Attention Deficit Hyperactivity Disorder is a behavioral condition that makes it difficult to focus on everyday routines and requests. ADHD is the most commonly diagnosed mental health disorder among children in the US. Sleep Disorders, also called sleep-wake disorders, involve problems with the quality, timing, and amount of sleep, which result in daytime distress and impairment in functioning. The CDC reports that 38%-44.1% of the population in Ohio experience sleep-related disorders. Three out of four children and adolescents diagnosed with ADHD also have a sleep disorder, and four of out five adults with ADHD also have a sleep disorder (The National Resource Center on ADHD, 2022).
Why individuals with ADHD are commonly diagnosed with sleep disorders can be due to a few factors. One reason for this correlation is that having ADHD messes with your sleep-wake cycle, also known as a circadian rhythm. People with ADHD feel more alert at night than they do in the daytime, making it more difficult to get regular sleep in the evening. Another reason for this connection could be the consumption of caffeine or ADHD medication with stimulants. Even non-stimulant ADHD medication can alter the sleep cycle, as drowsiness can lead to the person wanting to sleep in the morning after taking the medicine.
How Sleep Disorders and ADHD Affect Daily Life
Even without medication, ADHD alters the sleep-wake cycle. Individuals with ADHD experience impulsivity and hyperactivity, which makes it more difficult to release the natural melatonin needed to induce sleepiness. The following are ways in which Sleep Disorders affect the daily lives of individuals with ADHD:
- Physical illness - Sleep is one of the main ways immune systems get strengthened. Less sleep makes getting sick happen more often because the body does not have enough strength to fight foreign invaders.
- Behavioral changes - After adequate sleep, the human body is alert and more ready to handle complicated tasks and routines. Tasks such as driving, remembering events and important dates and focusing at school or work all become negatively impacted when not enough sleep is obtained.
- Mood changes - Just like a battery, humans need to power down and recharge to function at their best. When people with ADHD do not get enough sleep, their emotions can be more dysregulated, leading to outbursts or inappropriate behavior. These emotional disturbances potentially lead to damaging personal and professional relationships.
- Neurocognitive changes - People with ADHD have short sleep cycles so, when sleep is consistently inadequate, neurocognitive impairments can occur such as loss of balance, loss of motor function, and blurred vision.
Sleep Disorders That Commonly Affect People With ADHD
People with ADHD are commonly diagnosed with the following sleep disorders:
- Sleep-disordered breathing (SDB) - SDB consists of a spectrum of conditions, ranging from primary snoring to obstructive sleep apnea (OSA). This disorder primarily causes upper airway dysfunction during sleep, leading to obstruction of airflow while sleeping. 25-30% of people with ADHD are diagnosed with OSA compared to only 3% of the general population (Youssef et al. 2011).
- Restless legs syndrome (RLS) - This sleep disorder is characterized by an uncontrollable urge to move the legs to relieve uncomfortable sensations at rest. While RLS is not common in the general population of children, it is more prevalent among children diagnosed with ADHD (The National Resource Center on ADHD, 2022).
- Circadian-rhythm sleep disorders - The major component of circadian-rhythm sleep disorders is a misalignment of sleep patterns and the timing of daily routines. In children with ADHD, it is common for them to become more hyperactive in the evening and increase daytime sleepiness. In adults with ADHD, there is a high prevalence of comorbidity of ADHD and insomnia (Youssef et al. 2011).
Sleep Disorders and ADHD Can Be Managed
There a therapy models that are effective for managing ADHD and sleep disorders:
- Cognitive Behavioral Therapy for Insomnia (CBT-I) - Certain behaviors can energize the body just as other behaviors depress the nervous system. Interventions in CBT-I for insomnia include implementing certain behaviors to induce sleepiness to correct the sleep-wake cycle.
- Dialectical Behavioral Therapy (DBT) - An intervention in DBT called Sleep Hygiene Protocol gives effective skills for increasing restful sleep before and during bedtime.
- Cognitive Behavioral Therapy - This is a common therapy for individuals with ADHD who might feel hopeless about regaining control of their sleep patterns. CBT helps participants recognize and change negative beliefs and thoughts (cognitions) that contribute to their sleep problems.
