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Sleep problems are among the most frequent co-occurring disorders in people with ADHD. Research has shown that many people with ADHD even suffer from more than one sleep disorder, often of different etiology. Science has not yet solved the questions arising from these findings, but we do know that sleep loss impairs concentration, memory, mood stability, and the immune system’s functioning, increasing risk for infections and allergies. Not surprisingly, ADHD is associated with many allergies and infections. The importance of good sleep and its association with overall health cannot be overstated.

The good news is that most sleep disorders can be treated effectively, and doing so can reduce ADHD symptoms and lead to improved health and wellness.

In this webinar, you will learn:

• Why people with ADHD commonly suffer with sleep problems and disorders
• About the different kinds of sleep disorders, including the circadian sleep-wake disorder, delayed sleep phase type, insomnia, restless legs, periodic limb movement disorder and sleep apnea
• How researchers are working to better understand the close relationship between ADHD and sleep disorders
• About treatment study findings that show low-dose melatonin, bright light therapy and other interventions may help reduce ADHD symptoms and lead to better overall health.

Have a question for our expert? There will be an opportunity to post questions for the presenter during the live webinar.

Meet the Expert Speaker

J.J. Sandra Kooij is a psychiatrist at PsyQ, psycho-medical programs, and Head of the Expertise Center Adult ADHD, in the Netherlands. She is a professor of adult ADHD studies at the Department of Psychiatry, VU University Medical Center, Amsterdam. She has published more than 100 peer-reviewed international papers and more than 20 books or book chapters on ADHD in adults.

Since 2002, Dr. Kooij has been the head of the Dutch Expertise Center Adult ADHD, leading research, treating patients, educating professionals, informing the public, and publishing books, scientific papers, websites, webinars and podcasts. She recently launched a new ADHD app, Super Brains. Read more about Dr. Kooij here.

Join an ADHD and Women’s Health Survey!  PsyQ Expertise Center Adult ADHD, in collaboration with ADHD Europe, developed an international survey on the experiences and health of women with ADHD. Are you a woman and do you have ADHD symptoms? You are invited to participate in this survey!

ADHD and Sleep: More Resources

• Download: Sleep Disorders Linked to ADHD
• Self-Test: Could You Have Delayed Sleep Phase Disorder?
• Read: What Comes First: ADHD or Sleep Problems?
• Read: How to Fall Asleep with a Rowdy, Racing ADHD Brain
• Free eBook: How to Sleep Better with ADHD

Webinar Sponsor

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ADHD and disordered sleep can disrupt daily life, but you can take back control. Play Attention, inspired by NASA technology and backed by Tufts University research, helps you strengthen executive function and gain cognitive control. By combining mindfulness training with cognitive exercises, our program empowers you to manage focus, emotions, and routines—building the foundation for better sleep and overall well-being.

Start our online ADHD assessment now or schedule your 1:1 consultation. www.playattention.com 828-243-9291

ADDitude thanks our sponsors for supporting our webinars. Sponsorship has no influence on speaker selection or webinar content.

Certificate of Attendance: For information on how to purchase the certificate of attendance option (cost $10), register for the webinar, then look for instructions in the email you’ll receive one hour after it ends. The certificate of attendance link will also be available here, on the webinar replay page, several hours after the live webinar. ADDitude does not offer CEU credits.

Closed captions available.

Q: Do people with ADHD experience winter depression more often and more severely than do neurotypical individuals? Also, why is my quality of sleep affected in winter?

Winter depression is marked by two or more weeks of low mood, usually starting in the Northern Hemisphere’s fall or winter when there is less daylight, that resolves in the spring or summer when there is more light. There is an association between winter depression, also known as seasonal affective disorder, or SAD, and ADHD.

In the Netherlands, where I live, researchers asked 259 patients with ADHD about seasonal mood swings; 27% reported winter depression compared with 3% in neurotypical people.¹ Other researchers have confirmed this increased rate among people with ADHD.² What’s more, females are four times more likely than males to have winter depression.¹

Sleep problems are also common among people with ADHD: About 80% are late sleepers³ , which means they have a short sleep duration — they fall asleep at a later time and sleep less because they must wake up for work or school.

Q : How does winter depression relate to screen addiction in children with ADHD?

Children with ADHD who are late sleepers and who experience winter depression may turn to video games and the Internet. Screens emit blue light, and they’re often held close to the eye, so the effects are similar to light therapy if you’re staring at them for a while.

[Get This Free Download: How to Sleep Better with ADHD]

Screen use at night can induce delayed circadian rhythms, disrupting your sleep-wake cycle.⁴ Many children with ADHD are already late sleepers, so using screens after 9:30 pm will delay their rhythm even more; this is not recommended. Keep in mind that when sleep gets delayed, mood is affected.

The good news is that winter depression and sleep problems can be easily and quickly treated with artificial light therapy. A 10,000-lux light therapy lamp can be used for 30 minutes a day for 5 to 20 consecutive days. The lamp, or light box, should be used at a close distance to your eyes; the distance is very important for the intensity of the treatment. It’s best to do this every day at the same time, preferably between 7 and 8 am, to reset your biological clock and alter the sleep-wake cycle.

You may also consider using light therapy glasses, which work in the same way as lamps. You can wear these for 30 minutes a day while you’re dressing or eating breakfast; in other words, without disrupting your routine.

Light therapy is a serious antidepressant that often unlocks better mood, improved sleep, and more energy.

[Read: How to Fall Asleep with a Rowdy, Racing ADHD Brain]

Q:  Is vitamin D recommended for people with winter depression?

If your vitamin D is too low, then taking vitamin D is recommended. Vitamin D is generally low in people with ADHD, though we don’t know why.⁵ You get vitamin D from sunlight; in winter, when there is less light, you may need to take a supplement. Another way we can get vitamin D is by eating fatty fish, though many people don’t eat enough to affect levels.

Winter Depression: Next Steps

• Self-Test: Could You Have Delayed Sleep Phase Disorder?
• Read: 9 Sleep Deprivation Solutions for Adults with ADHD
• Read: 6 Tips to Overcoming Winter Depression
  

J.J. Sandra Kooij, M.D., Ph.D., is a psychiatrist and head of the Expertise Center Adult ADHD at PsyQ in the Netherlands.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹Amons, P. J., Kooij, J. J., Haffmans, P. M., Hoffman, T. O., & Hoencamp, E. (2006). Seasonality of mood disorders in adults with lifetime attention-deficit/hyperactivity disorder (ADHD). Journal of affective disorders, 91(2-3), 251–255. https://doi.org/10.1016/j.jad.2005.11.017

²Wynchank, D. S., Bijlenga, D., Lamers, F., Bron, T. I., Winthorst, W. H., Vogel, S. W., Penninx, B. W., Beekman, A. T., & Kooij, J. S. (2016). ADHD, circadian rhythms and seasonality. Journal of psychiatric research, 81, 87–94. https://doi.org/10.1016/j.jpsychires.2016.06.018

³Van Veen, M. M., Kooij, J. J., Boonstra, A. M., Gordijn, M. C., & Van Someren, E. J. (2010). Delayed circadian rhythm in adults with attention-deficit/hyperactivity disorder and chronic sleep-onset insomnia. Biological psychiatry, 67(11), 1091–1096. https://doi.org/10.1016/j.biopsych.2009.12.032

⁴Hartstein, L. E., Mathew, G. M., Reichenberger, D. A., Rodriguez, I., Allen, N., Chang, A. M., Chaput, J. P., Christakis, D. A., Garrison, M., Gooley, J. J., Koos, J. A., Van Den Bulck, J., Woods, H., Zeitzer, J. M., Dzierzewski, J. M., & Hale, L. (2024). The impact of screen use on sleep health across the lifespan: A National Sleep Foundation consensus statement. Sleep health, 10(4), 373–384. https://doi.org/10.1016/j.sleh.2024.05.001

⁵Khoshbakht, Y., Bidaki, R., & Salehi-abargouei, A. (2018). Vitamin D Status and Attention Deficit Hyperactivity Disorder: A Systematic Review and Meta-Analysis of Observational Studies.. Advances in nutrition, 9 1, 9-20 . https://doi.org/10.1093/advances/nmx002.

