Sleep problems are common in children, teenagers, and adults with attention deficit hyperactivity disorder (ADHD). The disruptive behavior associated with ADHD can make it harder to fall asleep and stay asleep, and psychostimulant medication can harm sleep, too.
It has been suggested that increasing cases of ADHD are related to increasing rates of sleep deprivation — particularly among children. Since the behavioral symptoms of sleep deprivation are so similar to those of ADHD, researchers are starting to ask whether individuals with ADHD actually may be suffering from a sleep disorder. Some wonder if ADHD is itself a sleep disorder.
The circadian connection
This theory was formally proposed by psychiatry professor Sandra Kooij, founder of the [European Network Adult ADHD, at the European College of Neuropsychopharmacology conference](https://www.ecnp.eu/~/media/Files/ecnp/About ECNP/Press/2017/Kooij pr FINAL_Sunday.pdf) in Paris in 2017. Kooij confirmed that ADHD and sleep problems are closely intertwined, pointing out a number of of associated sleep disorders, including:
The body clock in three quarters of ADHD patients is delayed by as much as one-and-a-half hours, meaning these individuals fall asleep later and typically get less overall sleep. This delay has a huge effect on the body — it influences body temperature, activity levels, and even when we eat our meals. These changes, argue Professor Kooij, can lead to behavioral symptoms associated with ADHD. She suggests it may be possible to treat ADHD by addressing abnormal circadian patterns.
If you suffer from ADHD and have trouble sleeping, you should discuss your concerns with your doctor, particularly if you recognize any of the symptoms of delayed sleep phase syndrome such as:
- Finding it easy to fall asleep in the morning or afternoon but finding it hard to fall asleep at night before 2:00 a.m.
- Finding it hard to wake up early in the morning
- Having no issues falling asleep when you can follow your own schedule (for example, on weekends or vacations)
- Feeling most alert and creative at night
Treating a pre-existing circadian rhythm disorder may help to alleviate ADHD symptoms. A 2017 pilot study published in the Journal of Psychiatric Research found that advancing circadian rhythms through bright light therapy helped reduce ADHD symptoms.
The sleep apnea connection
A 2012 study found that children were significantly more likely to demonstrate behaviors associated with ADHD by the age of seven if they exhibited symptoms of sleep-disordered breathing such as snoring, mouth breathing, and pauses in breathing. In another, from 2006, half the children studied who had been diagnosed with ADHD no longer met the diagnostic criteria for the condition after undergoing a tonsillectomy.
It’s worth reminding ourselves that ADHD affects adults, too. Although the condition often starts in childhood, many cases can persist into adulthood — and research has found that adults with ADHD have more sleep problems than those without ADHD.
Since studies have found a connection between sleep disordered breathing and ADHD symptoms, consider speaking with your doctor if you recognize any of the following symptoms of sleep apnea:
- Loud snoring
- Dry mouth when waking
- Irritability and mood swings
- Feeling tired even after a full night of sleep
So is ADHD a sleep disorder, or not?
ADHD is not currently recognized as a sleep disorder, and the suggestion that it may be one is certainly controversial.
That said, there is no denying that the behavioral symptoms of sleep deprivation can be similar to ADHD symptoms — and that sleep problems are associated with ADHD. More research is needed to fully investigate this link and to determine whether ADHD causes sleep disturbances, or whether sleep disturbances cause ADHD.