Is There A Connection Between ADHD And Narcolepsy?
Attention-deficit hyperactivity disorder (ADHD) is often associated with comorbidities with other mental illnesses or disorders, including sleep disorders. For this reason, some individuals may wonder whether ADHD has any connection to narcolepsy and how the two are related. Understanding this connection could be the start to understanding your own unique symptoms and seeking support.
Is there a link between ADHD and narcolepsy?
Studies suggest a link between attention-deficit hyperactivity disorder and narcolepsy, as "both narcolepsy and ADHD share the symptoms of sleep disturbance and excessive daytime sleepiness" among others.
Child and adult ADHD is a neurodevelopmental condition with a pattern of hyperactivity, inattention, and impulsivity. ADHD is also a form of neurodiversity associated with unique brain differences. Narcolepsy is a neurological condition characterized by excessive daytime sleepiness and cataplexy, depending on its type. Cataplexy refers to the sudden loss of muscle control that may be incited by strong emotions.
Some people with narcolepsy also experience ADHD symptoms. Moreover, both ADHD and narcolepsy are associated with a higher prevalence of sleep disorders when compared to the general population. Understanding this connection may help individuals with both conditions understand what condition could be causing symptoms. However, if you’re experiencing new or worsening physical symptoms, talk to a medical doctor for guidance.
Attention-deficit hyperactivity disorder (ADHD) and narcolepsy studies
Another study of pediatric patients with narcolepsy suggests that more severe ADHD symptoms may produce higher levels of "sleepiness, fatigue, and insomnia." Stimulant medication is often used to treat ADHD and narcolepsy symptoms. The study's findings, however, indicated that stimulant medications did not alleviate these individuals’ ADHD symptoms. Another study of children with ADHD showed that one-fifth of research participants had a "narcolepsy-like sleep phenotype."
ADHD and narcolepsy: What's the connection between Attention-deficit hyperactivity disorder (ADHD) and narcolepsy?
Narcolepsy and ADHD may be characterized as distinct disorders, but they share some symptoms, especially in relation to sleep disturbances and their effects.
Researchers are studying the mechanisms connecting these two conditions, suggesting there might be "shared genetic, neurochemical, or environmental factors that contribute to both." Some research also indicates a "shared brain pathophysiology" as well as dysregulation of noradrenaline, a neurotransmitter that may contribute to changes in REM sleep.
ADHD, narcolepsy, and sleep disturbances
One aspect connecting ADHD and narcolepsy is the prevalence of sleep-related disturbances in both conditions. Between 25% and 50% of people with ADHD report a sleep disturbance.
Some people with ADHD may also experience sleep disorders, such as delayed sleep phase syndrome (DSPS), circadian rhythm sleep disorder, sleep-disordered breathing (SDB), obstructive sleep apnea (OSA), and restless legs syndrome (RLS). Circadian rhythm sleep disorders cause an alteration in the timing of the sleep-wake cycle, which may be attributed to behavioral and biological factors, such as delay in melatonin increase release.
RLS causes an uncontrollable urge to move the legs and possible discomfort. According to researchers in the above study, up to 44% of people with ADHD have RLS symptoms, which have been linked with dopamine deficits in both disorders.
Narcolepsy itself is sometimes referred to as a sleep disorder, as it relates to the brain's ability to regulate the sleep-wake processes. People with narcolepsy may also have RLS, sleep apnea, insomnia, and excessive daytime sleepiness (EDS). ADHD patients often also experience EDS, sometimes called hypersomnia. Studies suggest a connection between ADHD and narcolepsy in relation to hypersomnia.
Presence of ADHD symptoms in sleep disorders
Factors like daytime sleepiness, fatigue, severity of insomnia, and quality of life are associated with the presence of ADHD symptoms in people with narcolepsy. Those with narcolepsy type two (narcolepsy without cataplexy) are more likely to experience ADHD symptoms, according to findings. Some researchers speculate the possibility of ADHD with hypersomnia being a subtype of narcolepsy type two.
