Sleep disturbances are common in children with attention deficit hyperactivity disorder (ADHD). Hyperactivity may cause sleeplessness, and sleeplessness appears to exacerbate ADHD symptoms.
This information was confirmed in 2014 by researchers in the BMJ Open medical journal.
The relationship between ADHD symptoms and sleep problems can create a cycle that is challenging for children and their parents and caregivers. However, many strategies can help kids with ADHD have better sleep.
In this article, we look at the relationship between ADHD and sleep, techniques for improving sleep, and when to seek support from a doctor.
Most studies on the subject suggest that ADHD can cause difficulty sleeping. For example, the research from 2014 suggests that 50–95% of children with neurodevelopmental disorders, including ADHD, have trouble sleeping.
Behavioral insomnia is the most common cause, according to this research. The term refers to insomnia that is caused by bedtime habits and behavior, rather than an underlying medical condition or medication. Behavioral insomnia may cause children to resist sleep, wake up frequently, or need more help from caregivers to fall asleep.
Adults with ADHD also experience insomnia. A
A number of factors may contribute to insomnia in children with ADHD, including:
- Sleep hygiene: This refers to the habits that help people sleep well on a regular basis. If a child is often hyperactive in the evening, it may be difficult to teach them good sleep hygiene practices, such as winding down before bedtime or going to sleep at the same time regularly.
- Caregiver fatigue: People who look after children with ADHD during the day may feel worn out by bedtime. This can make it harder to manage resistance, implement a routine, and encourage healthy sleep practices.
- Mental health conditions: Children with ADHD and depression or anxiety may have difficulty falling or staying asleep as a result of their mental health condition. Addressing this effectively may improve their sleep problems.
- Other medical conditions: Some children with ADHD have other medical conditions that worsen their trouble sleeping.
There are many ways to help kids with ADHD get to sleep more easily. They include:
Addressing the child’s needs before bed
Children sometimes use tactics to delay going to sleep. These can include asking to go to the bathroom or asking for food or a glass of water. Addressing these types of needs before bed, as part of a routine, can make it easier to spot and stop these delay tactics.
Before a child needs to go to sleep, try:
- making sure that they have had enough to eat — avoiding products with caffeine, such as chocolate or cola
- placing a cup of water near their bed
- taking them to the bathroom
- helping the child learn to use the bathroom on their own at night
Reducing anxiety and dependence on caregivers
Some children feel dependent on their parents or caregivers to fall asleep. They may want a caregiver to rock them to sleep or lie next to them. They may also use delay tactics to keep their caregiver around for longer.
Children can behave this way because they are afraid of bad dreams, the dark, or simply of their caregiver leaving them. This is called separation anxiety. It is normal in young children, and it can persist as a child grows up.
Reducing anxiety around sleep can help children feel less dependent on adults. Try:
- installing a night light
- giving the child a comfort object, such as a stuffed toy
- teaching them relaxation techniques
- talking with them about their worries during the daytime, not in the evening
- gradually encouraging a child to get used to separating from caregivers, using the graduated extinction method
Establishing a healthy sleep environment
Where possible, create an environment for sleep that is calm, cool, and quiet. Allow the child to help with this, as they can tell adults what makes them feel comfortable and safe. This may mean:
- moving objects around so that they do not cast scary shadows
- moving the bed to another place in the room
- letting the child choose their own bedding or pajamas
- removing things that they find distracting, such as ticking clocks or screens
Maintaining a consistent routine
A consistent bedtime routine can help children fall asleep more easily. Try:
- checking that the child’s bedtime is appropriate for their age
- sticking to the same sleep schedule, even on weekends
- doing the same, predictable tasks before bed every night, such as brushing the teeth, combing the hair, or reading a bedtime story
- avoiding activities that are too stimulating, such as watching TV or playing video games, in the hours leading up to sleep
Implementing sleep hygiene
Try making the child’s sleeping area or bedroom a place for calm activities and relaxation time only, rather than a place for more active play or punishment. This helps preserve sleep hygiene and strengthen the association between the bedroom and sleep.
Similarly, try to discourage children from using screens or doing homework in bed. If a child is used to using screens right up until sleep, try reducing their usage so that they stop 5 minutes before bedtime, then 10 minutes, and so on.
If a child often wakes up during the night or early in the morning, it can help for them to get up and do something boring until they feel sleepy again, rather than lie in bed unable to sleep. Try pointing out some quiet activities that the child can do on their own if they wake up. Some options might be:
- reading a book
- listening to an audiobook
- listening to relaxing music
Establishing healthy daytime practices
Changing daytime habits can also help improve sleep. A person might try:
- avoiding all sources of caffeine, including cola, chocolate, tea, or coffee
- encouraging kids to get active earlier in the day
- reserving calm, quiet activities for later in the day or for the evening
The Food and Drug Administration (FDA) has not approved any medication for sleep disorders in kids. Giving sleeping pills to a child without a doctor’s guidance can be dangerous. It also may lead to further sleep problems if the child becomes accustomed to taking them.
Similarly, a person should not give melatonin to a child unless a doctor recommends it. While some melatonin occurs naturally in the body, the supplements that a person purchases qualify as a medication — they can interact with other drugs and cause side effects.
A 2010 review found that melatonin may be an effective sleep aid for children with ADHD, but confirming that it is safe in the long term requires larger studies.
In cases of behavioral insomnia, changes to sleep-related behaviors, such as bedtime routines, are often very effective and can create long-term improvements. A
- an improvement in the child’s sleep, ADHD symptoms, and daily functioning
- better behavior at school
- improved working memory after 6 months
- increased work attendance for parents
It is important to try these approaches first, before medication.
Stimulant medications can reduce many ADHD symptoms. This may help with insomnia, especially when hyperactivity makes getting to bed difficult.
However, stimulants also increase the activity of the central nervous system. And insomnia is one of the most frequently reported side effects of common ADHD medications, such as methylphenidate hydrochloride (Ritalin).
If sleep disturbances begin or worsen after a child starts taking ADHD medication, consult a doctor. It may help to lower the dosage or have the child take their medication earlier in the day.
Difficulty sleeping can result from many factors that may not directly relate to ADHD. Other possible causes of trouble falling or staying asleep include:
If a child’s insomnia is severe, causes disruption at home or school, or does not respond to behavioral changes, it is a good idea to speak with a doctor. If possible, speak with a pediatrician who has a good knowledge of ADHD in children.
Doctors can help people adjust a child’s routine. They may also prescribe medication or make a referral to a specialist, if appropriate. Healthcare professionals can also provide information and support for parents and caregivers.
People may also find it helpful to join groups of others who care for children with ADHD, as these can provide support and advice.
ADHD can cause difficulty sleeping, and sleep disturbances can contribute to ADHD symptoms. However, it is possible to break this cycle. Changes to bedtime routines, reducing stimulation in the evenings, and creating a more peaceful sleep environment
If a child continues to struggle with sleep, contact a mental health professional or a pediatrician who is knowledgeable about ADHD.