ADHD And Sleep: Problems Or Sleep Disorders?
ADHD And Sleep Problems Are Common
Approximately three in four (75%) of children and adults with attention deficit hyperactivity disorder (ADHD) experience sleep difficulties.
Historically sleep has been considered a separate issue.
However, scientists are now proposing a new theory which suggests that much of ADHD may be caused by inadequate circadian regulation of sleep.
Professor Sandra Kooij, Associate Professor of Psychiatry at VU University Medical Centre in Amsterdam and founder and chair of the European Network Adult ADHD, that first proposed this idea said:
"There is extensive research showing that people with ADHD also tend to exhibit sleep problems. What we are doing here is taking this association to the next logical step: pulling all the work together leads us to say that, based on existing evidence, it looks very much like ADHD and circadian problems are intertwined in the majority of patients.”
Prof. Kooij noted that the disturbance of day and night rhythm results in the disruption of physical processes, not only related to sleeping habits but also to temperature, movement patterns, meal timing, and more.
She commented:
“If you review the evidence, it looks more and more like ADHD and sleeplessness are 2 sides of the same physiological and mental coin."
The Connection Between ADHD and Sleep In People with ADHD
Professor Kooij noted the connections between ADHD and sleep disorders which culminated in the synthesis:
Studies indicate that 75% of individuals living with Attention Deficit Hyperactivity Disorder (ADHD) demonstrate a one-and-a-half hour (1.5hr) delay in their physiological sleep phase when compared to individuals without the disorder. This includes changes in the level of their sleep hormone melatonin and sleep-related movement.
There are delays in core body temperature changes that occur with sleep (related to melatonin production shifts).
Comprehensive research has determined that Attention-Deficit/Hyperactivity Disorder (ADHD) is frequently linked to numerous sleep disorders, including Restless Leg Syndrome, Obstructive Sleep Apnea, and the Circadian Rhythm Sleep Disorder of Delayed Sleep Phase Syndrome.
Individuals with ADHD tend to demonstrate heightened levels of alertness in the evening, a phenomenon that is opposite to what is typically seen in the overall population.
Many of those diagnosed with ADHD who struggle with their sleeping patterns find relief by taking melatonin in the evening, or by using bright light therapy during the morning hours. This approach assists in readjusting the body's internal clock.
Research has revealed that approximately 70% of adults with Attention Deficit Hyperactivity Disorder (ADHD) demonstrate an oversensitivity of the eyes to light. This can lead to prolonged sunglass-wearing during daylight hours, which may further exacerbate the challenges linked to circadian disruption.
Chronic delayed or insufficient sleep can lead to a sustained sleep debt, which has been linked to obesity, diabetes, cardiovascular disease and cancer. Establishing a healthy sleep rhythm may help reduce the risk of these unfavorable health outcomes.
Could ADHD Actually Be A Kind Of Sleep Disorder?
Researchers are now working to confirm this physical-mental association by assessing biomarkers, including Vitamin D levels, glucose content in blood, cortisol levels, 24-hour blood pressure, heart rate variability.
Professor Kooij commented:
“If the connection is confirmed, it raises the intriguing question: does ADHD cause sleeplessness, or does sleeplessness cause ADHD? If the latter, then we may be able to treat some ADHD by non-pharmacological methods, such as changing light or sleep patterns, and prevent the negative impact of chronic sleep loss on health."
Currently stimulant medications are the first-line recommendation to treat ADHD. Could addressing common sleep problems and sleep disorders in patients with ADHD be an alternative?
Professor Kooij commented:
"We don't say that all ADHD problems are associated with these circadian patterns, but it looks increasingly likely that this is an important element."
Further commenting, Professor Andreas Reif (University Hospital, Frankfurt, and leader of the EU CoCA project on ADHD ), who was not involved in the research, remarked:
"A disturbance of the circadian system may indeed be a core mechanism in ADHD, which could also link ADHD to other mental illnesses such as depression or bipolar disorder. But also beyond these pathophysiological considerations, sleep problems and abnormalities of circadian rhythms are a huge problem for many patients, heavily impacting on their social life"
Clinical Comment
We offer treatment for circadian rhythm sleep-wake disorders and delayed sleep phase syndrome is by far the most common circadian rhythm disorder we see in the clinic.
We’ve treated many ADHD patients with delayed sleep phase syndrome and have had good success. A thorough initial assessment is key to differentiating sleep onset insomnia from delayed sleep phase syndrome. Sometimes we see clients that have come from other clinics that don’t offer a thorough assessment and the delayed sleep phase has been missed.
Interestingly, because we devote time to a thorough assessment we have also noticed the disrupted physical processes that the researchers in this article mention, such as body temperature, meal timings, etc.
If you think you may need treatment you can book an initial assessment online. Alternatively, you can talk with us first.
Quick Facts On ADHD
What Are Symptoms Of ADHD?
Attention deficit hyperactivity disorder (ADHD) is a group of behavioral symptoms with neurobiological roots. ADHD symptoms include inattention, hyperactivity, fluctuating emotions and impulsiveness.
Is ADHD Genetic?
Research has demonstrated hereditary links in ADHD, as well as differences in brain volume and functioning when compared to those without.
Is ADHD Only A Childhood Thing?
Generally speaking, signs of ADHD may surface early on in life and become more distinct in moments like entering school. So it is common to talk of children with ADHD or children and adolescents with ADHD. But adult ADHD is also recognized.
Are There Adults WIth ADHD?
Despite most diagnoses occurring between 6-12 years of age, it is becoming increasingly important to acknowledge that adult or older sufferers also exist. ADHD can remain throughout the entirety of an individual's life. People with ADHD frequently experience additional mental health problems and disorders such as anxiety and depression. Estimates suggest that 2-5% of children, adults and older people across the globe experience ADHD.
How Common Are Sleep Disorders In ADHD?
Approximately 75% of individuals with an ADHD diagnosis experience Delayed Sleep Phase Disorder, a Circadian Rhythm Sleep Wake Disorder that makes it difficult to fall asleep at conventional times and can be mistaken for sleep onset insomnia.
What Are The Most Common Sleep Disorders In ADHD?
Sleep disorders are common in ADHD with the most prevalent being the Circadian Rhythm Sleep Disorder of Delayed Sleep Phase Syndrome, Restless Leg Syndrome, Obstructive Sleep Apnea.
Are People With ADHD More Sensitive To Light?
Approximately 70% of adults with Attention Deficit Hyperactivity Disorder (ADHD) have an oversensitivity of the eyes to light.
The study was published in Sleep Medicine (Vogel et al., 2017).
Article Author: Dan Ford Sleep Psychologist