Sleep disturbances are associated with:
- Impairments in the processing of emotional facial expressions
- Increased likelihood of depression, anxiety, and other mental disorders
- Increases in hyperactivity
- Increases in inattention
- Increased vulnerability to physical illness
- Fatigue
- Restlessness
Ways to address sleep patterns in narcolepsy and ADHD
Sleep routine for attention deficit hyperactivity disorder and narcolepsy
Developing a sleep routine that can promote quality sleep may help individuals alleviate ADHD and narcolepsy symptoms. According to the Division of Sleep Medicine at Harvard Medical School, the following habits may reduce narcolepsy symptoms:
- Taking a 15 to 20 minute nap in the afternoon to improve alertness (for those with extreme tiredness, an additional nap in the late morning might be recommended)
- Staying active by taking walks or partaking in physical exercise
- Fostering positive sleep habits, such as going to bed at the same time each night, ensuring the room is comfortable, listening to relaxing music, and unplugging from technology and TV before bedtime
- Avoiding coffee in the late afternoon, evening, and night
- Eating light meals, as some people with narcolepsy may experience more drowsiness after eating a large meal
Managing ADHD symptoms at night
The following techniques might be beneficial for managing symptoms of ADHD at night:
- Taking melatonin supplements
- Taking a bath shortly before bed
- Reading a book
- Avoiding engaging in projects that require intense focus at night
- Exercising during the day and avoiding extraneous exercise right before bed
- Wearing a weighted blanket
- Keeping your bedroom comfortable, quiet, and dark
- Considering light therapy to regulate the sleep-wake cycle
- Avoiding taking naps during the day
- Avoiding caffeine and substance use later in the day
- Discussing the side effects of your medication with your doctor
If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources.
Consult a medical doctor before starting, changing, or stopping a medication for any condition. The information in this article is not a replacement for medical advice or diagnosis.
Support options for ADHD and narcolepsy
Living with challenging symptoms can take a toll on one’s well-being. Seeing a therapist may be a way to receive personalized advice. However, some individuals face barriers to in-person sessions, such as distance or time. In these cases, online therapy platforms like BetterHelp allow clients to have sessions with a licensed therapist via phone, video, or live chat. In addition, online platforms often offer resources like journaling prompts and group sessions.
One of the therapeutic approaches used by therapists is cognitive-behavioral therapy (CBT), as it may reduce core and emotional symptoms of ADHD. CBT may also be helpful in addressing narcolepsy symptoms, particularly hypersomnia and depression.
A meta-analysis and systematic review that looked at online interventions for ADHD suggests that virtual therapy could be effective for addressing attention deficit and social functioning in adults with ADHD. The meta-analysis evaluated six randomized controlled trials involving 261 people with the condition. Another CBT-based online therapy for insomnia, a condition that often affects people with narcolepsy or ADHD, has also been found to be an "effective approach for lessening insomnia" and anxiety symptoms.
Takeaway
Some people with narcolepsy also experience ADHD symptoms. Moreover, sleep disorders have been found to be more common in people with ADHD as well as those with narcolepsy when compared to the general population.
Developing a sleep routine that can promote quality sleep may be helpful in alleviating ADHD and narcolepsy symptoms. Learning to manage symptoms that affect your well-being can be challenging. The support of a therapist may be a helpful option. Consider reaching out to a provider online or in your area to get started.
Can attention-deficit/hyperactivity disorder cause daytime sleepiness?
ADHD can result in daytime sleepiness, but this effect may be due more so to sleep problems that have a high prevalence in those with this form of neurodivergence rather than a symptom of ADHD itself. As a 2020 study on the topic puts it, “cognitive performance deficits routinely attributed to ADHD [...] are largely due to on-task sleepiness and not exclusively due to ADHD symptom severity.” In addition, it reports that as many as 70% of adults with ADHD experience comorbid sleep disorders.
It can also be important to note that narcolepsy, a rare sleep disorder, has significant comorbidity with ADHD too. One study published in Sleep Med suggests that the prevalence of ADHD symptoms in those with narcolepsy was greater than 30%.
How do I know if my children have narcolepsy?
