Sleep and ADHD/ADD

Updated: January 1, 2020

By: Mary Sweeney RN, BSN, CEN, ONN-CG

It Can Be A Chronic Issue

We’ve all been there – you lay down to sleep and just can’t shut your mind off. It happens to everyone at some point in our lives, but for some it can be a chronic issue. Let’s talk about attention deficit/hyperactivity disorder and how it affects your ability to get a good night’s sleep.

What is ADHD?

Attention Deficit/Hyperactivity Disorder (commonly referred to as ADHD) is a mental disorder that affects as many as 8 percent of children and close to 3 percent of adults (source). It is characterized by things like high activity levels, inability to concentrate, inattention, and limited attention spans, among other things. There are three different subtypes of ADHD:

  • Inattentive: This type is diagnosed if certain symptoms occur frequently. These symptoms can include problems staying focused, organizing tasks, inability to listen when spoken to, not able to complete schoolwork, etc.
  • Hyperactive/impulsive: In this type, symptoms include inability to sit still or remain seated, has difficulty waiting in line, or blurting out an answer to a question before the person is finished asking it. 
  • Combined: This type is a combination of the inattentive type and hyperactive/impulsive type.

      The different types of ADHD are diagnosed when a certain number of symptoms are present for a certain amount of time. For example, if six out of nine symptoms of hyperactive ADHD are present in someone under the age of 17, they can be diagnosed with that particular type of ADHD.

      What Causes ADHD?

      No one knows exactly what causes ADHD, but there is evidence to suggest it may be a genetic condition. According to the American Psychological Association (APA), three out of four children that are diagnosed with ADHD have a relative that has also been diagnosed with the condition. It is also thought that smoking and drinking alcohol during pregnancy may contribute to the development of ADHD. There is no blood test or other concrete way of diagnosing ADHD, it is diagnosed through a thorough history and physical performed by your doctor, as well as identification of key symptoms.

      How is ADHD Treated?

      ADHD can be treated with medications, as well as with behavior modification strategies and psychotherapy. In children, teachers can help with behavior modification and training in the classroom, while parents continue to reinforce the behavior modifications in the home. Per the APA, students who have impaired learning ability may qualify for special education, in which there are special instructors who are trained in working with children with ADHD. Other accommodations include changes to the setup of a classroom, different learning techniques, and a modified classroom curriculum.

      In adults, treatment is very similar. After a comprehensive physical and cognitive exam, your doctor may prescribe certain medications, psychotherapy, or a combination of the two. It may also be recommended to minimize distractions and involve your immediate family members in your modifications (source).

      How ADHD/ADD Affects Sleep

      We’ve looked at how ADHD affects people during the day, but what happens at night? One study showed that in children diagnosed with ADHD, there were higher rates of sleepiness during the day, as well as more restless sleep at night. In adults, studies have shown that there is higher incidence of narcolepsy, hypersomnia, and other sleep disorders in those that have been diagnosed with ADHD (source). Both adults and children with ADHD may experience poor performance in school or at work, emotional problems, as well as a higher likelihood of being addicted to drugs or alcohol. These can also be attributed to poor sleep quality, which isn’t surprising.

      The Sleep Cycle

      To understand the effects of ADHD on sleep, we must understand how the sleep cycle works. A normal sleep cycle lasts about 90 minutes and can be broken down into two different types: Rapid eye movement (REM) sleep and non-REM (NREM) sleep. Within those two different types, there are 4 stages of sleep – here’s how they work:

      Stage 1: This first stage of NREM sleep is very light, lasting only a few minutes or so. Here, your body is preparing to fall into a deeper sleep, your eye movements slow down, and your brain begins producing alpha and theta waves. During this stage, you can be awoken easily since you’re only lightly sleeping.

      Stage 2: During this NREM stage, you’re in a state of light sleep but your heart rate slows down, your muscles relax significantly and your body temperature decreases slightly. Eye movements will slow down during this stage, and your brain waves slow down with occasional increases in activity. In those with ADHD, this stage may be interrupted if the person is unable to relax their muscles or remains restless. If this happens, the next stage in the sleep cycle can be hard to achieve.

      Stage 3: This NREM stage is restorative sleep, the kind that makes you feel refreshed. If someone were to wake you up during this stage, you would likely feel disoriented for a few minutes before realizing your surroundings. Our eye movements slow down or stop, and it’s very difficult to wake us up. This stage is an important one – it’s where your body starts repairing muscle, strengthening your immune system, and other vital processes. Again, in ADHD, it may be difficult to reach this stage if you are unable to completely relax.