Sleep problems are highly prevalent among adults with ADHD. Individuals who have ADHD and one or more psychiatric comorbidities face an increased risk for disordered sleep, according to a study published in the Journal of Attention Disorders.¹

The study followed a large sample of adults with ADHD in the Netherlands after they were referred to an outpatient mental health clinic. Nearly two-thirds of these patients screened positive for a sleep problem. Most screened positive for delayed sleep phase syndrome (35.8%), followed by insomnia (30.6%) and restless leg syndrome (28.8%).

Women with ADHD were more likely to report more types of sleep problems compared to men with ADHD. Women more often reported insomnia, hypersomnia, and parasomnia, while men more often reported sleep-related breathing disorders (SBD).

Adults with ADHD and mental health conditions faced a higher likelihood of having any type of sleep problem and of having more than one sleep problem than did those with ADHD alone. The risk of sleep problems was highest in adults with PTSD (OR=3.21), followed by:

• Substance use disorder (OR=1.76)
• Depression (OR=1.73)
• Anxiety (OR=1.51)
• Personality disorders (OR=1.54)

Why Do Adults with ADHD Struggle with Sleep?

Sleep disorders impact around 50 million Americans or 15% of the U.S. population.² This percentage is significantly higher in ADHD populations, as shown in the current study. According to data cited by the authors, disordered sleep affects an estimated 40% to 80% of adults with ADHD.^{3, 4} The most common sleep disorders are similar for both groups and include insomnia, restless legs syndrome (RLS), narcolepsy, and sleep apnea.^{5, 6}

ADHD and sleep go hand in hand, and the impact of one disorder can worsen the symptoms of the other. For example, the American Academy of Neurology found that people with ADHD and RLS experience more severe RLS symptoms than do those without ADHD.⁷

Many sleep problems are biological, but they can also be behaviorally motivated. A study cited by the authors shows that cognitive behavioral symptoms such as bedtime procrastination can delay sleep onset and potentially disrupt melatonin production.⁸

“Symptoms of ADHD exacerbate the things that make sleep hard for all of us,” said Joel Nigg, Ph.D., in his 2018 webinar with ADDitude, “Sleep and the ADHD Brain: Why It’s Critical and How to Get More.”

“Your body reacts more strongly to stimulation,” Nigg said. “You’re more hyper-aroused by things that happen during the day. It’s harder to turn your brain off. It’s a natural side effect of what ADHD is. Sleep requires the opposite of the energy that ADHD provokes, [making sleep] naturally difficult. That’s why it takes the kind of deliberate attention, behavioral strategy, or kind of tackling of this so often for those with ADHD.”

What Are the Consequences of Untreated Sleep Problems?

The impact of misdiagnosing symptoms of disordered sleep can have long-term consequences, leading to “poor treatment, and persistence and aggravation of symptoms,” the authors wrote.

Symptoms of poor sleep can look like ADHD and vice versa, making them somewhat difficult to differentiate. Left untreated, disordered sleep can worsen with age and cause a ripple effect from caregivers to their children.⁹

“Sung did a study [in 2008], which found that moderate or severe sleep problems in children with ADHD were strongly associated with the mental health of their primary caregivers and with those caregivers’ work attendance and overall family functioning,” said Roberto Olivardia, Ph.D., during his 2019 webinar with ADDitude, “Time for Bed! Sleep Solutions for the ADHD Brain.”

The good news is that “treatments for specific sleep problems are available, relatively accessible to implement in ADHD patients, and can improve ADHD treatment results substantially,” the authors wrote. Cognitive behavioral therapy (CBT) and lifestyle changes are first-line treatments for many sleep disorders and can be more effective than sleep medicine.¹⁰

Limitations, Strengths, and Future Research

The study followed 3,691 adults diagnosed with ADHD from 2018 to 2020. Data was assessed via electronic patient files and included an even male-to-female ratio. Adults with ADHD were referred to one of 46 specialized outpatient clinics in the Netherlands by their general practitioner or mental health counselor. The Holland Sleep Disorder Questionnaire (HSDQ) was used to assess sleep disorders, though it was used as a screening tool and not to diagnose. The DIVA-5 was used to test for ADHD, and the M.I.N.I was used to screen for psychiatric comorbidities.

Limitations of the study include a lack of control group. And although some patients had been diagnosed with a sleep disorder before being referred to an outpatient clinic, the HSDQ was only able to screen for sleep problems. Some data, such as BMI and treatment status, was not accounted for as it was not systematically recorded in patient files. Given each patient received a clinical referral, the severity of symptoms experienced by patients should be considered when interpreting results.

Future studies would benefit by measuring causal factors contributing to sleep problems in adults with ADHD. These studies should also include subjective sleep parameters, such as actigraphy and polysomnography, which were not included here. Insomnia has been widely studied in sleep research; more research is needed on other sleep disorders, including periodic limb movement disorder (PLMD), RLS, DSPS, and SBD.

Sources

¹ van der Ham, M., Bijlenga, D., Böhmer, M., Beekman, A.T.F., & Kooij, S. (2024). Sleep problems in adults With ADHD: prevalences and their relationship with psychiatric comorbidity. Journal of Attention Disorders, 28(13), 1642-1652. https://doi.org/10.1177/10870547241284477

² American Psychiatric Association. (2024). What are Sleep Disorders? https://www.psychiatry.org/patients-families/sleep-disorders/what-are-sleep-disorders

³Wynchank, D., Bijlenga, D., Beekman, A.T. et al. (2017). Adult attention-deficit/hyperactivity disorder (ADHD) and insomnia: an update of the literature. Curr Psychiatry Rep 19, 98. https://doi.org/10.1007/s11920-017-0860-0

⁴Batten, L. (2022, August 17). How ADHD Impacts Your Sleep And What You Can Do About It. Frida. https://www.talkwithfrida.com/learn/how-adhd-impacts-your-sleep/

⁵ U.S. Centers for Disease Control & Prevention. (2024, May 15). About Sleep. https://www.cdc.gov/sleep/about/index.html

⁶ Cleveland Clinic. (2023, June 19). Sleep Disorders. https://my.clevelandclinic.org/health/diseases/11429-sleep-disorders

⁷ American Academy Of Neurology. (2001, May 8). Adults With Restless Legs Syndrome More Likely To Have ADHD. ScienceDaily. www.sciencedaily.com/releases/2001/05/010508082849.htm

⁸ Li, X., Buxton, O. M., Kim, Y., Haneuse, S., & Kawachi, I. (2020). Do procrastinators get worse sleep? Cross-sectional study of U.S. adolescents and young adults. SSM – Population Health, 10, 100518. https://doi.org/10.1016/j.ssmph.2019.100518

⁹ Sung, V., Hiscock, H., Sciberras, E., Efron, D. (2008). Sleep problems in children with attention-deficit/hyperactivity disorder: prevalence and the effect on the child and family. Arch Pediatr Adolesc Med, 162(4):336–342. https://doi.org/10.1001/archpedi.162.4.336

¹⁰ Mitchell, M.D., Gehrman, P., Perlis, M. et al. (2012). Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review. BMC Fam Pract, 13, 40. https://doi.org/10.1186/1471-2296-13-40

Sleep problems in children are associated with restless behavior and iron deficiency, two problems more common in patients with ADHD, according to a small study published in the journal Nutrients.¹

The study followed 199 patients referred to a Sleep/Wake Behavior Clinic between 2021 and 2023. It found that patients with ADHD were nearly twice as likely as their neurotypical counterparts to have restless leg syndrome (RLS). The most common psychiatric comorbidities among patients with sleep disorders included ADHD (46%), autism (45%), and anxiety disorder (41%).

