Why Do People With ADHD Have Trouble Sleeping? ADHD Symptoms And Sleep Disorders

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by symptoms related to hyperactivity, impulsivity, and/or inattention. In addition, research suggests a bidirectional relationship between ADHD and sleep difficulties that can further exacerbate an individual’s symptomatic challenges and affect overall well-being. Below, we’ll explore that relationship, offer tips for better sleep, and share information on how you can seek support for ADHD symptoms and/or sleep-related challenges.

ADHD symptoms making it hard to fall asleep?

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About attention-deficit/hyperactivity disorder (ADHD)

ADHD is a spectrum disorder, meaning that symptoms can vary from mild to severe depending on the individual. When untreated, ADHD is often associated with behavioral problems, mental health challenges, and social difficulties that can significantly impact an individual’s daily life and well-being. ADHD affects individuals of all ages, genders, and races; however, some populations tend to receive more diagnoses than others. Data and statistics on ADHD from the Centers for Disease Control and Prevention (CDC) indicate that, as of 2022:

• Children are more likely to be diagnosed with ADHD than adults (11.4% versus 4.4%, respectively), since symptoms typically first appear in childhood
• Boys are more likely to be diagnosed than girls (15% versus 8%, respectively)
• Children with ADHD and co-occurring conditions like anxiety, depression, learning disorders, and/or behavioral or conduct problems are more likely to have severe ADHD symptoms than children without co-occurring conditions

Also, a growing body of research suggests that ADHD might impact other populations more than initially believed. For example, gender bias is thought to be a common factor in ADHD underdiagnosis in women and girls. Additionally, some research indicates that ADHD symptoms often overlap with those of other mental health conditions like anxiety and depression, potentially leading to overdiagnosis in some adult populations. 

Common ADHD symptoms and types

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), there are three main subtypes or presentations of ADHD. These include:

• Predominantly inattentive presentation

This type of ADHD includes symptoms such as trouble focusing or paying attention to details, difficulty listening, poor organizational skills, avoiding tasks that require sustained focus, forgetfulness, and making careless mistakes. For a predominantly inattentive ADHD diagnosis, the individual must experience five or more symptoms of inattention for at least six months.

• Predominantly hyperactive-impulsive presentation

Symptoms of this type of ADHD may include inappropriate interruptions, such as completing other people's sentences, blurting out answers, or intruding on others' activities. A person might also have trouble sitting still and staying quiet during activities and may be fidgeting constantly. Excessive talking, restlessness, and trouble waiting one's turn are also common symptoms. To receive a diagnosis, people with this type of ADHD must experience five or more of these symptoms for at least six months. 

• Combined type presentation 

Combined type ADHD is characterized by a mix of five or more inattention and hyperactive-impulsive symptoms for at least six months. 

Do people with ADHD have trouble sleeping? ADHD and sleep problems  

People with ADHD may have difficulty with falling asleep, waking, sleep duration, sleep quality, and/or daytime sleepiness. Conversely, children with sleep disturbance issues might be at higher risk for the development or worsening of ADHD symptoms like inattention, hyperactivity, and distractibility. Both sleep deprivation and ADHD can interfere significantly with an individual’s daily functioning and impact relationships at home, work, and school.

Neurology and circadian rhythm dysregulation  

Research indicates common neural correlates between ADHD symptoms and sleep disturbances. For example, the default mode network (DMN) often stays more active in ADHD brains, leading to challenges in “shutting off” the internal chatter and racing thoughts that can cause difficulty falling asleep.

ADHD is also associated with dopamine imbalance, potentially contributing to restlessness and sleeplessness. Alterations in the brain mechanisms modulating the circadian system have also been linked to ADHD. 

The role of hyperfocus and sleep avoidance  

Hyperfocus, an intense state of concentration, is a seemingly paradoxical ADHD symptom that might contribute to sleep problems. Hyperfocus is typically associated with activities the individual finds enjoyable or rewarding, like a creative project, game, or hobby. When an individual with ADHD is hyper focused, they might become so absorbed in an activity that they "tune out" and lose track of time—including at night when they’re supposed to be sleeping. 

The role of emotional dysregulation in ADHD-related sleep problems

Emotional dysregulation is thought to play a significant role in ADHD-related sleep problems as well, since individuals with ADHD often experience intense emotions that may make it difficult to fall asleep or stay asleep. Sleep deprivation, including ADHD-related sleep problems, can exacerbate emotional dysregulation. This can create a cycle where poor sleep leads to increased emotional reactivity, further disrupting sleep quality. 

The effects of ADHD medication on circadian rhythm functioning

ADHD medication, particularly stimulant medications, can significantly affect circadian rhythm functioning by disrupting the body's natural sleep-wake cycle. Although such medicines might improve daytime alertness, they can sometimes cause problems with falling asleep, staying asleep, and sleeping regularly. 

