The Relationship Between ADHD and Insomnia

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental condition marked by difficulty attending to non-preferred tasks, disorganization, hyperactivity, and impulsive behaviors. People with ADHD can experience primarily inattentive symptoms, primarily hyperactive and impulse-control symptoms, or a combination of both.

Although sleep disturbance is not an official diagnostic criterion for ADHD, many people with this diagnosis also struggle with insomnia as a result of their neurodivergence. How are these conditions related? Why do people with ADHD often have difficulty sleeping? And, if you have ADHD, what can you do to improve the quality of your sleep?

What Does It Mean to Have Insomnia?

Everyone has difficulty sleeping from time to time, but insomnia occurs when there is a pattern of being unable to fall asleep, stay asleep, and/or sleep as late as you would like. You might find yourself lying awake for hours after you go to bed or waking up much earlier than you need to with the inability to fall back asleep. This condition can lead to fatigue, issues concentrating, irritability, and other symptoms.

Insomnia is the most common sleep disorder and second most common mental health condition, with approximately 70 million Americans experiencing insomnia each year and up to 50% of Americans developing insomnia at some point in their lives.

Chronic insomnia can lead to difficulty concentrating, functional impairments, anxiety, depression, and medical conditions. Many individuals with ADHD already experience many of these issues, and insomnia can exacerbate these symptoms.

Why Might Someone with ADHD Have Insomnia?

People with ADHD often struggle with sleep and develop sleep disorders at a much higher rate than the rest of the population.

Several factors contribute to this:

• Circadian Rhythm: Circadian rhythm, also known as the body’s “biological clock,” is our natural sleep and wake cycle. People with ADHD often have a different sleep and wake cycle than people without ADHD, meaning that they may naturally feel more alert or tired at different times. For example, many people with ADHD describe themselves as “night owls” who do their best work late at night. Since we typically expect people to sleep at night and be awake during the day, this forces people with different cycles to go to sleep when their body’s natural rhythm wants them to be awake, causing sleep difficulties.
• Hyper-Focus: People with ADHD have a tendency to hyper-focus on preferred interests and activities, causing them to lose track of time when engaging in these activities. When they are caught up in one of these activities, they may not realize that several hours have passed, and it is very late.
• Time Blindness: Time blindness refers to difficulty correctly processing and sensing the passing of time. Especially during periods of hyper-focus, an individual with ADHD will not notice how much time has passed since they have slept, causing sleep deficits.
• Cognitive Hyperarousal: We often think of hyperactivity from ADHD as running around, fidgeting, or being unable to stay seated. However, some people with ADHD experience cognitive hyperarousal, or racing thoughts and difficulty calming their brains. This can lead to daydreaming, ruminating, and over-thinking when they lie down to go to sleep.

What Are My Options for Treatment?

Fortunately, treatment options exist for insomnia, ADHD, and the overlap of the two conditions. Depending on your unique needs and preferences, you can pursue therapy, medication, or a combination of the two.

Therapy and Medication

Cognitive behavioral therapy has been shown to help individuals with ADHD learn skills to manage time, become more organized, and complete necessary tasks. In addition, a therapist specializing in CBT can help you develop and stick to a healthy sleep schedule. Additionally, Cognitive Behavioral Therapy for Insomnia (CBT-I) can effectively treat sleep issues and has been proven to reduce reliance on medication interventions for sleep.

If appropriate, your physician may prescribe medication to help you fall or stay asleep. These medications are often taken on an as needed basis (for nights that you are struggling to fall asleep), but some might be prescribed for daily use.

How Can I Cope With My Insomnia if I Have ADHD?

Sleep difficulties can be incredibly frustrating. Whether you are having trouble falling asleep, waking up frequently during the night, or getting up earlier than you would like, the exhaustion that comes with not getting enough sleep can have a huge impact on your functioning, work, and relationships.

Revise Your Sleep Routine

If possible, adjust your schedule to accommodate your body’s natural sleep and wake cycle. Forcing your body into a pattern that goes against its natural cycle is an uphill battle. If you are naturally energized at night, it makes sense to change your sleep habits to be active around this time.

One benefit of working from home is that you have more control and flexibility with your work hours, and you might be able to change your sleep schedule to match your body’s needs.

Track Your Sleep

You can also use apps to track the duration and quality of your sleep, helping you identify patterns and habits that help you feel rested and refreshed. These apps often give praise and reinforcement for healthy sleep habits, giving you an extra dose of dopamine when you use them. This is particularly reinforcing to people with ADHD, who are particularly sensitive to the effects of dopamine on the brain.

ADHD can make sleep particularly challenging, but with proper supports, you can get the quality sleep you need to be at your best.