Most patients in the study had an iron deficiency (94%), and 41% knew someone in their family who did. When comparing ADHD patients only, a family history of iron deficiency increased the patient’s risk of having RLS and insomnia.

“Recently, iron has received increasing attention due to its role in sleep disorders, as well as wake behaviors associated with mental health and/or neurodevelopmental disorders such as ADHD, autism spectrum disorder, and prenatal alcohol exposure/fetal alcohol spectrum disorder,” the research authors wrote.

RLS was the most common sleep disorder (74%) in the study, followed by:

• Chronic insomnia: 61%
• Signs of sleep-disordered breathing: 50%
• Restless sleep or PLMS: 30%
• Circadian rhythm sleep disorder (CRSD): 16%
• Probable painful RLS: 11%

Sleep and ADHD

Nearly three-quarters of children with ADHD experience a sleep problem or disorder.² For many children, sleep problems last into adolescence and can aggravate ADHD symptoms during the day.

“By the time they get into adolescence, we know that teens with ADHD are more likely than their peers without ADHD to get insufficient sleep on school nights,” said Stephen Becker, Ph.D., in his 2021 webinar with ADDitude, “Why Am I Always So Tired? The Latest Science on Improving Sleep in Children and Teens with ADHD.”

“We’ve also shown that poor sleep impacts academics, including academic performance, organization, and lower grades based on report cards that we’ve acquired from schools and college institutions,” Becker said. “In some of our work with young teens, even after we account for a teen’s initial levels of depressive symptoms or oppositional behaviors, those teens who had sleep problems went on to experience an increase in depressive symptoms and oppositional behaviors over time.”

Restlessness, defined as the “urge to move,” was a strong risk factor for sleep problems in children with and without ADHD in the present study. Hypermotor restlessness and hyper-arousal are central to ADHD and RLS but are often missed in pediatric patients, according to the authors. Symptoms of restlessness are based on adult criteria and do not account for physical differences that may be present in children.

“Characterizing hyper-motor restlessness during sleep as a new diagnostic entity supports our understanding that disorders presenting with hypermotor restlessness and/or hyper-arousability need an in-depth phenotyping approach from a pediatric sleep medicine perspective,” the authors wrote.

Limitations & Future Research

Standard diagnostic evaluations for sleep disorders typically do not assess for iron levels, according to the authors. Testing iron levels using blood tests could help improve treatment outcomes, as many patients in the present study were shown to be deficient. The authors noted that iron supplementation is often an effective treatment approach.

Evening activities, screen time, stimulant medication, homework stress, and inconsistent sleep/wake times may also make it difficult for children with ADHD to wind down at night.

Patients ages 3 months to 23 years and/or their family members answered questions upon intake about bedtime habits, excessive daytime sleepiness, nighttime awakenings, routines, sleep-disordered breathing, quality of sleep, and other non-specific concerns. The Sleep Disturbance Scale for Children (SDSC) and ADHD Rating Scale-IV were also administered.

The study has several limitations, including the absence of a control group and a small sample size. Additionally, medication use was not controlled, and there was no distinction made between anemic and non-anemic individuals with iron deficiency, nor between maternal and paternal family histories. Future research should explore the causes of iron deficiency. Inadequate nutrition, inflammation, and malabsorption were listed as potential contributors to iron deficiency.

Findings associated with other psychiatric disorders, including autism, were also shared in the study and can be found here.

Sources

¹ Ipsiroglu, O.S., Pandher, P.K., Hill, O., McWilliams, S., Braschel, M., Edwards, K., Friedlander, R., Keys, E., Kuo, C., Lewis, M.S., et al. (2024). Iron deficiency and restless sleep/wake behaviors in neurodevelopmental disorders and mental health conditions. Nutrients, 16(18):3064. https://doi.org/10.3390/nu16183064

² Sung, V., Hiscock, H., Sciberras, E., Efron, D. (2008). Sleep problems in children with attention-deficit/hyperactivity disorder: prevalence and the effect on the child and family. Arch Pediatr Adolesc Med, 162(4):336–342. https://doi.org/10.1001/archpedi.162.4.336

Heavy social media use and poor sleep quality can alter brain activity related to executive function and reward processing in adolescents, suggest findings from the American Academy of Sleep Medicine (AASM) presented last month at the SLEEP 2024 annual meeting.

The findings demonstrate a strong correlation between greater social media use, shorter sleep duration, and lower activity in the inferior and middle frontal gyrus regions in the prefrontal cortex of adolescents ages 10 to 14. The inferior frontal gyrus brain region influences inhibitory control; weakness in this region may impact how teens assess and respond to social media’s rewarding stimuli. The middle frontal gyrus region is tied to executive function and decision-making, impacting how teens balance the immediate dopamine hits of social media with other priorities, like sleep. AASM researchers analyzed data from the Adolescent Brain Cognitive Development Study of 6,516 adolescents for the study.

Prior research established a link between poor sleep hygiene and social media engagement. A 2022 survey from the AASM found that 93% of Gen Z members (people born between the late 1990s and early 2010s) have lost sleep by staying up “past their bedtime” to view or participate in social media.

Poor sleep quality due to excessive screen time is especially concerning for adolescents with ADHD since they spend more time on digital media and have more severe symptoms of problematic internet use compared to youth without ADHD.¹

“Among teens, high-frequency use of multiple forms of modern digital media (texting, visiting social media platforms, streaming videos, etc.) is associated with increased odds of ADHD symptom occurrence,” said Jeremy Edge, LPC, IGDC, during the ADDitude webinar “Addictive Technology and Its Impact on Teen Brains.”²

Poor Sleep Hygiene May Lead to Cannabis Use in Teens with ADHD

Some teens and young adults with ADHD use cannabis as a sleep aid, despite research showing that neurodivergent teens face an outsized risk for developing cannabis use disorder.³

“Cannabis is an unsurprising motivator given the extraordinarily high prevalence of sleep problems and disturbances associated with ADHD, from sleep apnea and insomnia to delayed sleep phase disorder and more,” Mariely Hernandez, Ph.D., explained during the ADDitude webinar “How Cannabis Use Affects ADHD Symptoms and Sleep in Adolescents.” ⁴

“In the short term, cannabis can help with sleep,” Hernandez continued. “But frequent cannabis use builds up tolerance; more and more of it is required to exert the same effect on sleep. Ultimately, chronic cannabis use only worsens sleep and feeds a vicious cycle. ⁵ Poor sleep increases cravings for cannabis and dampens the cognitive resources that allow an individual to resist cravings, make better choices, and curb impulsivity.”⁶

Sleep Hygiene Tips for ADHD Teens

Sleep interventions may help teens with ADHD improve their sleep quality and maintain a healthy relationship with social media. The AASM recommends that adolescents do the following:

• Get 8 to 10 hours of sleep per night.
• Disconnect from devices at night. Turn off all electronics at least 30 minutes before bedtime.
• Follow a relaxing nighttime routine. Take a warm bath or shower, read, or journal to help wind down.
• Leave phones in another room. Remove the temptation to get on the phone by keeping it in a separate room at night. If phones are used as a morning alarm, consider using an alarm clock instead.
• Turn off push notifications. If phones must be in bedrooms at night, turn off push notifications and sound to avoid phone usage.
• Set time limits on social media. Many phones and apps allow users to activate limits that notify them when they have reached their designated time amount on a site.
• Have a sleep schedule. Go to bed and get up at the same time. Don’t let scrolling stop you from getting precious hours of sleep.

