If your child has been diagnosed with ADHD, then you probably already know there’s a correlation between ADHD and sleep problems. It makes sense: hyperactivity makes it harder to calm down and lie still at night, and difficulty focusing and relaxing can lead to racing thoughts and late nights lying awake. But the truth is that the relationship between sleep problems and ADHD is much more complex than it looks at first glance - sometimes, one can even be mistaken for the other. Here’s the truth about sleep problems and ADHD: how they relate, how they feed each other and how they can be confused.
What We Know
There’s a lot that’s still uncertain about sleep and ADHD, but here’s what we do know. First, sleep difficulties seem to be much more common among people with ADHD - both kids and adults. A 2008 study on self-reported sleep issues by caregivers of children with ADHD found that 75% of families reported sleep problems for their child, including difficulty falling asleep, difficulty waking up, frequent night wakings and snoring.
This correlation is complicated, however, by the fact that sleep deprivation can mimic symptoms of ADHD, especially in kids. According to the DSM-V, symptoms of ADHD include difficulty paying attention to details and keeping attention focused, losing things, being easily distracted and forgetful, fidgeting, interrupting, having trouble sitting still and excessive talking. In children, the symptoms of sleep deprivation are nearly identical: irritability, forgetfulness, inability to concentrate and over-activity.
In addition, ADHD often correlates with additional coexisting sleep issues. Numerous studies have found that ADHD correlates with sleep problems including nocturnal movement, obstructive sleep apnea, daytime sleepiness, and restless legs syndrome. Sleep disordered breathing occurs in 25% of ADHD people (compared to 3% of the general population), while restless legs syndrome occurs in as many as 44% of the ADHD population. Depression and anxiety are also more common among ADHD sufferers, as is having a delayed circadian rhythm (leading to bedtime resistance and difficulty getting up in the morning).
What We Don’t Know
What we don’t know is exactly how poor sleep and ADHD interact. Does ADHD cause poor sleep, or does poor sleep cause ADHD behaviors? Do they truly exist independently of each other? Do they really correlate at all, or does the connection only exist in self-reported studies?
Some scientists are beginning to suspect that the symptoms we diagnose as an ADHD disorder are really just symptoms of chronic sleep debt. There’s a lot of evidence to make this argument compelling. For example, some studies have found that treating a sleep disorder (such as a tonsillectomy to cure sleep apnea) can actually improve hyperactive behavior so a child no longer qualifies for an ADHD diagnosis. Children who have sleep problems as infants are more likely to be diagnosed with ADHD when they’re older. And a 2017 pilot study using a drug commonly prescribed for narcolepsy to treat ADHD had promising results, all of which could add up to the conclusion that ADHD is really just a sleep disorder.
However, other research shows that the relationship isn’t simple. Some scientists think the relationship could go the other way: it’s ADHD - or maybe even the drugs we use to treat ADHD - that cause sleep problems, and not the other way round. Defiant behavior can be a symptom of ADHD, and bedtime resistance is a common type of defiance - which, naturally, leads to less sleep. The drugs we commonly use to treat ADHD are stimulants, and the use of stimulants in ADHD children could have a negative impact on sleep - creating a vicious cycle of less sleep and more hyperactive behavior. Other studies, however, found that children with ADHD have the same amount of trouble sleeping whether they’re medicated or not, so stimulants certainly aren’t the whole picture.
What Can Help?
Even though we don’t fully understand the complex relationship between ADHD and sleep, we do know some things that can help the issue.
First, if you suspect (or know) that your child has ADHD, it’s important to also get a comprehensive diagnosis of your child’s sleep patterns. This will help prevent a misdiagnosis of ADHD, and it will help you identify ways you can improve your child’s sleep. Even if sleep isn’t the core problem, improving your child’s sleep is likely to improve his ADHD symptoms too.
Next, treat whatever sleep problems you identify. If your child struggles to fall asleep at bedtime, melatonin has been shown to be both safe and effective to help kids with ADHD fall asleep earlier. Sleep apnea can be treated with tonsillectomy or CPAP. And good sleep hygiene, such as cutting off screentime a few hours before bedtime or adding blue light filters in your child’s bedroom, can help everyone sleep better.
Then, talk with your doctor about the right treatment if your child has ADHD. If you and your doctor decide that stimulants are the right treatment, monitor closely to make sure they’re not having a negative impact on your child’s sleep, and if they are, talk with your doctor about changing the treatment. Ongoing monitoring is very important anytime you’re changing your child’s medications, especially with medications that are likely to impact sleep.
Finally, don’t assume your child will outgrow ADHD. Even though only about 2.5% of adults are diagnosed with ADHD, as compared to 10.4% of children, ADHD in childhood can have an impact on memory and brain function as an adult. This is true even if your adult child no longer has diagnosable symptoms - which might be because he’s learned to manage the ADHD behavior, or it might be because he’s adjusted his life to better conform to his need for variety and stimulation. Either way, treating and managing ADHD symptoms early will do more than ignoring it to help your child succeed long-term. Whether it’s ADHD, sleep deprivation or some combination of the two, understanding the problem and helping your child function better now will impact his health for the rest of his life.