People with attention deficit hyperactivity disorder (ADHD) may also experience sleep disorders such as insomnia, restless legs syndrome, and changes in the circadian rhythm.

Around 25–50% of people with ADHD also report sleep problems such as insomnia, narcolepsy, and restless legs syndrome (RLS).

Researchers are not sure exactly why ADHD and sleep disorders commonly occur together. However, factors such as ADHD medication side effects and certain ADHD symptoms, such as hyperactivity and restlessness, may play a role in sleep disturbances.

This article looks at the sleep disorders a person with ADHD may experience, the causes of sleep problems in people with ADHD, and potential treatment options, including tips for improving sleep and when to contact a doctor.

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Several sleep conditions may occur in people with ADHD.

Insomnia

According to a 2017 research review, the prevalence of insomnia in adults with ADHD is 43–80%.

Insomnia is a sleep disorder in which people find it difficult to fall or stay asleep. Adults and children with ADHD typically wake often during the night, delay their bedtime, and take longer to fall asleep than people who do not have ADHD.

Sleep-disordered breathing (SDB)

People with SDB have abnormal patterns of respiration during sleep. A common type of SDB is obstructive sleep apnea, which causes partial or total obstruction of the upper airway.

In a 2019 study involving 194 people at a sleep center, researchers found that around 19% of people with obstructive sleep apnea also had ADHD.

In sleep apnea, a person’s breathing frequently stops and starts during sleep, which can restrict oxygen and cause poor-quality sleep. This can increase a person’s risk of chronic health problems and affect their mental health.

Narcolepsy

Narcolepsy is a chronic neurological condition that causes people to feel excessively sleepy during the day and experience fragmented sleep at night.

Research suggests that adults with narcolepsy may be twice as likely as those without narcolepsy to have received a childhood diagnosis of ADHD.

RLS

Studies suggest that up to 44% of people who have ADHD also have RLS or RLS-like symptoms, while up to 26% of people with RLS also have ADHD or ADHD-like symptoms.

People with RLS experience uncomfortable sensations in their legs or other body parts and an urge to move their legs, especially at bedtime. The need to move around and the accompanying discomfort can cause restlessness and sleep disruption.

Circadian rhythm sleep disorders

People with ADHD may experience changes in the natural mechanisms of the circadian rhythm that let a person know when to sleep and wake. This may affect their natural ability to fall asleep.

According to the National Sleep Foundation, the circadian rhythm is typically aligned with the day-night cycle. It follows a biological process in which the body releases the sleep hormone melatonin at night.

This helps a person feel sleepy at night and more alert in the morning, as melatonin production slows with light exposure. However, people with circadian rhythm sleep disorders may not share this experience.

Researchers do not know the causes of sleep disorders in people with ADHD. However, they believe various aspects of ADHD may contribute to sleep problems.

Neurotransmitter dysregulation

Some research associates ADHD with the dysregulation of neurotransmitters, especially norepinephrine and dopamine.

These neurotransmitters affect arousal and attention. An imbalance in their functioning may play a role in ADHD and cause sleep disturbances.

Researchers also believe there may be a link between ADHD and sleep disorders such as narcolepsy due to the dysregulation of noradrenaline, a neurotransmitter and hormone.

They suggest that dysregulation of both noradrenaline and dopamine underlies ADHD and causes changes to REM sleep similarly to narcolepsy.

Difficulty settling down

People with ADHD may have difficulty managing impulses. This can make it more difficult to settle down at night, maintain sleep routines, and maintain good sleep hygiene.

Genetic changes

People with ADHD may have differences in specific genes that play a role in the sleep-wake cycle.

Changes in these genes may make it biologically more difficult for people to settle down and sleep in the evening, as their circadian rhythm may function differently.

Stimulant medication

Methylphenidate treatments for ADHD, such as Ritalin and Concerta, are stimulant medications that increase mental alertness. Sleep difficulties are the most common side effect of this type of medication.

Potential causes not related to ADHD

Factors unrelated to ADHD that could influence sleep quality include:

  • use of caffeine, nicotine, or alcohol before bed
  • consumption of heavy meals before bed
  • inadequate sleep hygiene
  • an irregular schedule
  • aging
  • certain medications
  • mental health conditions such as anxiety
  • medical conditions such as nerve disorders, muscle pain, and heart disease

To treat specific sleep conditions, doctors may prescribe medication or therapies such as:

A doctor may also recommend lifestyle habits to help a person with ADHD build a routine and sleep better at night, such as getting enough physical activity each day.

The following strategies may help a person improve their sleep quality:

  • keeping the sleeping environment dark, quiet, and at a comfortable temperature
  • maintaining a regular sleep schedule
  • using relaxation techniques before bedtime
  • avoiding heavy meals before bedtime
  • avoiding caffeine, alcohol, and nicotine close to bedtime
  • keeping screens out of the bedroom

If lifestyle strategies and sleep hygiene habits do not improve a person’s sleep difficulties, they should speak with a healthcare professional.

If a person thinks they have a sleep disorder such as sleep apnea, RLS, or insomnia, they should contact a doctor, as prolonged poor-quality sleep can lead to health complications and affect mental health.

ADHD and sleep disorders may occur together. Examples of sleep disorders include insomnia, narcolepsy, RLS, sleep apnea, and circadian rhythm sleep disorders.

A doctor may treat sleep disorders with medication, a CPAP machine, CBT, or bright light therapy.

However, lifestyle strategies may also help a person with ADHD sleep better. These can include practicing good sleep hygiene and avoiding certain activities close to bedtime, such as smoking and consuming alcohol.