Sources

¹ Werling, A. M., Kuzhippallil, S., Emery, S., Walitza, S., & Drechsler, R. (2022). Problematic Use of Digital Media in Children and Adolescents with a Diagnosis of Attention-Deficit/Hyperactivity Disorder Compared to Controls. A Meta-Analysis. Journal of Behavioral Addictions, 11(2), 305–325. https://doi.org/10.1556/2006.2022.00007

² Ra, C. K., Cho, J., Stone, M. D., De La Cerda, J., Goldenson, N. I., Moroney, E., Tung, I., Lee, S. S., & Leventhal, A. M. (2018). Association of Digital Media Use With Subsequent Symptoms of Attention-Deficit/Hyperactivity Disorder Among Adolescents. JAMA, 320(3), 255–263. https://doi.org/10.1001/jama.2018.8931

³ Zaman, T., Malowney, M., Knight, J., & Boyd, J. W. (2015). Co-Occurrence of Substance-Related and Other Mental Health Disorders Among Adolescent Cannabis Users. Journal of Addiction Medicine, 9(4), 317–321. https://doi.org/10.1097/ADM.0000000000000138

⁴ Hernandez, M., & Levin, F. R. (2022). Attention-Deficit Hyperactivity Disorder and Therapeutic Cannabis Use Motives.The Psychiatric Clinics of North America, 45(3), 503–514. https://doi.org/10.1016/j.psc.2022.05.010

⁵ Kaul, M., Zee, P. C., & Sahni, A. S. (2021). Effects of Cannabinoids on Sleep and their Therapeutic Potential for Sleep Disorders. Neurotherapeutics: The Journal of the American Society for Experimental NeuroTherapeutics, 18(1), 217–227. https://doi.org/10.1007/s13311-021-01013-w

⁶ Graupensperger, S., Fairlie, A. M., Ramirez, J. J., Calhoun, B. H., Patrick, M. E., & Lee, C. M. (2022). Daily-Level Associations Between Sleep Duration and Next-Day Alcohol and Cannabis Craving and Use in Young Sdults. Addictive Behaviors, 132, 107367. https://doi.org/10.1016/j.addbeh.2022.107367

What’s sleep got to do with cannabis use? A whole lot.

Many teens and young adults with ADHD turn to cannabis to help them sleep, an unsurprising motivator given the extraordinarily high prevalence of sleep problems and disturbances associated with ADHD, from sleep apnea and insomnia to delayed sleep phase disorder and more.¹

In the short term, cannabis can help with sleep. But frequent cannabis use builds up tolerance; more and more of it is required to exert the same effect on sleep. Ultimately, chronic cannabis use only worsens sleep and feeds a vicious cycle.² Poor sleep increases cravings for cannabis³ and dampens the cognitive resources that allow an individual to resist cravings, make better choices, and curb impulsivity. Insomnia, a common symptom of cannabis withdrawal, can drive further cannabis use.

Another potential outcome of chronic cannabis use? Dependence. Youth with ADHD — a group that may be far more likely to use cannabis daily to try to get some shut-eye because of condition-related sleep issues — are at greater risk for developing cannabis use disorder compared to neurotypical peers.⁴

[Take This Self-Test: Symptoms of Substance Use Disorder]

So what can be done? Improving sleep may be key to curbing cannabis use and even increasing adherence to substance use treatment.

A Primer on Sleep Interventions

First, assess the following dimensions of sleep quality in adolescent patients with ADHD. Developed by Dr. Daniel Buysse, the RuSATED acronym can be used to recall elements of multidimensional sleep health:

• Regularity — does the patient go to bed and get up around the same time daily?
• Satisfaction — does the patient feel well-rested after sleep?
• Alertness — how alert or sleepy is the patient during the day?
• Timing — does the patient feel sleepy/fall asleep around the same time regularly?
• Efficiency — how much time in bed is spent sleeping?
• Duration — How many hours of sleep does the patient get, including naps?

Next, consider the following sleep interventions for improving one or more dimensions of sleep quality:

• Sleep hygiene education
• Cognitive behavioral therapy for insomnia
• Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C)
• Chronotherapy (light therapy)
• Brief Behavioral Treatment of Insomnia (BBTI)

[Read: Sleep Problems in Teens with ADHD — Causes and Solutions]

A benefit of behavioral sleep interventions is that they can be started immediately, even as the patient is still using cannabis. It may not take long to see incremental results. In addition to using these interventions, properly treating ADHD and other comorbid conditions that impact sleep and functioning is crucial. Patients may be less motivated to use cannabis if underlying causes of sleep problems are effectively treated.

Anxiety and pain may be other motivators of cannabis use, so be sure to inquire about other reasons your patient may be using. Pharmacologic or behavioral interventions to treat these concerns can be part of your patient’s treatment plan alongside reducing cannabis use.

Cannabis and Sleep for ADHD Adolescents: Next Steps

• Free Download: Sleep Disorders Linked to ADHD
• Read: How to Treat a Teen Self-Medicating ADHD and Anxiety with Marijuana
• Read: How to Fall Asleep with a Rowdy, Racing ADHD Brain

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “How Cannabis Use Affects ADHD Symptoms and Sleep in Adolescents” [Video Replay & Podcast #504] with Mariely Hernandez, Ph.D., which was broadcast on May 7, 2024.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹ Hernandez, M., & Levin, F. R. (2022). Attention-Deficit Hyperactivity Disorder and Therapeutic Cannabis Use Motives. The Psychiatric clinics of North America, 45(3), 503–514. https://doi.org/10.1016/j.psc.2022.05.010

² Kaul, M., Zee, P. C., & Sahni, A. S. (2021). Effects of Cannabinoids on Sleep and their Therapeutic Potential for Sleep Disorders. Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics, 18(1), 217–227. https://doi.org/10.1007/s13311-021-01013-w

³ Graupensperger, S., Fairlie, A. M., Ramirez, J. J., Calhoun, B. H., Patrick, M. E., & Lee, C. M. (2022). Daily-level associations between sleep duration and next-day alcohol and cannabis craving and use in young adults. Addictive behaviors, 132, 107367. https://doi.org/10.1016/j.addbeh.2022.107367

⁴ Zaman, T., Malowney, M., Knight, J., & Boyd, J. W. (2015). Co-Occurrence of Substance-Related and Other Mental Health Disorders Among Adolescent Cannabis Users. Journal of addiction medicine, 9(4), 317–321. https://doi.org/10.1097/ADM.0000000000000138

The increasing decriminalization of cannabis and cannabis-derived products has resulted in greater access to the drug and has reduced perceptions of harm related to frequent cannabis use. These factors are related to escalation of and frequent cannabis use. Despite the limited, federally approved medical uses for cannabis-derived products, cannabis is perceived to be relatively harmless, and to improve insomnia and ADHD symptoms. However, individuals with ADHD may be more vulnerable to developing problematic cannabis use than their neurotypical peers due to ADHD-related traits.

This webinar will examine the research on risks and benefits of cannabis-derived products, specifically regarding how it relates to sleep and ADHD. Sleep is a frequent motive and may be a driver of daily cannabis use. This webinar also will discuss the role of sleep health and substance use, the challenges of communicating these findings to youth who are at greatest risk, and some harm-reduction strategies for engaging youth in reducing drug use.

In this webinar, you will learn about:

• Effects of infrequent and frequent cannabis use on cognition
• Risks of frequent cannabis use among ADHD youth today
• Sleep disturbances in ADHD, cannabis use motives, and how frequent cannabis use affects sleep health over time
• Strategies to improve sleep health and engage youth in reducing problematic cannabis use

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Substance Use Disorder and ADHD: More Resources

• Download: Sleep Disorders Linked to ADHD
• Get: The Parents’ Guide to Raising a Teen with ADHD
• Learn: SUD Risk Is Elevated by ADHD
• Q&A: “My Teen is Smoking Marijuana and Changing Before My Eyes. What Do I Do?”