According to the Children's Hospital of Philadelphia, narcolepsy is a chronic, neurological sleep disorder characterized by excessive daytime sleepiness and, in some cases, "sleep attacks,” which cause the individual “to fall asleep at very unusual and sometimes dangerous times.” It reports that common symptoms of narcolepsy patients with this sleep disorder may also include:
- Cataplexy (“brief, sudden losses of muscle control”)
- Sleep paralysis
- Hypnagogic hallucinations (vivid, dreamlike experiences)
- Automatic behavior that can continue even when asleep
- Disrupted nighttime sleep, resulting in poor sleep quality overall
It also notes that children with pediatric narcolepsy may demonstrate trouble keeping up with friends or schoolwork as a result of their symptoms. If you’re concerned about your child’s sleep habits or behaviors, it may be best to consult with their doctor for evaluation and diagnosis and to address impact and management challenges.
What are the best medications for narcolepsy and ADHD?
There are certain medications that may work to treat narcolepsy and ADHD as well. One example according to a 2020 study is a non-stimulant medication known as modafinil. While it's primarily a medication for narcolepsy, research suggests that it may also improve ADHD symptoms significantly compared to a placebo.
Why is it that narcolepsy may be more common in ADHD patients?
According to a 2020 study, individuals with ADHD are at greater risk of narcolepsy (as defined by the International Classification of Sleep Disorders) than the control group. The study utilized the ADHD Self-Report Scale, subjective sleep measures, and the Epworth Sleepiness Scale to quantify symptoms, along with the Multiple Sleep Latency Test to diagnose narcolepsy.
However, the study indicates that the reasons for this common comorbidity aren't well understood. It notes that “Causality is unclear because sleep disorders can induce ADHD-like symptoms, which could be due to excessive daytime sleepiness.” The study also reports that other sleep disorders, such as restless leg syndrome, periodic limb movements of sleep (PLMS), and psychiatric disorders like depression that can cause sleep quality issues are commonly comorbid with an ADHD diagnosis too.
Does melatonin work for children with ADHD?
Research suggests that low doses of melatonin may be helpful for children with attention-deficit/hyperactivity disorder (ADHD), particularly those who are already taking stimulant medications and experiencing negative sleep effects as a result. In some cases, melatonin may help address delayed sleep timing, speed up sleep onset, improve sleep efficiency, reduce insomnia severity, and improve poor sleep overall. Speak with their doctor to see if this approach might be helpful for your child.
What medications help ADHD kids sleep?
Some ADHD medications can cause children with ADHD to have trouble sleeping, which is often severe enough to be measured in a sleep lab on the Insomnia Severity Index. This fact is important to note, as those in ADHD populations are already prone to sleep issues even without medication. A 2023 systematic review and meta-analysis of research on the topic suggests that “although no certain results could be obtained,” behavioral strategies and melatonin as a sleep medication may be the most promising approaches for improving sleep characteristics in children who meet the diagnostic criteria for ADHD.
Why are narcoleptics always tired?
A key symptom of people with narcolepsy is excessive sleepiness during the day. One reason this occurs is because the condition causes disruptions to the sleep cycle at night. The clinical implications of this are that the individual typically doesn't get enough REM sleep each night compared to healthy controls, and REM sleep is necessary in order to feel truly rested. According to the American Academy of Sleep Medicine, diagnostic delay is common in those with narcolepsy because it’s often mistaken for other conditions that can cause sleepiness or side effects of poor sleep quality, such as depression, schizophrenia, or ADHD.
What is the strongest stimulant for narcolepsy and other sleep disorders?
Some examples of stimulant medications used for individuals with narcolepsy include modafinil, armodafinil, pitolisant, and Solriamfetol. The strength of the dose depends on the individual and their needs. Speak to your doctor before starting, stopping, or changing any medication.
Is it true that ADHD is commonly comorbid with narcolepsy?
Yes; ADHD and narcolepsy are commonly comorbid. The prevalence of ADHD in those with narcolepsy is over 30%, according to one study. Only a qualified healthcare provider can diagnose ADHD or narcolepsy, so it's recommended that you seek professional care if you're experiencing symptoms of either.
Can ADHD get worse with age?
According to Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), “It is important to keep in mind that ADHD is not like an infection or a tumor that gets worse or better.” ADHD is a form of neurodivergence rather than a changing condition. That said, CHADD also points out that a person with ADHD who has to take on new challenges over time without sufficient support may experience additional challenges, which could make it feel like their ADHD symptoms are worsening.
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