Attention deficit hyperactivity disorder (ADHD) is a chronic condition that causes various hyperactive and disruptive behaviors. People with ADHD often have trouble focusing, sitting still, and controlling their impulses. ADHD affects millions of children every year, and in many cases continues into adulthood. The disorder is much more common in boys than girls, but occurs equally in men and women.
The exact cause of ADHD isn’t known. However, researchers believe genetics and certain environmental factors may contribute to its development. There’s no cure for ADHD, but several treatments can help to reduce the severity of symptoms.
Symptoms of ADHD can appear in children as young as age 2, and they usually decrease with age. Common symptoms of ADHD include:
- trouble focusing or staying on task
- daydreaming often
- appearing not to listen
- difficulty following directions or finishing tasks
- losing or forgetting things easily
- problems organizing tasks and activities
- frequently fidgeting or squirming
- talking excessively
- regularly interrupting others peoples’ conversations or activities
- being impatient and easily irritated
Symptoms of ADHD can affect many areas of life. People with ADHD often struggle with school, work, and relationships. They’re also more likely to have co-existing conditions, such as anxiety, depression, and sleep disorders.
Sleep disorders are believed to be one of the most common types of conditions among adults and children with ADHD. It’s thought that the symptoms of ADHD make it challenging to settle down enough to fall asleep or stay asleep. This can cause a variety of sleep problems that make it difficult to get a good night’s rest.
A lack of sleep can exacerbate some ADHD and ADHD-related symptoms, especially anxiety. However, poor sleep quality usually affects children and adults differently. When children don’t get enough sleep, they usually become more hyperactive. Adults, on the other hand, typically feel more fatigued and have a lack of energy.
Sleep disorders are defined as conditions that interfere with the ability to sleep well on a regular basis. Most adults require seven to eight hours of sleep each night, while children may need nine to 13 hours of sleep.
Researchers aren’t sure exactly why ADHD and sleep disorders often occur together. However, it’s believed that ADHD symptoms may make it difficult for people to sleep well. Some medications used to treat ADHD can also cause sleep issues, especially if taken later in the day.
Common sleep disorders among people with ADHD include insomnia, restless legs syndrome, and sleep apnea.
Insomnia is a sleep disorder that makes it difficult to fall asleep, stay asleep, or both. People with insomnia usually don’t wake up feeling rested. This can make it hard for them to function normally throughout the day. It can affect mood, energy level, and overall quality of life.
Insomnia tends to become more common with age, as changes in sleep patterns and general health occur. Symptoms of insomnia often include:
- trouble falling asleep
- waking up from sleep during the night
- waking up too early
- not feeling refreshed after sleeping
- feeling tired or sleepy during the day
- feeling anxious, depressed, or irritable
- trouble focusing or remembering things
- making more errors than usual
- tension headaches
- digestive issues
Restless Legs Syndrome
Restless legs syndrome, also known as Willis-Ekbom disease, is characterized by an overwhelming need to move one’s legs. This desire is usually triggered by leg discomfort, such as throbbing, aching, or itching. These uncomfortable sensations often occur at night, especially when a person is lying down. Moving can make the discomfort go away temporarily.
Restless legs syndrome can affect people of any age, but it typically becomes more intense as time goes on. It may make sleeping difficult, which can result in daytime sleepiness and fatigue. The symptoms of restless legs syndrome include:
- an uncomfortable sensation in the legs that begins after lying down or sitting for a long period of time
- irresistible urge to move the legs
- leg discomfort that temporarily subsides when the legs are moved
- twitching or kicking legs during sleep
- waking up from sleep due to leg movements
Sleep apnea is a serious sleep disorder in which breathing temporarily stops during sleep. People with sleep apnea often snore loudly and feel tired even after a full night’s rest. There are three main types of sleep apnea:
- obstructive sleep apnea, which occurs when the muscles in the throat relax abnormally
- central sleep apnea, which occurs when the brain doesn’t send the right signals to the muscles that control breathing
- complex sleep apnea syndrome, which occurs when someone has both obstructive and central sleep apnea at the same time
While there are different types of sleep apnea, they all share the common symptoms. These symptoms include:
- snoring loudly (mostly in people with obstructive sleep apnea)
- breathing that starts and stops during sleep (observed by another person)
- waking up during sleep and feeling short of breath (mostly in people with central sleep apnea)
- waking up with a dry mouth or sore throat
- having a headache in the morning
- trouble staying asleep
- being very sleepy during the day
- trouble focusing
Sleep disorders may sometimes mask ADHD diagnoses, especially in adults. So doctors must take extra care when screening for sleeping problems in people with ADHD.
If someone with ADHD complains of sleeping problems, their doctor will take a thorough sleep history. This involves asking the person about:
- their usual bedtime
- the amount of time it takes to fall asleep
- awakenings during the night
- problems waking up
- daytime naps
- daytime energy levels
The doctor may also give them a “sleep diary.” In the diary, they’ll be asked to record their sleeping habits over several weeks.
If a sleep disorder is suspected, the doctor may run different diagnostic tests. There are two main tests used to diagnose sleep disorders:
Nocturnal polysomnography test
This test is done in a laboratory while a person sleeps. The person is connected to equipment that monitors vital signs as well as activity in the heart, lungs, brain, and legs during sleep. People with sleep disorders usually have a shorter overall sleep time, move their limbs more during sleep, and may exhibit other irregular behaviors while sleeping.
Home sleep tests
As the name suggests, this test is done at home. It’s performed in the same way as a nocturnal polysomnography test. The person will be given the monitoring equipment to use at home while they sleep. Abnormal vital sign measurements, movements, and breathing patterns tend to indicate a sleep disorder.
In people with ADHD, it’s important to establish a good treatment plan for sleep disorders. This often involves psychotherapy or medical treatments that help promote normal sleep.
Some common psychotherapy techniques include:
- cognitive behavioral therapy, which can show you how to manage or eliminate feelings of anxiety and thoughts that keep you from falling asleep
- relaxation techniques, such as meditation and deep breathing exercises, which can help reduce stress before bedtime
- stimulus control, which can teach you how to limit the time you spend in bed so you only associate your bed with sleep
- sleep restriction, which intentionally deprives you of sleep so you get better sleep the next day
- light therapy, which can help reset your internal clock so that you fall asleep at a later or more appropriate time
Some medical treatments that can help with sleep disorders include:
- prescription sleeping pills, such as zolpidem (Ambien), eszopiclone (Lunesta), or zaleplon (Sonata)
- calcium-channel blockers and muscle relaxants to help those with restless legs syndrome
- continuous positive airway pressure (CPAP) machine, which helps keep airways open and prevents sleep apnea
- oral appliances to keep the throat open and prevent sleep apnea
It’s also important to make certain lifestyle adjustments. Some lifestyle and home treatments for sleep disorders include:
- going to bed and waking up at the same time every day, even on weekends
- avoiding caffeine in the late afternoon and evenings
- avoiding nicotine and alcohol close to bedtime
- avoiding using electronics before bedtime
- using the bed only for sleeping
- keeping the bedroom dark, quiet, and cool
- getting enough exercise during the day
- avoiding heavy meals close to bedtime
- establishing a relaxation routine before bed, such as reading, doing yoga, or taking a warm bath
Having a sleep disorder in addition to ADHD isn’t easy. With the right treatment and lifestyle modifications, however, you can greatly reduce your symptoms and improve your sleep.