When ADHD Keeps You Up:
Insights into ADHD Insomnia
It’s 3 am, and you haven’t made it off the couch yet.
You wake up to pee, but your brain decides it’s never going back to sleep.
Your alarm blares for 45 minutes while you hide under 3 pillows until it finally gives up and realizes you’re just not going to budge.
You’ve got 18 critically important things to do, but your exhausted brain feels like its ADHD is on steroids, and there’s no way any single one is happening today.
These are just some of the many, many pictures of that messy, torturesome combination of ADHD and insomnia that goes both ways:
ADHD makes it harder to sleep
Lack of sleep makes ADHD harder.
So if you’re one of the 50-70% of ADHD brains 1,2 that is struggling to get enough zzzz’s, grab a cup of coffee and read on- this is the post for you.
Can ADHD Cause Insomnia?
If you've ever found yourself counting sheep while your mind races at a million miles an hour, you might wonder if ADHD is to blame for your insomnia adventures. Well, the short answer is: Yes, it can! ADHD has been known to have a sneaky connection with insomnia, making it harder for you to catch that precious Zzzs.
Because let’s face it. Your ADHD doesn’t go to sleep just because you turn off your light. All the unique aspects of your ADHD brain that make it do the weird and wonderful things it does still exist when you’re trying to play around in dreamland.
It’s the regulation difference of ADHD brains- its tendency to flip-flop between all in or all out, that’s so prominent during daylight hours that comes into play at night too. Differences like:
All-on thoughts
So your all-on thoughts continue to race like a bustling amusement park that refuses to shut down even when it's long past bedtime. Thoughts, ideas, and worries bounce around, leaving you wide-eyed and staring at the ceiling.
All-out focus
Your all-out focus causes your mind becomes a wild explorer, venturing into different territories while you lie in bed, trying to drift off to dreamland. It's as if your brain has decided to turn the nighttime into an adventure-packed extravaganza!
All-on Energy
Your all-on energy and motion have your body dancing to its own beat while your sleepy self begs for some tranquility and rest.
Off/On Regulation
And your off/on regulation system doesn’t turn off just because it’s past your bedtime. Causing your brain to take a herky-jerky path between sleep and wake throughout the night.
ADHD and Insomnia:
The 9 Most Common Types of Sleep Problems for ADHD Brains
Research suggests that there are 9 types of sleep issues that are most common for ADHD brains.2 And guys- this is more like an all-you-can-eat buffet, not an al-a-carte menu. Studies also show that many ADHD brains struggle with 4-7 of these sleep issues, and, unsurprisingly, the more sleep issues you deal with, the more tired you’re likely to be.2,3
1. Bedtime Procrastination and Trouble Getting to Sleep:
Before you can actually sleep (or toss and turn), you’ve got to get to bed. And that’s the first place where ADHD brains tend to struggle. Often times it’s a revenge bedtime procrastination that obstinately refuses to stop doing the fun, appealing things like scrolling through TikTok or binging the newest Netflix obsession. Other times, it’s the inspiration that strikes at 11 pm, kicking off a second wind of hyperfocus and productivity. Regardless, ADHD brains often struggle to get to bed when they intend.
2. Difficulty Falling Asleep:
So you got to bed, but now what?!? ADHD brains don’t always take the cue that getting into bed means it’s time to fall asleep- instead, circling, spiraling, and spinning on thought after thought, taking what feels like forever to quiet down and fall into sleep.
3. Unrefreshing Sleep:
Given how hard it is to get and stay asleep, once you conquer those hurdles, the sleep itself should be heavenly, right?!? Unfortunately, no, even if you manage to get your ADHD brain to clock enough hours asleep, you can still end up waking up feeling unrefreshed. Because of the regulation differences that bely so many of the other aspects of the ADHD experience, don’t turn off when you go to sleep. So ADHD brains are more likely to have disrupted circadian rhythms, less deep sleep, and more awakenings throughout the night, all leading to feeling less get-up-and-go in the morning. 4
4. Waking Frequently:
When we sleep, we cycle through various phases of sleep, going from a light, easily roused sleep to a deeper, sleeping-like-a-log kind of sleep over and over again. ADHD brains are more likely to have more of those light sleep periods at the beginning of their evening, which can cause them to pop awake at the slightest disruption 5 (particularly because ADHD brains are more sensitive to external stimuli even when asleep).