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Meet the Expert Speaker

Mariely Hernandez, Ph.D., is a clinical psychologist and a Postdoctoral Research Fellow in the Division on Substance Use Disorders at Columbia University Medical Center. After completing her undergraduate degree in Neuroscience & Behavior at Columbia College, Dr. Hernandez pursued a master’s in general psychology and researched mood disorders in pediatric and adult populations for 7 years before shifting her focus to research of ADHD and substance use risk during her doctoral studies at the CUNY Graduate Center.

She also runs a part-time private practice, specializing in helping adults with ADHD thrive. Identifying as part of the ADHD community herself, Dr. Hernandez is also a mother to two very active boys, one recently diagnosed with ADHD.

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DSPS is often mistaken for insomnia and poor sleep hygiene. But initiating and staying asleep actually comes easily for those with DSPS, as does waking up, so long as it lines up with their body’s natural sleep-wake times. Those with DSPS may also have poor sleep hygiene, but challenges falling asleep at socially conventional times may still occur even with healthier habits because of underlying circadian rhythm differences.

DSPS is linked to other conditions, including depression and attention deficit hyperactivity disorder (ADHD).^{1 2}

Clinicians use sleep diaries, sleep tests, and actigraphy devices (usually a wrist device that monitors sleep) to diagnose DSPS and rule out other sleep disorders. Treatment for DSPS comprises light exposure therapy, melatonin supplements, and sleep-wake time adjustments.

Answer the questions below to see if you may be showing signs of delayed sleep phase syndrome. Share your results with your doctor.

This self-test, drafted by ADDitude editors, is informed by criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This self-test is designed to screen for the possibility of delayed sleep phase syndrome, and it is intended for personal use only. This self-test is not intended as a diagnostic tool.

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Delayed Sleep Phase Disorder: Next Steps

• Subscribe to ADDitude magazine
• Free Download: Sleep Disorders Linked to ADHD
• Guide: How to Sleep Better
• Read: What Comes First — ADHD or Sleep Problems?

Sources

¹ Murray, J. M., Sletten, T. L., Magee, M., Gordon, C., Lovato, N., Bartlett, D. J., Kennaway, D. J., Lack, L. C., Grunstein, R. R., Lockley, S. W., Rajaratnam, S. M., & Delayed Sleep on Melatonin (DelSoM) Study Group (2017). Prevalence of Circadian Misalignment and Its Association With Depressive Symptoms in Delayed Sleep Phase Disorder. Sleep, 40(1), 10.1093/sleep/zsw002. https://doi.org/10.1093/sleep/zsw002

² Bijlenga, D., van der Heijden, K. B., Breuk, M., van Someren, E. J., Lie, M. E., Boonstra, A. M., Swaab, H. J., & Kooij, J. J. (2013). Associations between sleep characteristics, seasonal depressive symptoms, lifestyle, and ADHD symptoms in adults. Journal of attention disorders, 17(3), 261–275. https://doi.org/10.1177/1087054711428965

DSPS and ADHD: Key Takeaways

• Delayed sleep phase syndrome is a sleep disorder that disrupts one’s ability to sleep and wake and conventional times. DSPS is commonly seen with ADHD.
• DSPS is frequently misdiagnosed or overlooked in individuals with ADHD, leading to ineffective treatments and continued sleep disturbances.
• Proper treatment of DSPS comprises specialized approaches like light therapy and melatonin supplementation, which aim to regulate the internal body clock and improve sleep quality.

Sleep disorders and related issues often appear alongside ADHD, but we have yet to “wake up” to the relationship between ADHD and delayed sleep phase syndrome (DSPS) – a type of circadian rhythm sleep disorder. In fact, DSPS is quite common in individuals with ADHD but is seldom recognized, often brushed off as poor sleep hygiene or another sleep disorder.

When DSPS goes unrecognized or misdiagnosed, it can wreak havoc on ADHD symptoms and seriously disrupt quality of life. Accurate identification of DSPS – a treatable condition – is essential, as conventional approaches to manage sleep problems are often inadequate or ineffective for this sleep disorder.

What Is Delayed Sleep Phase Syndrome (DSPS)?

DSPS is characterized by significant difficulty falling asleep and waking up at socially conventional times. As a circadian rhythm sleep disorder, DSPS affects the internal body clock, causing individuals to naturally sleep and wake several hours later (usually more than two hours later) than most people.

According to the American Academy of Sleep Medicine², DSPS symptoms and characteristics include the following:

• difficulty getting to sleep at a desired time
• a relatively consistent, albeit delayed, time of sleep onset each night
• relatively unbroken sleep once initiated
• difficulty waking at a desired time
• an inability to correct delayed sleep-wake patterns by scheduling sleep and wake times

[Symptom Test: Could You Have Delayed Sleep Phase Syndrome?]

Many individuals with DSPS, feeling completely alert and energized during normal sleeping hours, will stay up very late engaging in various activities (and often getting a lot of artificial light exposure, which further affects circadian rhythm). They’ll often go to bed in the early hours of the morning, when sleepiness finally sets in.

Other individuals with DSPS will go to bed at socially conventional times, only to lie awake in the dark for hours, waiting to fall asleep. They are alert and restless not because of anxiety or a racing mind that can’t shut off; they are awake because their brain and body are physiologically unready for sleep.

No matter what nighttime looks like, the result for those with DSPS is often a short sleep window, as obligations like work and school await in the morning – at normal hours. That’s why waking up is extremely difficult for these individuals, who often have to force themselves awake with multiple alarms or even with the help of another person. Once up, these reluctant risers – sleep deprived and with their brain still half asleep – feel awful.

But when individuals with DSPS get a chance to sleep in on weekends and during vacations, they usually wake up feeling refreshed and ready to go. Some people with DSPS, whether they know they have this condition or not, will structure their lives around their later sleep cycle, which can work if they have a flexible study or work schedule. For the most part, though, a delayed sleep cycle leads to significant impairment. Individuals who adopt a completely reversed sleep cycle, sleeping during the day and staying awake all night, often have additional mental health problems and functional impairments.

[Get This Free Download: Sleep Disorders Linked to ADHD]

Delayed Sleep Phase Syndrome and ADHD

As clinical psychologists who work with adults with ADHD, we are surprised by how often we see DSPS in our clients – and how many of them have never heard of it. Many have tried to seek help for their sleep-wake problems, only to be misdiagnosed and put on the wrong kind of strategies and treatment (like sleeping pills). Understandably, these clients continue to experience significant sleep problems that affect overall functioning.

DSPS vs. Bedtime Procrastination

DSPS, we have found, is often mistaken for bedtime procrastination, or the deliberate delay of one’s bedtime in favor of other activities, like scrolling through social media, streaming a new television series, and other (often dopamine-boosting) activities that keep the brain alert. With ADHD’s dopamine- and self-regulation challenges, it’s easy to assume that bedtime procrastination is the sole reason for problems sleeping and waking up at normal times. Further complicating matters are time-management and organization challenges brought on by ADHD that can also make it difficult to get to bed and wake up at reasonable hours.

While DSPS can occur with bedtime procrastination, the key here is that those simply engaging in bedtime procrastination are likely able to fall asleep at socially conventional times, but resist doing so. They likely feel sleepy as they’re engaging in bedtime procrastination, or, if they’re not sleepy, they’ll readily fall asleep once the stimuli keeping them up is removed. Individuals with DSPS, on the other hand, are not able to sleep at socially conventional times, even under the best sleep conditions, because of circadian rhythm differences.

DSPS vs. Insomnia

Due to superficial similarities, DSPS is frequently mislabeled as insomnia, a type of sleep disorder characterized by difficulty falling or staying asleep and/or poor sleep quality. Insomnia can co-occur with DSPS, and it’s often seen with ADHD, too.

Individuals experiencing insomnia will report trouble initiating sleep, while those with DSPS will have trouble initiating sleep at conventional, socially normal times. Falling asleep actually comes easily for those with DSPS when it aligns with their internal clock, even if that’s several hours later than what’s considered normal. Additionally, staying asleep isn’t an issue for those with DSPS, but it often is for those with insomnia.

