ADHD in children and adults is often characterized by inattentiveness, hyperactivity, and impulsivity. Interestingly, children with sleeping problems may not become drowsy and less attentive as is the case with adults. Sometimes, children have the opposite reaction and the overlap of symptoms between the ADHD and sleep insomnia may result in a misdiagnosis, i.e., the child with sleep insomnia may be diagnosed with ADHD.
The Four Patterns of Sleep Disturbances Related to ADHD:
1. Difficulty Falling Asleep
About three-fourths of all adults with ADHD report an inability to “shut off their minds”. Many who take stimulants, particularly too close to bedtime, have a higher prevalence of sleep problems, most notably insomnia.
2. Restless Sleep
Individuals with ADHD often toss and turn once they do fall asleep. Reasons for this may include:
a. Restless Legs Syndrome (RLS) - This irresistible urge to move limbs while at rest, has been shown to exist in about 25% of subjects with ADHD, compared to just 5% of controls. The number of disruptive movements at night are strongly associated with the degree of hyperactivity during the day.
b. Snoring, Sleep Apnea and Hyperactivity - Enlarged tonsils, obesity, allergies and other conditions can cause difficulty in breathing resulting in light snoring to sleep apnea. Children with sleep problems may not exhibit drowsiness, but rather bed-wetting, sweating, development delays and learning and behavior difficulties.
3. Difficulty Waking
Because of fitful sleep and waking up several times in the night, many find it difficult to awaken to the alarm clock. Often, family members must wake them and generally the person with ADHD does not feel “awake” until later in the day.
4. Intrusive Sleep
The ability to hyper-focus, or engage deeply in activities that one enjoys, enables the person with ADHD to remain awake. Once this person loses interest in a subject, their nervous system disengages, even to the point of falling asleep wherever they are. This can be life-threatening if the individual is driving a vehicle.
Does ADHD result in sleep disorders?
There is not a complete consensus, however, about three-fourths of all adults with ADHD report an inability to “shut off their minds,” which can lead to lack of sleep. For some, comorbid conditions, such as depression and anxiety, may be the reason for the sleeplessness. Some researchers believe that the signal that sets the internal circadian clock (the gradual changes in light caused by the sun's setting and rising) is weak in people with ADHD. As a result, their circadian clock is never truly set, and sleep drifts into to the 4 a.m.-to-noon pattern or disappears entirely, until the sufferer is exhausted.
Relaxation techniques and exercise help induce sleepiness, as does turning off electronics at least one hour before bedtime. Creating a calming bedtime routine, such as listening to music or reading a book can help, as well. Avoidance of caffeine, alcohol and stimulant medication before bedtime is also recommended.
The Importance of Treatment
Sleep problems are often not just “habits” for people with ADHD, so should be treated as symptoms. Talk with your doctor about sleep issues to determine if you have sleep apnea or other issues that can be treated or whether ADHD medications (such as stimulants taken late in the day) might be adding to sleeplessness. Sometimes, optimizing patient treatment in general can improve sleep, particularly if depression or anxiety is a factor.