5. Restlessness:
Tossing, Turning, Restless legs, and a body that feels like it always wants to be in motion can make it hard to find a comfortable and restful sleep position. And unsurprisingly, ADHD brains are more likely to experience all of that. 6
6. Sleep Breathing Issues:
Sleep breathing issues can sometimes be the unexpected duet partners of ADHD. It's like a secret concert happening in your sleep! Snoring, mouth breathing, and the occasional sleep apnea solo might join the performance, making the whole experience a whole lot noisier and also a whole lot less restful come morning.6,8
7. Waking Too Early:
For some ADHD brains, the circadian rhythm differences they experience cause them to wake earlier than they would like- popping up at 3 am with a brain that thinks it’s ready to tackle the day (or at least wander downstairs to make some coffee). And the real kicker here is that even though the brain is convinced at 3 am that now is the perfect time to get out of bed, come 3 pm (or even just 6 am), it’s exhausted and unable to function.
8. Sleeping Too Much:
As with any ADHD trait, ADHD brains are always most likely to fall along the far ends of a spectrum. And sleep is no different. So while some ADHD brains struggle with insomnia, others may experience excessive sleepiness and find themselves sleeping for extended periods.
9. Difficulty Waking in the Morning:
Because of the circadian rhythm differences that ADHD brains often experience, mornings can feel like a battle of alarms, snoozing, and sleep-induced befuddlement. 75% of ADHD brains have delayed sleep onset or delayed circadian rhythm disorder, which means that the melatonin that makes us sleepy doesn’t start kicking in until about 1.5 hours (on average) later than others. This pushes all sleep later. But it also means that there is often a flip-flopping of sleep phases for ADHD brains- where rather than getting their deeper sleep earlier in the evening, ADHD brains are more likely to fall into the deep, hibernating bear type of sleep right before their alarms start blaring. Making waking up feel like an uphill battle, leading to repeated snoozing and tardiness.
ADHD and Fatigue:
What Happens to Sleepy ADHD Brains
How does lack of sleep impact ADHD?
So ADHD brains are more likely to struggle with sleep. That stinks. Partly because sleep can be a lovely respite from the world and the day. But also because…
…and here’s the real kicker…
Fatigue and daytime sleepiness make ADHD struggles MORE difficult!
Yup, you heard that right. It’s not just your imagination. Your ADHD brain is that much more ADHD after a particularly difficult night's sleep. In fact, research shows that difficulties regulating attention, emotion, and focus are all dramatically more significant for ADHD brains when daytime sleepiness is strongest. 7,9,10
This association is so strong, in fact, that some researchers have suggested that one ADHD may actually be the result of sleep issues rather than an organic brain difference itself.1,7
That conclusion doesn’t account for the ADHD brains that don’t struggle with sleep or the fact that ADHD differences often show up long before sleep issues. But it may be true that some people with ADHD brains may actually just have really tired brains or – more often– that their ADHD may not seem as strong or significant if their brains could get the rest they crave.
But that’s really just the tip of the iceberg. There are at least 8 reasons why your ADHD brain needs more sleep. Check them out!
Rise and Shine:
Overcoming ADHD’s Morning Struggles and Sleepiness
If you’re tired of counting sheep and feeling like they're playing hopscotch in your brain– fret not, my friend. I’ve got a smorgasbord of science-approved sleep solutions that actually work for ADHD brains. So, grab your comfiest pajamas, fluff up your favorite pillow, and get ready to embark on a journey to the land of better sleep.
The Power of CBT-i (Cognitive Behavioral Therapy for Insomnia) for ADHD Brains
CBTi (Cognitive Behavioral Therapy for Insomnia) is the gold-standard treatment for sleep issues, including those sleep issues common in ADHD brains.
What does gold-standard mean, exactly?
It means that a huge amount of research has found it to be the most reliable and effective approach in the field. Gold standard treatments have been extensively studied and supported by robust scientific evidence and proven to yield consistently positive outcomes.
It’s a big deal to have a behavioral treatment- with all the inconsistencies inherent within, reach gold-standard status. And CBT-i got there. Not sheep counting. Not turkey-munching. Not even snore-inducing meds. But a short, contained, power-packed treatment called CBT-i.
What exactly does CBTi involve?
CBTi involves a combination of techniques that aim to address the negative thoughts and behaviors that contribute to ADHD and insomnia. It involves a power-packed mix of sleep behavior education, stimulus control therapy, relaxation techniques, cognitive therapy, mindfulness techniques, and sleep restriction therapy.