Delayed Sleep Phase Syndrome: Treatments

Talk to your doctor or a sleep specialist if you suspect that your sleep problems are due to DSPS. A proper diagnosis is critical, as DSPS has its own distinct physiological component that needs to be treated directly. Managing DSPS requires knowledge of circadian physiology, as effective interventions for this sleep disorder target the internal clock.

Standard interventions for sleep difficulties (like those recommended for insomnia), such as sleep hygiene, sleep restriction, and stimulus control strategies, as well as sedative medication, are unlikely to be effective for individuals with DSPS.

Understanding Circadian Rhythm: A Primer on the Importance of Light and Dark

Many bodily and behavioral processes – from sleepiness and alertness to core body temperature fluctuations – follow a predictable 24-hour cycle. Ideally, the body’s internal timekeeper is reset each morning with exposure to light. Without enough morning light, the sleep-wake cycle may gradually drift later and later each day, decoupling from the day-night cycle.

Darkness also influences circadian rhythm, as it triggers the secretion of melatonin, a hormone that facilitates a drop in core body temperature and prepares the body to sleep (and stay asleep). Bright light in the evening, even low levels, suppresses melatonin production, which has the effect of pushing off sleep and delaying circadian rhythm. Treating DSPS, therefore, centers heavily on careful timing of light and dark exposure.

Delayed Sleep Phase Syndrome Treatment: Light Therapy

Light therapy for DSPS involves increasing exposure to bright light after waking up and reducing light exposure as much as possible before bed — along with gradually shifting sleep-wake times — to regulate the internal clock.

Under this intervention, bright light exposure should occur within two hours of natural waking time*, and for at least 30 minutes. Exposure to unfiltered daylight is best; even light exposure on an overcast day is better than indoor lighting, which is rarely bright enough to get a circadian effect. A morning walk for light exposure is ideal for strengthening and calibrating the circadian rhythm, but light exposure devices, like wearable LED light visors (the modern-day equivalent of light boxes),  are also helpful. Potential side effects of light therapy include eye strain and headaches.³

*An important note: If you wake up within six hours of falling asleep (either naturally or forced) you will need to delay light exposure to avoid delaying your body clock even more. This has to do with core body temperature, which reaches its lowest point about six hours after sleep onset. Light exposure after the six-hour point promotes earlier sleep onset and waking. Light exposure before this point does the opposite.

If you normally fall asleep at 3 a.m., for example, light exposure should not happen until after 9 a.m. But if rising before 9 a.m. is unavoidable, avoid sunlight (keep the curtains closed) and turn off or keep artificial light sources dim. If you must be outside before 9 a.m., wear sunglasses and a hat and try to avoid direct sunlight.

To augment light therapy, avoid light exposure before and during sleep to prevent melatonin suppression. Dim the lights and avoid looking at screens two hours before bedtime to assist natural melatonin production. If this is not feasible, install a blue light filter on your device, or don eyewear with orange lenses. Wear a sleep mask or install blackout curtains to make your sleep environment as dark as possible.

The final component of light therapy is gradually shifting bedtime and rise time 15 minutes earlier each day, with the goal of adjusting your internal clock to sleep and wake at normal times. It may take a couple of weeks to reach desired sleep-wake times; after this point, (relaxed) maintenance is key in the form of fairly consistent rise times and morning light exposure times on most days.

Delayed Sleep Phase Syndrome Treatment: Melatonin

Talk to your doctor about taking melatonin to manage DSPS, as carefully timed melatonin administration can aid in shifting circadian rhythm.⁴ For optimal circadian shifting, take melatonin about six hours before your natural sleep onset. For example, if you typically fall asleep at around 3 a.m., take a 3 mg dose of melatonin at about 9 p.m. As your sleep phase shifts earlier, adjust the timing of melatonin intake accordingly. Once you’ve reached your desired sleep time, help maintain it by taking a lower dose (1-2 mg) of melatonin two hours before bedtime. Be sure to discuss any changes to your melatonin use with your health provider.

Delayed Sleep Phase Syndrome: Next Steps

• Free Download: How to Sleep Better with ADHD
• From WebMD: What Are Circadian Rhythm Disorders?
• Read: Your ADHD Brain Needs More Sleep — How to Get It
• Read: Seasonal Affective Disorder and the ADHD Brain

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Sources

¹ Coogan, A. N., & McGowan, N. M. (2016). A systematic review of circadian function, chronotype, and chronotherapy in attention deficit hyperactivity disorder. ADHD Attention Deficit and Hyperactivity Disorders, 8(3), 129-147, DOI 10.1007/s12402-016-0214-5.

² American Academy of Sleep Medicine. (2014). International Classification of Sleep Disorders – Third Edition (ICSD-3). Darien, IL: American Academy of Sleep Medicine.

³ Terman M, Terman JS. Light therapy for seasonal and nonseasonal depression: efficacy, protocol, safety, and side effects. CNS Spectr. 2005 Aug;10(8):647-63; quiz 672. doi: 10.1017/s1092852900019611. PMID: 16041296.

⁴ van Andel, E., Bijlenga, D., Vogel, S. W. N., Beekman, A. T. F., & Kooij, J. J. S. (2021). Effects of chronotherapy on circadian rhythm and ADHD symptoms in adults with attention-deficit/hyperactivity disorder and delayed sleep phase syndrome: a randomized clinical trial. Chronobiology International, 38(2), 260-269. doi:10.1080/07420528.2020.1835943

Weighted blankets help children with attention deficit hyperactivity disorder (ADHD) who struggle with sleep disorders by improving both sleep quality and duration, according to a new study published in The Journal of Sleep Research.¹ While the results revealed weighted blankets can be beneficial for all children with ADHD, the effects were particularly notable in children aged 11 to 14 years with inattentive type ADHD.

Specifically, the study found that weighted blankets increased sleep duration by 8 minutes, on average, for all study participants and by 16 minutes, on average, for children aged 11 to 14 with inattentive ADHD. The study also found that children without weighted blankets were awake for three minutes more during the night, on average, than were children with weighted blankets.

Children with ADHD frequently experience a host of sleep problems including difficulty falling asleep, waking throughout the night, daytime sleepiness, and circadian abnormalities. A recent systematic review of research revealed that short sleep duration is linked to ADHD,² and another study found that children with ADHD sleep less overall, compared with children who don’t have ADHD.³

“A lack of sleep can lead to other health problems, including a weakened immune system, a dysregulated appetite and metabolism, and moodiness,” explains Roberto Olivardia, Ph.D., in his ADDitude article “How to Fall Asleep with a Rowdy, Racing ADHD Brain.” “Sleep problems also exacerbate executive functioning skills like memory, concentration, and problem solving, which are already weakened by ADHD.”

Weighted blankets have long been observed to exert a calming effect on adults and children alike, prompting researchers to understand the therapeutic potential of this simple, non-pharmacological intervention to improve the sleep of children with ADHD.

The randomized controlled study included 94 children with ADHD and verified sleep problems, with a mean age of 9, who were sorted into two groups: the first used a weighted blanket for sleep, while the second group used a lighter control blanket. Researchers collected data using actigraphy at 0, 4, and 8 weeks, and they asked parents and children to complete questionnaires as well as a daily sleep diary.

The study found that weighted blankets improved sleep efficiency (percentage of time spent asleep while in bed), as well as total sleep time and waking during the night. The weighted blankets had no effect on the amount of time it took children to fall asleep.

Sleep Disorders in Children with ADHD

In a recent survey of ADDitude readers, 66% of caregivers said that their children with ADHD showed noticeable signs of sleep difficulty from a very early age (under 3). Of those:

• 61% reported frequent night wakings
• 72% reported shorter sleep duration due to difficulty falling asleep

“My son always took upwards of two or three hours to fall asleep, even when exhausted, due to busy brain and intrusive thoughts, which scared him,” says Helena, an ADDitude reader from York. “Even at four years old, he would ask, ‘How do I get my thoughts to stop?’”