Note that not everyone taking ADHD medications experiences sleep issues, however. For some, the medications calm overactivity in the brain, making it easier to fall asleep and stay asleep. 

Common sleep disorders in people with ADHD  

Sleep disturbance is a frequently reported ADHD symptom. However, problems like daytime drowsiness, frequent waking, nightmares, anxiety around bedtime, or brief sleep duration can sometimes be indicative of a separate, sleep-specific disorder. A few possibilities are listed below: be sure to consult with your doctor for evaluation and treatment if you’re experiencing symptoms of such a disorder.

Circadian rhythm sleep disorder (CRSD)

In circadian rhythm sleep disorders, an individual’s internal clock (circadian rhythm) is misaligned with their environment. There are several types of CRSDs, including:

• Delayed sleep phase syndrome (DSPS) in which individuals stay up late and wake up late 
• Advanced sleep phase syndrome (ASPS) in which individuals go to bed early and wake early
• Irregular sleep-wake rhythm disorder (ISWRD) in which people have an inconsistent sleep-wake pattern
• Non-24-hour sleep-wake rhythm disorder (N24HSWD) in which people have a sleep-wake cycle that is longer or shorter than 24 hours

Restless legs syndrome (RLS) and periodic limb movements (PLM)

Restless legs syndrome is a condition that causes an irresistible urge to move the legs, usually accompanied by uncomfortable sensations—especially when resting at night. PLM refers to repetitive leg movements that occur during sleep. PLM is often associated with RLS but can happen independently, too. 

Research suggests a strong connection between RLS, PLM, and ADHD. This connection might be related to shared underlying neurological issues, which can disrupt sleep and aggravate ADHD symptoms. 

Do people with ADHD have trouble sleeping due to other types of sleep disorders?

Sleep-disordered breathing (SDB) conditions are also frequently associated with ADHD. This group of conditions is characterized by abnormal breathing patterns during sleep. Obstructive sleep apnea (OSA) is the most common, followed by central sleep apnea (CSA) and mixed sleep apnea (a combination of OSA and CSA). Upper airway resistance syndrome (UARS) and sleep-related hypoventilation also fall under the SDB umbrella.  

Strategies for managing ADHD symptoms to help you fall asleep and stay asleep

There are evidence-based techniques that individuals with ADHD can use to potentially improve sleep hygiene and get better rest. These begin with establishing a consistent sleep routine in which you wake up and fall asleep at the same time every day. You might also optimize your bedroom sleeping conditions by keeping the sleeping area quiet, dark, and cool. 

Reducing distractions and limiting stimulating activities before bed may also set you up for sleeping success. In some cases, melatonin and other types of sleep medicine help people with ADHD sleep better too, but they can also cause issues like misuse or dependence and side effects like dizziness, confusion, memory issues, and balance problems. People considering sleep aids should speak to a physician before trying them. 

Using relaxation techniques to fall asleep faster

Relaxation techniques may also help a person fall asleep. Mindfulness, meditation, breathing exercises, progressive muscle relaxation, and guided imagery can help. Some also find that engaging in relaxing activities before bed, such as taking a warm bath, enjoying a cup of herbal tea, or listening to calming music, is enough to send them off to sleep. 

ADHD symptoms making it hard to fall asleep?

Get support in therapy

Talk therapy for ADHD 

Therapeutic modalities like cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) are often used to assist individuals in managing ADHD symptoms. Additionally, coaching is often helpful for improving executive function skills like managing time, staying organized, and goal setting—all areas that people with ADHD might struggle with. 

Despite its potential effectiveness, many people with ADHD don’t seek therapy for a wide range of reasons. For example, symptomatic challenges such as trouble focusing, executive functioning issues, overwhelm, and anxiety might keep people from reaching out for help. Fear of stigma might deter some too, while others might assume that therapy won’t work for them. 

Although it might not be appropriate for everyone, teletherapy can often be a convenient alternative that helps reduce many of these barriers. In many cases, it can be an effective alternative to in-person treatment for managing both ADHD and associated sleep problems. Online platforms can match a user with a licensed provider from a broader pool of licensed therapists experienced in treating ADHD, who can offer personalized support and guidance. Online therapy also allows users to attend sessions from the comfort of home on a schedule that fits their needs, which can be helpful for people with ADHD struggling with time management.  

Research suggests that online therapy, particularly internet-delivered cognitive behavioral therapy (CBT), can often be effective in helping a person manage ADHD symptoms. For example, one meta-analysis of six randomized controlled trials including 261 adults and children with ADHD suggests that online CBT may be more effective than waiting list groups in improving attention deficits and social functioning.