Overall, CBTi is a great treatment for sleep issues for ADHD patients because it addresses the root causes of sleep problems, promotes healthy sleep habits, and helps improve both sleep quality and quantity. Which ends up making the sleep improvement that comes from it more long-lasting and effective than medication.
Do I need specific ADHD-informed CBTi?
Yes! CBTi that has been translated and modified for ADHD brains is essential for effectiveness. Not just because the ADHD brain brings its own unique struggles to sleep but also because the treatment itself, when done in the standard way, isn’t always very ADHD-friendly (think homework without a plan, vague instructions, etc.). So making sure you find a CBTi therapist well-versed in working with ADHD brains is essential!
Live in Pennsylvania and want to see if CBTi might be just the right thing for you? Check out the ADHD CBTi program at Rittenhouse Psychological Services
Light Therapy
When it comes to tackling sleep issues in ADHD brains, one bright idea that research is clear is worth considering is light therapy.4,5,6 This illuminating approach harnesses the power of specialized light boxes to help regulate sleep patterns and promote better rest. Light therapy can effectively reset the body's internal clock, known as the circadian rhythm, by exposing your brain to bright, all-spectrum light, typically in the morning or early part of the day.
This is particularly great for those having a hard time falling asleep or waking up in the morning. So, instead of hitting the snooze button repeatedly, why not bask in the glow of light therapy and let its scientifically-backed rays help you catch some quality Z's? It's like giving your sleep routine a sunrise serenade!
Wondering which light box is best for you? Check out my favorite here.
Sunrise Alarm Clocks
Rise and shine, ADHD brains! If you're tired of feeling groggy and struggling to wake up in the morning, a sunrise alarm clock might be just the bright idea you need. These clever devices mimic the natural progression of sunlight, gradually brightening your bedroom to gently rouse you from your slumber. By simulating a sunrise, sunrise alarm clocks can help regulate your sleep-wake cycle and make waking up a more pleasant experience.
Sunrise alarm clocks are a great solution for those with delay-sleep onset disorder, as they can help pull you out of the deep sleep that ADHD brains are more likely to be in during the early morning hours. Instead of jolting awake to a blaring alarm, you can wake up gradually and feel more refreshed. It's like having your own personal sunrise on your nightstand, bringing a ray of sunshine to your mornings and helping you start the day on a brighter note.
Wondering which sunrise alarm clock is best for you? Check out my favorite here!
Melatonin
Numerous medications can be helpful for managing sleep. And often, particularly for ADHD brains with a delayed sleep onset but a life requiring non-delayed sleep schedules, a combination of medication and bright light therapy can be the perfect cocktail. And of course, you should talk to your doctor about which medication options are most effective for managing your sleep.
But one over-the-counter option that is useful for many is Melatonin. Melatonin is a hormone that helps regulate the sleep-wake cycle and is commonly used as a supplement to aid with sleep. Research supports the use of melatonin for ADHD brains, suggesting that it can increase total sleep times and help people fall asleep sooner. 11
Q&A
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A: According to research, ADHD is associated with increased rates of sleep problems, including sleep deprivation. It’s estimated that up to 70% of children with ADHD may experience ADHD child sleep problems, and up to 50% of adults with ADHD may have sleep problems, such as excessive daytime sleepiness ADHD. These sleep problems can include difficulty falling asleep, restless sleep, frequent waking during the night, lower cognitive ability, and difficulty waking up in the morning. ADHD and fatigue is also a big issue. The exact cause of this association between ADHD and sleep problems is not fully understood, but it may be related to the underlying neurological differences in individuals with ADHD. Additionally, stimulant medications commonly used to treat ADHD can also affect sleep.
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A: Taking Adderall on no sleep is not recommended. Lack of sleep can lead to drowsiness, fatigue, and decreased cognitive performance. Taking Adderall without proper rest may aggravate these symptoms, disrupt sleep/wake patterns, and potentially cause harmful side effects. It is always best to consult a doctor before starting or stopping any ADHD sleep medication.
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A: Yes, there is a possible connection between ADHD and sleep apnea. Research suggests that people with ADHD may have a higher risk of developing sleep apnea due to their difficulty in maintaining regular sleep patterns and breathing-related abnormalities during sleep. Sleep apnea may also worsen ADHD symptoms by causing daytime sleepiness, cognitive impairment, and decreased alertness. Diagnosing and treating both conditions simultaneously is essential to achieve optimal health.