“My goal is always to have the kids in bed before 8:30 and I am often chasing them down at 9:30. It often just feels impossible,” shares ADDitude reader Abigail from Michigan. “Then in the morning they do not want to wake up since they haven’t slept nearly enough, and they are often late for school.”

These early sleep problems often persist and may grow more intense through childhood into adulthood, says William Dodson, M.D., in his ADDitude article, “ADHD and Sleep Problems: This is Why You’re Always Tired.” Dodson shares that, in his experience, 10 to 15 percent of pre-pubertal children with ADHD have trouble getting to sleep; by age 12 ½, that number rises to 50% and by the age of 30, more than 70% of people with ADHD report that they spend more than one hour trying to fall asleep.

How to Improve Sleep in Kids with ADHD

Theories that attempt to explain the cause of sleep disturbance in people with ADHD abound, and they include biological, genetic, and behavioral explanations. Regardless of how the sleep problems are understood, Dodson explains: “The remedy usually involves ‘sleep hygiene,’ which considers all the things that foster the initiation and maintenance of sleep. This set of conditions is highly individualized. Some people need absolute silence. Others need white noise, such as a fan or radio, to mask disturbances to sleep.”

The new study confirms that, for many children with ADHD, weighted blankets may be a piece in the sleep hygiene puzzle.

Natasha, an ADDitude reader in Perth, shares that her son had significant difficulty falling asleep, but he was able to find interventions that helped, including a weighted blanket. “He likes having my hand on his tummy; looking back, that was probably the equivalent of his weighted blanket he has now.”

Faith, in Missouri, shares a similar story of sleep onset challenges for her son, and the trial-and-error process that resulted in effective solutions: “We learned he needed darkness, white noise, a routine of songs sung to him, and eventually a modest weighted blanket.”

“Various interventions need to be available in clinical practice to target children’s different needs and purposes for intervention, as the preferences of families struggling with sleep problems may differ” write the authors of the new study. “Weighted blankets can provide an important addition to current sleep intervention practices.”

Sources

¹ Lönn, M., Svedberg, P., Nygren, J., Jarbin, H., Aili, K., & Larsson, I. (2023). The efficacy of weighted blankets for sleep in children with attention-deficit/hyperactivity disorder—A randomized controlled crossover trial. Journal of Sleep Research, e13990. https://doi.org/10.1111/jsr.13990
² Gruber, R., Xi, T., Frenette, S., Robert, M., Vannasinh, P., & Carrier, J. (2009). Sleep disturbances in prepubertal children with attention deficit hyperactivity disorder: a home polysomnography study. Sleep, 32(3), 343–350. https://doi.org/10.1093/sleep/32.3.343
³ Lee, S. H., Kim, H. B., & Lee, K. W. (2019). Association between sleep duration and attention-deficit hyperactivity disorder: A systematic review and meta-analysis of observational studies. Journal of Affective Disorders, 256, 62–69. https://doi.org/10.1016/j.jad.2019.05.071

SLEEP: What sleep disorders commonly co-occur with ADHD in children?

A: In one study, about half the parents said their child with ADHD had difficulty sleeping. They said their child felt tired when they woke up, had nightmares, or had… | Keep reading on ADDitude »

SPD: What distinguishes ADHD from sensory processing disorder?

A: Both disorders will make you restless and unable to concentrate. You could also find it hard to control your emotions. Children might have frequent meltdowns… | Keep reading on ADDitude »

EATING DISORDERS: What distinguishes eating disorders from ADHD?

A: For individuals with bulimia nervosa, food is self-medication for anxiety, stress, anger, and boredom. Eating is stimulating, and food fills the gap. People with ADHD who… | Keep reading on ADDitude »

PTSD:  Does trauma increase the likelihood for ADHD in children, and vice versa?

A: ADHD is a largely genetic condition that impacts specific areas of the brain. Because trauma affects those same areas of… | Keep reading on ADDitude »

BFRB: What body-focused repetitive behaviors common co-occur with ADHD in children?

A: Recent studies suggest that 20 to 38 percent of children with trichotillomania also meet the criteria for ADHD. Available prevalence rates are few, but they suggest that… | Keep reading on ADDitude »

TRAUMA: What should I know about the impact of trauma and stress on developing brains?

A: Under stress and exposure to trauma, the brain effectively enters survival mode. It funnels more fuel and resources into the limbic system and diverts them away from the prefrontal cortex… | Keep reading on ADDitude »

FIRST-PERSON: “Sometimes, Raising My Sensitive Child Was Hell”

“Baths, sounds, clothing textures, food textures, naptime, bedtime — almost every daily routine set off meltdowns that made our daily life hell. I called them tantrums, but looking back, they were much more than that. My thought every day was ‘just get through it.'” | Keep reading on ADDitude »

RELATED RESOURCES

SYMPTOM TEST: Sensory Processing Disorder in Children

SPD interferes with the body’s ability to interpret sensory messages from the brain, and may manifest as meltdowns or anxiety. | Take the self-test on ADDitude »

SYMPTOM TEST: Eating Disorders in Children and Teens

Does your child express concerns about their body size? Feel guilty after eating? | Take the self-test on ADDitude »

8-Part Guide to ADHD Diagnosis in Children:

Q 1: How can I better understand ADHD, its causes, and its manifestations?
Q 2: How can I understand the aspects of ADHD that might be new to the doctor?
Q 3: How can I improve the odds of an accurate ADHD evaluation for my child?
Q 4: How can I find a professional to diagnose and treat my child’s ADHD?
Q 5: What should a thorough evaluation for pediatric ADHD include and exclude?
Q 6: How can I be sure my child’s evaluation screens for psychiatric comorbidities?
Q 7: How can I be sure my child’s evaluation considers look-alike comorbidities?
> Q 8: Should my child be screened for the sleep, eating, and other disorders?

SLEEP: What distinguishes sleep disorders from ADHD?

A: If you feel tired, your ADHD symptoms get worse, and that makes it harder to sleep the next night. This cycle repeats… | Keep reading on ADDitude »

EATING DISORDERS: What distinguishes eating disorders from ADHD?

A: Many people with ADHD have poor impulse control and emotional regulation. This combination sets the stage for binge eating… | Keep reading on ADDitude »

MEMORY LOSS: What distinguishes cognitive decline (memory impairment) from ADHD?

A: If you have ADHD, forgetfulness is something you’ve dealt with your whole life. But maybe your memory problems are starting to feel different… | Keep reading on ADDitude »

BPD: What distinguishes borderline personality disorder from ADHD?

A: People with BPD experience chronic instability — in their emotions, behaviors, relationships, and sense of self… | Keep reading on ADDitude »

BFRB: What distinguishes body-focused repetitive behaviors from ADHD?

A: BFRBs are intense urges like biting, picking, and pulling that can cause damage. As many as 1 in 20 people have a BFRB… | Keep reading on ADDitude »

ASPD: What distinguishes antisocial personality disorder from ADHD?