      Rapid eye movement (REM) sleep: During REM sleep, our eye movements increase dramatically, as the name suggests. REM sleep is the stage where you dream the most, and it’s thought that the eye movements are related to the dreaming that you’re doing. During this stage, most of your muscles are in a paralyzed state, to keep you from acting out your dreams. Don’t worry though, the important muscles like your heart and diaphragm aren’t paralyzed and are working like they’re supposed to!

      While the average sleep cycle lasts 90 minutes, you will go through several cycles of varying lengths during one night. During your first few sleep cycles, you’ll go through longer cycles of NREM sleep, followed by a few cycles of REM sleep. As if that doesn’t complicate things enough, there has been research that shows that the time of day can affect what type of sleep you get. For example, it is thought that most NREM sleep happens between the hours of 11pm and 3am, and REM sleep more often happens between 3am and 7am (source).

      Circadian Rhythms

      Our bodies have internal clocks that every organ system uses to function on a daily basis. When we talk about sleep, these clocks tell us when it’s time to be awake and when it’s time to go to sleep. They regulate our sleep cycles by giving us our circadian rhythms, which are the schedules our bodies follow for the physical and mental changes we go through on a daily basis. Circadian rhythms regulate the body’s sleep cycles regulating the production of melatonin, the hormone that makes you feel tired. Melatonin is naturally produced by the brain when there is little to no natural light, usually at night. Its production decreases during daylight hours, which is why we feel awake during the day and sleepy at night.

      Circadian rhythm disorders are extremely prevalent in those who have been diagnosed with ADHD. It is thought that because ADHD symptoms can interrupt a normal sleep cycle (like we discussed above), it can also reset your internal body clock. If your circadian rhythm is off-kilter, you can have a harder time falling asleep and/or staying asleep, which can contribute to daytime sleepiness and exacerbation of ADHD symptoms. In kids, if melatonin production is decreased at night, they may be more likely to stay awake and engaged in activities, preventing them from getting the good night’s sleep they need.

      Sleep Issues With ADHD

      In addition to the symptoms and issues above, there are a plethora of other factors present in ADHD that can affect sleep quality in children and adults. These can include (source):

      Alcohol: Alcohol can help you easily fall asleep, but the quality of the sleep you get may not be the best. Add in an ADHD diagnosis and it’s a recipe for disaster when it comes to a restful night’s sleep.

      Co-existing conditions: Underlying conditions like anxiety and depression are often present in people who have been diagnosed with ADHD. These can affect and exacerbate sleep disturbances, which can in turn affect the severity of symptoms of ADHD.

      Sleep apnea: Sleep and breathing disorders like snoring and obstructive sleep apnea have a higher rate of incidence in those who have been diagnosed with ADHD. Sleep apnea is a condition in which a person may go for a period of several seconds without breathing while sleeping. When this happens, the brain sends a message to the body to wake up and breathe, which causes many interruptions in sleep throughout the course of a night. Side effects of sleep apnea include headache, fatigue, and trouble concentrating, similar to the symptoms of ADHD. The relationship between ADHD and sleep apnea is a two-way street, where each of these conditions affects the other. Those who have ADHD are more likely to suffer from sleep apnea, and those that suffer from sleep apnea are likely to have poorer sleep quality. 

      Restless legs syndrome: Restless leg syndrome is a condition in which you experience uncomfortable sensations in your legs that is relieved by moving them. The sensations often pop up at night and can make it difficult to fall asleep. Restless leg syndrome can significantly affect the quality and amount of sleep that you get, and can be more prevalent in those with ADHD.

      Tips for Sleeping with ADHD

      Take prescribed medications regularly. If your doctor has prescribed you or your child medication to manage ADHD, be sure that the medication is being taken on time and in the correct dosage. Be aware of side effects and time those medications appropriately.

      Turn off electronics. This is a good idea across the board. Research has shown that the blue light emitted from screens can interfere with your melatonin production. In addition, screens and activities on devices can keep you or your child from focusing on relaxing and quieting the mind before going to bed.

      Have a routine. This is especially important for children, whether or not they have been diagnosed with ADHD. Both adults and children can benefit from a soothing, relaxing bedtime routine. For children, this may include a warm bath and a quiet story. In adults, this can include meditation or guided imagery. Do whatever works best for you!

      If you are concerned that you may have ADHD or that your sleep problems may be related to it, always consult your doctor or healthcare team.

      References And Continued Reading

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