Women with ADHD often complain about having difficulty “shutting off” their brains at night to go to sleep. They report that their thoughts jump around from one concern, thought, or worry to the next, resulting in significant difficulty with falling asleep (initiation insomnia). They report that once they finally fall asleep, their sleep is very restless. They toss and turn. They awaken to any noise in the house. In the morning they often find the bed torn apart and the covers kicked onto the floor. Most report that their sleep is not at all refreshing, resulting in excessive daytime sleepiness and fatigue.
Women with ADHD often complain about having difficulty “shutting off” their brains at night to go to sleep.
ADHD and sleep disorders have not been the subject of a great deal of research, but the few studies that have been conducted, nevertheless, report that sleep disorders are very common in adults with attention-deficit/hyperactivity disorder. Adults with ADHD report going to bed later, have a wider range of bedtimes, were more likely to take over an hour to fall asleep, and were more likely to experience difficulty going to bed, going to sleep, sleeping restfully, or waking in the morning than adults without attention-deficit/hyperactivity disorder. They also experienced daytime sleepiness more often.
Sleep disorders are very common in adults with attention-deficit/hyperactivity disorder.
Children with ADHD have also been found to have problems with going to sleep, staying asleep, and waking up in the morning. In addition, they, too, experience excessive daytime sleepiness. ADHD has been generally demonstrated to reduce the time in rapid eye movement (REM) or dream sleep among children while also increasing the frequency of periodic leg movements. There are several theories about the causes of sleep disturbances in people with attention-deficit/hyperactivity disorder. One simple explanation is that the sleep disturbances are directly related to the problems with arousal associated with the ADHD itself.
In addition to insomnia, many adults and children with ADHD report being restless when they sleep, but for some it may be more serious than just tossing and turning. Restless leg syndrome (RLS) and sleep-disordered breathing or obstructive sleep apnea are among the more commonly observed sleep disorders in people with attention-deficit/hyperactivity disorder. It seems that people with RLS are more likely to have ADHD than people without RLS. In a 2005 review of clinical studies reporting cases of RLS and attention deficit hyperactivity disorder, Cortese and colleagues found that 44% of the adults with ADHD in these studies were found to have RLS, and as many as 26% of individuals with RLS also had attention-deficit/hyperactivity disorder. A similar preliminary study found that 20% of adults with ADHD had RLS compared to 7.2% of those without attention-deficit/hyperactivity disorder. For more on this important topic, you may want to read 100 Questions & Answers About Restless Leg Syndrome by Sudhansu Chokroverty (Jones & Bartlett Learning, 2011).
Treating ADHD Can Improve Sleep
For years, the association of sleep disorders and ADHD has been overlooked because of the focus on insomnia as a side effect of stimulant medication used to treat attention deficit hyperactivity disorder, rather than a coexisting condition. Stimulants may be associated with a delay of sleep onset and insomnia in some people, but in a significant number of patients with attention deficit hyperactivity disorder, stimulants may actually improve their ability to fall asleep. In a study by Sobanski and colleagues (2008), 34 adult nonmedicated patients with ADHD were compared to 34 age-matched and sex-matched, medication-free control subjects without psychiatric or sleep disorders. The investigators studied these adults for 2 consecutive nights in the sleep laboratory. When first studied, all 34 adults with ADHD displayed reduced sleep efficiency with longer sleep onset latency and more awakenings. At follow-up, those treated with stimulant medication showed a significant reduction in sleep onset latency and improved sleep efficiency. This study clearly underscores the importance of carefully discussing sleep history with your doctor prior to being treated with stimulants. If it is determined that sleep problems are present prior to the beginning medication and that these problems may possibly be the result of over-arousal, your doctor might prescribe an additional dose of stimulants later in the day or a dosing schedule that provides coverage of symptoms at bedtime.
If problems with sleep persist after adequate treatment of attention deficit hyperactivity disorder, however, the clinician may elect to treat problems such as falling asleep with prescription medications. Sleeping pills, however, should be avoided, as the majority of people quickly develop tolerance and they can become habit-forming. Instead, physicians may choose medications with sedative properties that cause sleepiness. These include antihistamines like Benadryl (diphenhydramine) and clonidine or similar drugs administered before bedtime. These medications, however, tend to produce grogginess well into the next day, making getting up the next morning even more difficult. Melatonin and bright light therapy during the day to regulate sleep/wake cycles have also been tried and proven to be somewhat effective in treating insomnia in both children and adults with attention-deficit/hyperactivity disorder.
In addition to my symptoms of attention deficit hyperactivity disorder, I have a great deal of difficulty settling down to go to sleep in the evening. As soon as I get in bed, I develop a crawling sensation in my legs and feel like I need to get up and move around. In the morning, my bedclothes are a mess with everything tossed everywhere. The comforter is never on the bed any more. I have always been a restless sleeper, since I was a child, but this is worse.
Selections from the book: “100 Questions & Answers About Attention-Deficit Hyperactivity Disorder (ADHD) in Women and Girls”, Patricia O. Quinn, MD, Director National Center for Girls and Women with AD/HD, Washington, DC, 2011