You can help manage your sleep disorder on your own with the following tools:
- Maintain a consistent routine - It is important for both children and adults to have a daily routine that consists of the same wake, sleep, and activities schedules. When your body gets used to a routine, it becomes less likely for sleep disruption to occur. Bedtime routines should be consistent, such as the order of behaviors, like brushing teeth or a bath, and the same time every night. Using the bed for only sleep or rest activities is proven to eliminate insomnia because the brain then associated the bed with only sleep and not wake activities. When struggling to fall asleep, doing awake activities, such as reading or eating, outside of the bedroom is important to break the association your brain has made between being awake and your bed.
- Revise your diet - Caffeine and any stimulants should be limited or avoided if possible for both children and adults. That means coffee, chocolate, and soda should be eliminated to reduce alertness and hyperactivity.
- Relax your senses - A hot bath or shower or aromatherapy can be a great way to relax the nervous system before bed, making you more likely to feel sleepy. Massage, bodywork, or yoga regularly can also help release tension in the body, which will make responding to calming sensations easier.
- Avoid sleep medications, if possible - Over-the-counter sleep medications, such as melatonin and Nyquil are good for short-term solutions, but should be avoided long-term. The body makes hormones to induce sleep on its own, but when the body is given these hormones externally, hormone production stops.
- Avoid illicit substances - Sometimes people will get so frustrated with poor sleep that they take alcohol, marijuana, or pills not prescribed by a physician in an effort to fall asleep. This desperate attempt at inducing sleep has many damaging side effects, such as increasing the risk of dependence and addiction, cognitive impairment, impulsive behavior, and poor physical functioning.
Since children with ADHD are more likely to have issues with falling asleep or sleeping for longer periods of time, it is important to be aware of some ways to help them manage sleep disorders:
- Bring in more light - The light from the sun helps regulate circadian rhythms and get sleep schedules back on track. Going outside or opening window curtains can give a child a good dose of sunlight. If unable to access natural sunlight, then lightboxes or light lamps that mimic sunlight can be used in the morning or afternoon for a similar effect.
- Get them moving - Movement and exercise helps regulate hormones and tire the body out. When we exercise, melatonin is secreted, which benefits children with ADHD as the hormone is in short supply. Something as simple as a 10-minute walk every day can increase the production of melatonin and as a result, increase sleepiness.
- Sleep routine is key - Having a set bedtime and routine eventually builds the association between time of day and sleepiness. Adults feel this too when having to be awake earlier or later than usual. Making sure children with ADHD at least have a scheduling time to wind down with quiet activities, such as reading or a hot bath, will help their body and mind begin to rest at that certain time when followed consistently.
- Quiet time - Even if your child with ADHD has grown out of naps, quiet time can still be beneficial to managing their ADHD and sleep disorder. Children with ADHD more commonly have hyperactivity than adults, which means they don’t get the same signals to take a break as children without ADHD. Quiet activities such as coloring, mediation, and yoga give the mind a break while releasing dopamine, a critical neurotransmitter that can lead to limited sleep when in short supply.
Living with ADHD can disrupt the sleep-wake cycle, leading to more sleep problems and negative impairments to physical and mental health. Trying to manage ADHD and sleep disorders can be challenging without the right tools. If you or your child has ADHD and is struggling with getting enough sleep, you should consider getting help.
ADHD Treatment at Sun Behavioral Columbus
If you believe you or your child is experiencing signs of ADHD and sleep disorders, Sun Behavioral Columbus is here to help. Open 24 hours and 7 days a week, SUN Behavioral Columbus has onsite treatment and counselors as well as connections to behavioral resources in the community to help you. Navigating mental health crises or treatment can be challenging, and we are here to make the process easier for you and your family.
Treatment for ADHD with co-occurring sleep disorders may be provided via a partial hospitalization program (PHP) or an intensive outpatient program (IOP). PHP includes five group therapy sessions per day, five days per week. The PHP groups use a cognitive behavioral therapy (CBT) approach. PHP offers coping skills training and a Wellness Recovery Action Plan (WRAP), which is an evidence-based system to help people understand and apply wellness techniques for the purpose of relapse prevention.
The IOP program includes three group sessions per day, five days per week. Key components of the IOP include stress management, life skills development, mindfulness, cognitive behavioral therapy, and yoga and physical wellness strategies. There are also outpatient programs tailored for children with ADHD and sleep disorders. These treatment approaches will help you or your loved one gain new skills to better cope with ADHD-related sleep disorders.
Sleep Disorders and ADHD
Here at SUN Behavioral Columbus, we believe in empowering our patients to be the expert in their life. This includes being able to identify their own needs and learning how to overcome obstacles. To learn more about how we can help, call 614-706-2786.