A: ADHD and ASPD share symptoms linked with being impulsive that might make you confuse one with another… | Keep reading on ADDitude »

FIRST-PERSON: “My ADHD Was Obscured by Comorbidities”

“I was diagnosed with anxiety disorder, major depression, and OCD. When I finally got my ADHD diagnosis nine years later and went on medication, almost all my problems with depression and anxiety disappeared.” | Keep reading on ADDitude »

RELATED RESOURCES

SYMPTOM TEST: Eating Disorders in Adults

Do you struggle with your body image? Feel out of control around food or feel guilty after eating? | Take the self-test on ADDitude »

SYMPTOM TEST: Borderline Personality Disorder in Adults

How do your behaviors compare to those of this Cluster B personality disorder? | Take the self-test on ADDitude »

8-Part Guide to ADHD Diagnosis in Adults:

Q 1: How can I better understand ADHD, its causes, and its manifestations?
Q 2: How can I understand the aspects of ADHD that might be new to my doctor?
Q 3: How can I improve my odds of an accurate ADHD evaluation?
Q 4: How can I find a professional to diagnose and treat my ADHD?
Q 5: What should a thorough evaluation for adult ADHD include and exclude?
Q 6: How can I be sure my ADHD evaluation screens for psychiatric comorbidities?
Q 7: How can I be sure my ADHD evaluation considers look-alike comorbidities?
> Q 8: Should I also be screened for the sleep, eating, or other disorders?

Adults with ADHD rarely fall asleep easily, sleep soundly through the night, and wake up feeling refreshed.

The reasons for these sleep challenges are numerous — everything from faulty circadian rhythm and neurological abnormalities to engaging in common ADHD behaviors like overstimulating activities late at night.

Sleep disorders like sleep apnea, restless leg syndrome, and delayed sleep phase syndrome (DSWPD) are common in adults with ADHD. They can also exacerbate ADHD symptoms and lead to health problems, such as a weakened immune system, a dysregulated appetite and metabolism, and moodiness.

In this download, you will learn the following:

• How to distinguish between obstructive sleep apnea, restless leg syndrome, and delayed sleep-wake syndrome
• Symptoms of sleep disorders
• What to do if you are experiencing sleep disturbances
• Treatment options to help you fall asleep
• And more!

NOTE: This resource is for personal use only.

The Clinicians’ Guide to Differential Diagnosis of ADHD is a clinical compendium from Medscape, MDEdge, and ADDitude designed to guide health care providers through the difficult, important decisions they face when evaluating pediatric and adult patients for ADHD and its comorbid conditions. This guided email course will cover the following topics:

• DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
• DECISION 2: What do I need to understand about ADHD that is not represented in the DSM?
• DECISION 3: How can I avoid the barriers and biases that impair ADHD diagnosis for underserved populations?
• DECISION 4: How can I best consider psychiatric comorbidities when evaluating for ADHD?
• DECISION 5: How can I differentiate ADHD from the comorbidities most likely to present at school and/or work?
• DECISION 6: How can I best consider trauma and personality disorders through the lens of ADHD?
• DECISION 7: What diagnostic criteria and tests should I perform as part of a differential diagnosis for ADHD?

NOTE: This resource is for personal use only.

Early childhood sleep problems, including irregular sleep routines, short nighttime sleep duration, and frequent night awakenings, correlate with subsequent ADHD diagnoses, according to research published in the Journal of Child Psychology and Psychiatry. ¹

Researchers conducted an observational review of the Avon Longitudinal Study of Parents and Children (a U.K. birth cohort study), which included 7,769 10-year-old children (49.6% girls; 50.4% boys). Participants’ parents assessed their children’s sleep habits at age 3.5, answering questions such as ‘Does your child have regular sleep routines?’ ‘How long does your child sleep during the day?’ and ‘How often during the night does your child usually wake?’ Researchers calculated nighttime sleep durations from questions asking what time (to the nearest minute) the child ‘normally’ went to sleep in the evening and woke up in the morning. Findings showed that short nighttime sleep durations, frequently waking up in the middle of the night, and irregular sleep routines increased the toddler’s risk of receiving an ADHD diagnosis at age 10. (Researchers used the Development and Wellbeing Assessment to identify children with ADHD.)

Prior studies have identified sleep disturbances as a common comorbid condition with ADHD ² and found that 70% to 85% of children with ADHD experience sleep problems.³ However, researchers said this is the first longitudinal study that “specifically investigated the prospective association between inflammation, sleep, and ADHD.”

“These results highlight the potential of future preventative interventions in ADHD, with the novel target of sleep and inflammation,” they said.

Sleep Problems Comorbid with ADHD

The study’s findings mirror those of a recent ADDitude poll, which found that 66% of participants noticed sleep problems in their children with ADHD at age 3 or younger.

“As an infant, my daughter was a horrible sleeper,” said a reader from Colorado. “She almost never napped for more than 20 to 30 minutes. She woke up several times throughout the night until she was 18 months old. She’s 7 now and still has trouble falling asleep without melatonin. Even with melatonin, she’ll wake up after a couple of hours.”

Said another respondent, “Our son has fought sleep since infancy. He has always tried to stay awake as long as possible. He often has disrupted sleep and does not want to return to sleep, even at midnight.”

“She would wake up every two hours and then be ready to party for two hours,” said a panelist from Maryland. “It was absolutely exhausting. At age 1, she finally started to sleep more consistently but continued to wake up very early (before 5 a.m.).”

Sleep Problems in Early Childhood

Reader panelists indicated the following early childhood sleep problems in their children who were later diagnosed with ADHD:

• Shorter nighttime sleep due to difficulty falling asleep: 71.63%
• Frequent waking during the night: 60.58%
• Shorter nighttime sleep due to waking up very early: 44.71%
• Inconsistent bedtime routine: 25.96%

Sleep problems persisted for some panelists’ children as they aged. “Both of my kids took forever to fall asleep,” said a panelist from Wisconsin. “By the time my son started daycare at four months old, I could not get him to nap. One of us still lies with our kids at night; we usually fall asleep and spend the night in their beds. They are now ages 8 and 5 (both have ASD along with ADHD), and there is no end in sight.”

“My child seemed to need less sleep from the beginning,” said another parent. “As an infant, she often woke up in the middle of the night and was wide awake for quite some time. She took very short naps and gave up napping very early on. As she got older, we had to put an alarm on her door because she would go out in the garage during the winter or climb on kitchen counters looking for candy in the middle of the night.”

ADHD Sleep Solutions

Creative thinking, natural supplements, and medication helped some ADDitude readers’ children get to sleep. “There were a lot of ‘midnight snack’ escapades and much wandering around the house,” said a panelist from Georgia. “We made an approved snack drawer for her and gave her a flashlight, books, coloring books, etc., so she could do what she needed and stay in her room.”

A Michigan panelist said, “We were militant about sleep hygiene, diet, screens, etc., and it did not make a difference. Even lots of exercise wasn’t the answer. We finally had to use clonidine. It was like a miracle. My now 13-year-old is off clonidine with a ‘normal’ sleep routine.”

“My child began having difficulty falling asleep at six months,” a panelist from Virginia said. “Melatonin is a staple in our household. Just like you know, if you forgot your child’s ADHD medication on a Saturday morning, you also know when they haven’t had their melatonin!”

A North Carolina parent turned her son’s insomnia into a positive. “My oldest had a terrible time going to sleep,” she said. “Early on, I found ‘go to sleep’ meant nothing, so switched to ‘Lie down and be still and quiet;’ that was something he could do (even if it didn’t lead to immediate sleep). I read to him at length at night — and through middle school. It became a close sharing time and a chance to read some really good books.”

Sources

¹Morales-Muñoz, I., Upthegrove, R., Lawrence, K., et al. (2023). The Role of Inflammation in the Prospective Associations Between Early Childhood Sleep Problems and ADHD at 10 years: Findings from a UK Birth Cohort Study. J Child Psychol Psychiatry. https://doi.org/10.1111/jcpp.13755

²Bondopadhyay, U., Diaz-Orueta, U., and Coogan, A.N. (2022). A Systematic Review of Sleep and Circadian Rhythms in Children with Attention Deficit Hyperactivity Disorder. Journal of Attention Disorders. https://doi.org/10.1177/1087054720978556

³Yürümez, E., and Kılıç, B.G. (2013). Relationship Between Sleep Problems and Quality of Life in Children with ADHD. Journal of Attention Disorders. https://doi.org/10.1177/1087054713479666