ADHD and Sleep Disorders

ADHD symptoms and ADHD treatments might cause sleep disorders. Learn more about childhood and adult ADHD and sleep problems, sleep disorders.

ADHD symptoms usually begin before the age of seven, but associated sleep disorders often do not appear until around age twelve. While disordered sleep symptoms are not typically considered in ADHD diagnosis, current research points to ADHD as a possible cause of sleep disorders. Some researchers though, believe that stimulant medication, common in the treatment of ADHD, may be the cause of sleep disorders in those diagnosed with ADHD.²

What is ADHD?

Attention deficit hyperactivity disorder (ADHD) encompasses various hyperactive, impulsive and/or inattentive behaviors. An individual with ADHD may experience symptoms predominantly surrounding inattentiveness, hyperactive-impulsivity or a combination of both. ADHD is typically associated with children, but an estimated 60% of children continue to have symptoms as adults.

Inattentiveness symptoms include:

• Difficulty paying attention to details; tendency to make careless mistakes
• Distraction by irrelevant stimuli often interrupting ongoing tasks
• Difficulties with concentration and mental focus
• Difficulty finishing tasks or performing tasks that require concentration
• Frequent shifts from one uncompleted activity to another
• Procrastination
• Disorganized work habits
• Forgetfulness in daily activities (for example, missing appointments, forgetting to bring lunch)
• Frequent shifts in conversation, not listening to others, not keeping one's mind on conversations and not following the rules of activities in social situations

Hyperactivity-impulsivity symptoms include:

• Fidgeting, squirming when seated
• Getting up frequently to walk or run around; jumping and climbing
• Difficulty in playing quietly or engaging in quiet leisure activities
• Being always on the go
• Talking excessively
• Impatience; intolerance to frustration; interruption of others

Adults with ADHD may experience restlessness instead of the hyperactivity symptoms above. Other common adult ADHD symptoms include:

• Constant worry
• Sense of insecurity; low self-esteem; underachievement
• Mood swings, especially when disengaged from a person or project
• Poor anger management
• Inability to shift focus between mental activities

ADHD and Sleep Problems

The likelihood of a co-occurring sleep disorder with ADHD dramatically increases at the age of puberty and increases further with age.³ Both children and adults with ADHD commonly experience the following sleep disorders:

• Sleep apnea
• Restless leg syndrome
• Parasomnias including REM behavior disorders and nightmares

Childhood ADHD and Sleep Problems

About half of parents of children with ADHD report their child has difficulty sleeping. The specific relationship between sleep disorders and childhood ADHD is unknown, but children who have difficulty sleeping may have trouble concentrating during the day and display irritability similar to ADHD. Restless leg syndrome is also associated with inattentiveness, moodiness and hyperactivity as in ADHD.

Bedwetting is also common in childhood ADHD.

Adult ADHD and Sleep Disorders

About three-quarters of adults with ADHD report symptoms of insomnia, primarily consisting of a delay, often of an hour or more, in getting to sleep.³ People commonly report racing thoughts with an inability to "turn their brain off" to fall asleep. Once asleep, ADHD sufferers often toss and turn to the point where their sleep partner may choose to sleep in another room. Adults with ADHD can awaken to even quiet sounds and often do not find sleep refreshing.

Perhaps due to nightly insomnia, once a person with ADHD gets to sleep, they can be extremely difficult to wake. It is common for people to sleep through two or three alarms and be combative and irritable on being woken, some not feeling fully awake until noon.³ Some researchers believe this is because the circadian clock in an adult with ADHD is incorrectly set to sleep between the hours of 4 a.m. and noon.

While some adults with ADHD can't get to sleep, others sleep at inappropriate times. Some find that when they are uninterested in the world around them they disengage to the point of falling asleep. This is known as intrusive sleep, but in a physical sense it is really closer to unconsciousness. Intrusive sleep can be misdiagnosed as narcolepsy but is actually differentiated by a unique series of associated brain waves.³

ADHD is also associated with substance abuse issues, which further complicate the treatment of sleep disorders.

References:

¹Dodson, William M.D. ADHD Sleep Problems: Causes and Tips to Rest Better Tonight! ADDitude. Feb/March 2004 http://www.additudemag.com/adhd/article/757.html

²No listed author Attention Deficit Hyperactivity Disorder: ADHD in Adults WebMD. Accessed Aug. 10, 2010 http://www.webmd.com/add-adhd/guide/adhd-adults

³No listed author Attention-Deficit/Hyperactivity Disorder: Symptoms of ADHD WebMD. Accessed Aug 10, 2010 http://www.webmd.com/add-adhd/guide/adhd-symptoms

⁴No listed author ADHD and Sleep Disorders WebMD. Accessed Aug. 10, 2010 http://www.webmd.com/add-adhd/guide/adhd-sleep-disorders

⁵Peters, Brandon M.D. The Relationship Between ADHD and Sleep About.com. Feb. 12, 2009 http://sleepdisorders.about.com/od/causesofsleepdisorder1/a/ADHD_Sleep_2.htm