Understanding the Connection Between ADHD and Sleep Deprivation

Expert Insights by Dr. Funke Afolabi-Brown, a triple board-certified sleep medicine physician and founder of RestfulSleepMD, where she helps busy professional women and their children prioritize sleep. 

Medically Reviewed by Dr. Brooke Dulka, a medical writer and neuroscientist who received her Ph.D. in biological psychology from the University of Tennessee, and she is currently a postdoctoral researcher at the University of Wisconsin-Milwaukee where she studies the neurobiology of memory.

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It’s not easy getting through the day with Attention Deficit/Hyperactivity Disorder (ADHD). These are just some of the difficulties that challenge children and adults with ADHD:

• Struggling to stay focused on one thing, including instruction or directions
• Impatience with any kind of waiting
• Often forgetting things
• Inability to sit still no matter what the circumstances
• Difficulty controlling impulses or thinking about the consequences of actions

“Struggling to stay focused on one thing or an inability to sit still are common difficulties associated with ADHD,” explains Dr. Dulka. “These difficulties can also impact the sleep of a child with ADHD.”

The very nature of ADHD is antithetical to the processes of winding down, going to sleep, and staying asleep for a sufficient number of hours.

The exact relationship between sleep disorders and Attention Deficit/Hyperactivity Disorder (ADHD) is not clear. Some researchers suggest that people diagnosed with ADHD may be suffering from a sleep disorder since the symptoms for both conditions overlap. There is even a growing body of evidence that suggests that ADHD is actually a sleep disorder itself caused by a misalignment in the sleep/wake cycle.

The numbers tell the story of, at the very least, a strong association between ADHD and difficulty sleeping. As many as 50% of children with ADHD experience sleep difficulties, which usually appear around age 12. The numbers are worse for adults with as many as 80% of those diagnosed with ADHD struggling every night to get to sleep and stay asleep.

The ADHD/sleep deprivation connection

Researchers are still not sure about what causes people with ADHD to experience sleep challenges, but there are common themes in the complaints from people diagnosed with the disorder. Some of these themes point to common causes.

“[Those with ADHD are] also at risk for various types of sleep disturbances like insomnia, sleep apnea, sleep-related movement disorders, and daytime sleepiness and with a slightly delayed circadian rhythm. In addition to these problems, inadequate sleep hygiene practices such as excessive screen time and the use of technology contribute to sleep issues,” says Dr. Funke Afolabi-Brown, MD.

The most common sleep disorders found among children and adults with ADHD are:

• Restless leg syndrome. One of the most frequently reported sleep disorder among people with ADHD, RLS affects up to 44% of people with the diagnosis. The uncontrollable urge to move your legs can make it difficult to settle down or to remain sleeping through the night.
• Sleep-disordered breathing. A spectrum of conditions ranging from sleep apnea to snoring, affect many children with ADHD. Sleep-disordered breathing, especially sleep apnea, can cause a person to wake up many times each night and disrupt the sleep cycle, leading to extreme sleep deprivation and constant fatigue.
• Circadian-rhythm sleep disorders (also called “delayed sleep-phase disorders”) that impair the normal response to the 24-hour day/night cycle. Instead of naturally settling down when the sun goes down and waking up when it rises, people with circadian-rhythm sleep disorder often feel sleepy much later than most people and sleep much later in the morning.
• Difficulty falling asleep effects about 75% of adults with ADHD. Many report feeling unable to shut off their minds and feeling a burst of energy in the evenings when they should be powering down.
• Difficulty waking up. Many people wake up several times before about 4:00 am and then fall into a dead sleep from which they have difficulty rousing at an appropriate time to get to work/school on time. People with this disorder report feeling not fully awake until noon.
• Intrusive sleep. Often misdiagnosed a form of narcolepsy, this condition causes a person with ADHD to experience extreme drowsiness and even suddenly falling asleep when they become bored with an activity. This can be especially dangerous if it occurs while driving, operating machinery, or taking care of children.

Sleep deprivation has serious consequences

In addition to all of the health and well-being consequences of inadequate sleep, there is an additional concern for children with ADHD. Sleep deprivation exacerbates the symptoms of ADHD in children, leading them to be more hyperactive, impulsive, inattentive, and disruptive. As a parent, watching your child have increased difficulty navigating through his or her day is not easy. Because of this, parents of sleep-deprived kids may be more likely to turn to pharmacological treatments for ADHD that can have serious side effects such as:

• Weight gain
• Insomnia
• Liver damage
• Effects on the heart

There is also concern about long-term use of stimulant drugs like the kind often prescribed for ADHD.

15 ways to prevent ADHD from disturbing sleep

1. Establish consistent routines for:

• Eating meals
• Working
• Exercise
• Bathing
• Sleeping
• Waking

“Establishing a consistent routine helps tremendously with preventing your child’s ADHD from disturbing their sleep,” says Dr. Dulka. “Having both a solid routine for eating and working during the day as well as a healthy bedtime routine can help children with ADHD relax and prepare for a good night’s rest.”