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A: Yes, ADHD can cause insomnia. Numerous unique attributes of ADHD brains, such as impulsivity, hyperactivity, and racing thoughts, can make it difficult to fall asleep and stay asleep. Sleep deprivation and ADHD are common bedfellows (or maybe bed enemies?!?). Not only that though, some medications that help ADHD brains (I’m looking at you, stimulants) can also make it hard to get to sleep.
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A: Chronic sleep deprivation can cause damage to the brain. A prolonged lack of sleep can lead to the loss of brain tissue, which can affect memory, emotions, and cognitive function. So, can lack of sleep cause brain damage? Yes, in a chronic type of way. Sleep deprivation is also associated with a higher risk of developing neurological conditions such as Alzheimer's disease and dementia. This is one of the many reasons it’s so important to take your sleep seriously and work to get yourself the rest your deserve.
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1. European College of Neuropsychopharmacology. (2017, September 4). Is ADHD really a sleep problem?. ScienceDaily. Retrieved June 5, 2023 from www.sciencedaily.com/releases/2017/09/170904093443.htm
2. Fisher, B. C., Garges, D. M., Yoon, S. Y. R., Maguire, K., Zipay, D., & Gambino, M. (2014). Sex Differences and the Interaction of Age and Sleep Issues in Neuropsychological Testing Performance across the Lifespan in an Add/Adhd Sample from the Years 1989 to 2009. Psychological Reports, 114(2), 404-438E. https://doi.org/10.2466/15.10.PR0.114k23w0
3. Wajszilber D, Santiseban JA, Gruber R. Sleep disorders in patients with ADHD: impact and management challenges. Nat Sci Sleep. 2018 Dec 14;10:453-480. doi: 10.2147/NSS.S163074. PMID: 30588139; PMCID: PMC6299464.
4. Korman, Maria and Palm, Denise and Uzoni, Adriana and Faltraco, Frank and Tucha, Oliver and Thome, Johannes and Coogan, Andrew (2018) ADHD 24/7: Circadian Clock Genes, Chronotherapy and Sleep/Wake Cycle Insufficiencies in ADHD. The World Journal of Biological Psychiatry, 21 (3). pp. 1-35. ISSN 1562-2975
5. Lunsford-Avery JR, Kollins SH. Editorial Perspective: Delayed circadian rhythm phase: a cause of late-onset attention-deficit/hyperactivity disorder among adolescents? J Child Psychol Psychiatry. 2018 Dec;59(12):1248-1251. doi: 10.1111/jcpp.12956. Epub 2018 Sep 3. PMID: 30176050; PMCID: PMC6487490.
6. Hvolby A. Associations of sleep disturbance with ADHD: implications for treatment. Atten Defic Hyperact Disord. 2015 Mar;7(1):1-18. doi: 10.1007/s12402-014-0151-0. Epub 2014 Aug 17. PMID: 25127644; PMCID: PMC4340974.
7. Helfer B, Bozhilova N, Cooper RE, Douzenis JI, Maltezos S, Asherson P. The key role of daytime sleepiness in cognitive functioning of adults with attention deficit hyperactivity disorder. Eur Psychiatry. 2020 Mar 5;63(1):e31. doi: 10.1192/j.eurpsy.2020.28. PMID: 32131909; PMCID: PMC7315868.
8. Youssef NA, Ege M, Angly SS, Strauss JL, Marx CE. Is obstructive sleep apnea associated with ADHD? Ann Clin Psychiatry. 2011 Aug;23(3):213-24. PMID: 21808754.
9. Cohen A, Asraf K, Saveliev I, Dan O, Haimov I. The effects of sleep deprivation on the processing of emotional facial expressions in young adults with and without ADHD. Sci Rep. 2021 Jul 9;11(1):14241. doi: 10.1038/s41598-021-93641-7. PMID: 34244583; PMCID: PMC8271007.
10. Lucas I, Mulraney M, Sciberras E. Sleep problems and daytime sleepiness in children with ADHD: Associations with social, emotional, and behavioral functioning at school, a cross-sectional study. Behav Sleep Med. 2019 Jul-Aug;17(4):411-422. doi: 10.1080/15402002.2017.1376207. Epub 2017 Oct 13. PMID: 28922019.
11. Van der Heijden KB, Smits MG, Van Someren EJ, Ridderinkhof KR, Gunning WB. Effect of melatonin on sleep, behavior, and cognition in ADHD and chronic sleep-onset insomnia. J Am Acad Child Adolesc Psychiatry. 2007 Feb;46(2):233-41. doi: 10.1097/01.chi.0000246055.76167.0d. PMID: 17242627.
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