performance and quality of life.[9]

How do stimulants affect sleep?