You and your child will function better and feel more in control of the day if you both know a set schedule and can anticipate what’s coming next. Furthermore, maintaining a consistent schedule can help to reset your circadian rhythm to correspond to societal norms.

2. Create a soothing bedtime routine and stick to it. Avoid screen time since the light from electronic devices can inhibit the production of the sleep-promoting hormone melatonin. And watching TV can be over-stimulating for this time of day. See children’s bedtime routine dos and don’ts.

3. Include some relaxation techniques in your bedtime routine.

• Bedtime yoga will help you release bodily tension and calm your over-active mind. You can even try this with your child and make this part of the bedtime routine.
• Practice mindfulness meditation. Mindful awareness focuses your attention on your thoughts, feelings, and bodily sensations in order to promote a sense of well-being and tranquility.
  • You can practice throughout the day with the simple technique of paying attention to your breathing in and out. Notice how your diaphragm moves up and down and feel your lungs expand and contract. When your mind begins to wander, acknowledge the distraction and refocus back to your breathing. See more structured meditations here.
• Take a warm shower or bath. A lower core body temperature is associated with sleep. When you get out of the shower or bath, your temperature abruptly drops, signaling to your body that you are ready for sleep.

4. Create a tranquil sleep environment. Keep the bedroom cool, dark, and quiet. The optimal bedroom temperature is 65° -72°. Block outside lights with blinds, curtains, or shutters. Use a fan or white noise machine to drown out ambient noises. Keep electronic devices out of the bedroom, including the TV. See the best mattress for kids.

5. Avoid caffeine, especially after 4:00 pm. Remember that caffeine can be found not only in coffee and tea but also:

• Chocolate
• Hot cocoa
• Some sodas
• Coffee ice cream
• Some headache medicines
• Energy drinks, including energy water

6. Exercise daily to dissipate hyperactivity and restlessness. Be sure to exercise at least three hours before bedtime.

7. Adjust your circadian rhythm. Use light therapy to help you adjust your sleep/wake cycle to be aligned with the day/night cycle. Get exposure to light first thing in the morning, and dim household lights at night. Or use a light box for more controlled exposure.

8. Sleep with a weighted blanket. People with ADHD often crave deep pressure touch to help them feel grounded in space and calm their overactive central nervous system. A weighted blanket applies pressure to muscles and joints providing the deep pressure touch that can help your body relax and calm your overactive nervous system.

9. Help your child prioritize homework and chores. Using a checklist for daily chores and daily lists for homework and studying can help kids stay on task and able to finish their work before bedtime. Suggest time frames for each activity and use an egg timer to give a visual reminder of time elapsing. (Digital timers are less effective.) This will help to keep the process moving.

10. Offer a token or stickers to signify success in following the bedtime schedule or staying on a particular task. Allow your child to trade them in for a small reward the next day such as choosing a favorite after-school activity.

11. Ask your child’s doctor about ADHD medication and its possible effects on sleep. If your child is taking stimulant medication, the dosage or administration time may need to be adjusted

12. If your child snores, breathes through their mouth while sleeping, or if you suspect they have sleep apnea, see your child’s doctor. Simply removing their adenoids or tonsils may allow them to sleep better and improve their ADHD symptoms.

13. Give foot or back rubs. Be sure to let your child know how long the massage will be and stick to the time limit. Use firm pressure for any kind of massage.

14. Teach them to focus on their breathing. Have your child visualize a balloon inflating and deflating as they inhale and exhale. Encourage them to recognize when their mind wanders away from their breathing and to redirect their attention back to the inflating and deflating balloon.

15. Limit the use of electronics before bed. Dr. Funke Afolabi-Brown MD suggests having them turned off 30-60 minutes before bedtime, adding, “This will limit the blue light effect that could suppress melatonin production.”

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If these measures do not result in better sleep, you may need to consult with a doctor who may refer you to a sleep specialist. We welcome success stories as well as questions you have about ADHD and sleep disorders. Drop us a line in the comments below.

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SOURCES

• Psychiatry Research: psy-journal.com/article/S0165-1781(06)00044-8/fulltext
• Springer Link: link.springer.com/article/10.2165%2F11538990-000000000-00000
• ADDitude: additudemag.com/wired-tired-sleep-deprived/
• New Scientist: newscientist.com/article/mg23431283-100-is-adhd-a-sleep-disorder-stimulant-drug-improves-symptoms/
• ADDitude: additudemag.com/adhd-sleep-disturbances-symptoms/ 
• Healthy Sleep: healthysleep.med.harvard.edu/healthy/matters/consequences 
• Sleep Medicine: sleep-journal.com/article/S1389-9457(06)00184-5/fulltext 
• UCLA Mindful Awareness Research Center: marc.ucla.edu/mindful-meditations