10 Strategies for Better Sleep with ADHD

Sleep problems can disrupt attention deficit treatment in adults, children, even parents of ADHD kids. Here, expert strategies for satisfying sleep.

by William Dodson, M.D.

For many adults and children with attention deficit disorder (ADD ADHD), the thought of falling asleep easily, staying asleep through the night, and then waking up easily — and refreshed — seems but a dream.

Consider these facts:

1. About 1 in 5 kids with ADHD have difficulty falling asleep and staying asleep — about twice the rate among non-ADD children.

2. 57 percent of the parents of these children slept six hours or less, with 27 percent getting less than five hours. In other words, when children are awake, it’s hard for some parents to get any shuteye.

3. More than 70 percent of adults with ADHD report that they spend more than one hour trying to fall asleep at night; another 80 percent say they have difficulty waking up the next morning.

Here's expert ADHD sleep advice for catching Zzz's quicker, staying asleep better, and waking up healthier.

The Link Between ADHD and Sleep

Why do so many children and adults with attention deficit have trouble getting to sleep? Although there are several theories, the simplest is that many of the same regions of the brain regulate both attention and sleep. Thus, a person with attention problems is prone to sleep problems.

For both adults and children, sleep expert Dr. Thomas Brown — longtime researcher in ADHD and one of the first to give serious attention to the problem of sleep in children and adolescents with ADHD — recommends a two-pronged approach consisting of sedatives and good sleep hygiene.

Sleep Strategies for Kids

Dr. Patricia Quinn offers parents the following tips:

• Avoid sleeping pills and melatonin, which haven't been adequately tested for their safety and effectiveness in children. Doctors sometimes prescribe clonidine for ADD children who have trouble falling asleep.

• Set a realistic bedtime. Enforce it consistently. In the hour leading up to lights off, do something relaxing together (read, listen to music), turn off electronics, and allow him to have a snack if he's hungry.

• Keep the bedroom completely dark. If your child requires a nightlight, purchase a dim light and make sure that it goes off once she falls asleep.

QUICK TIP: If your child avoids going to bed or gets up shortly after being tucked in — a problem that’s common among kids with coexisting ADHD and, say, ODD or anxiety — your best bet may be a behavioral approach: Give strict orders, stay nearby to ensure she stays in bed. If your child gets up, calmly tuck her back into bed. After a few nights of this routine, she will come to understand that resisting is futile — and you’ll no longer have to sit vigilantly outside her door.

Sleep Strategies for Adults

You might be familiar with the following sleep guidelines, but they're critical, particularly for adults with ADHD.

• Use the bed only for sleep or sex, not as a place to confront problems or argue.

• Have a set bedtime and a bedtime routine and stick to it - rigorously.

• Avoid naps during the day.

• Get in bed to go to sleep. You might feel most energetic and productive at night when distractions are low, but staying up can be a cause of sleep disturbance later on.

• Avoid caffeine late at night.

Sleep Treatment Options

Sleep Treatment Options

For those who spend hours each night with thoughts bouncing and their body tossing, research suggests that taking a stimulant 45 minutes before bedtime improves sleep patterns in adults with attention deficit.

Prescription sleep medications are potentially habit-forming, and many physicians may recommend non-habit forming alternatives, including:

Melatonin

• Helps to set the circadian clock.
• Available without prescription at pharmacies and health food stores.
• Recommended dosage is 1 mg, though most doses sold over the counter are larger.

Periactin

• Works like Benadryl.
• Can reverse stimulant-induced appetite suppression.

Clonidine

• Treats the hyperactivity component of ADHD.
• When taken as 0.05 to 0.1 mg dose one hour before bedtime, exerts significant sedative effects for about four hours.

Antidepressants

• Can produce drowsiness the next day.
• Includes Trazadone (brand name Desyrel), 50 to 100 mg, and Mirtazapine (brand name Remeron), 15 mg.

QUICK TIP: Do you or your ADHD child experience problems with waking up and feeling fully alert? Try a two-alarm system.

1. Place a first dose of stimulant and a glass of water at bedside.
2. Set an alarm to go off one hour before the ADDer plans to rise.
3. When the alarm rings, take the medication and return to sleep.
4. When the second alarm rings, an hour later, the medication is approaching peak blood level, giving you a fighting chance to get out of bed and start the day.