Sleep & Mornings

How to Fall Asleep with a Rowdy, Racing ADHD Brain

Sleep difficulties — falling asleep quickly, staying asleep, and waking up on time — go hand-in-hand with ADHD. Theories for inherent sleep problems vary from biological to the behavioral symptoms of ADHD. Learn how to fall asleep reliably by considering these strategies and best practices ranging from taking melatonin to avoiding electronic devices at night.

Man sleeping in bed at night.

It seems, at times, that ADHD brains simply don’t know how to fall asleep. They regularly buzz and whir and perseverate well beyond bedtime, keeping us awake late, then tired and foggy in the morning.

Sleep problems – including restless nights and morning grogginess – are common, whether due to comorbid sleep disorders, biological causes, or difficulty with managing ADHD symptoms that prevent restfulness.

If you’re not sleeping well, every aspect of your life suffers. Here are the most common ADHD sleeping problems, why they occur, and how to overcome them to fall asleep – at last.

The ADHD-Sleep Connection: Problems and Causes

There’s no one single sleeping problem that afflicts people with attention deficit hyperactivity disorder (ADHD or ADD). In fact, there’s a plethora of reported sleep difficulties and disorders tied to or common with ADHD, including:

  • Difficulty falling and staying asleep. Compared to children without ADHD, children with ADHD experience more daytime sleepiness, sleep onset problems, and circadian abnormalities. They sleep less overall 1. A systematic review of research also found that short sleep duration is significantly linked to ADHD 2.
  • Unwillingness to nap even when exhausted
  • Increased nocturnal activity/feeling more alert/energized after dark
  • Going to bed late (around 2 a.m.)
  • Difficulty awakening (regardless of ample sleep)
  • Feeling tired despite ample sleep
  • Difficulty maintaining alertness during the day
  • Sleep talking/sleep walking
  • Narcolepsy
  • Restless Leg Syndrome (RLS). About a quarter of the ADHD population has symptoms that mimic RLS 3.
  • Bruxism (teeth grinding)
  • Sleep paralysis
  • Obstructive sleep apnea

[Click to Read: What Comes First – ADHD or Sleep Problems?]

A lack of sleep can lead to other health problems, including a weakened immune system, a dysregulated appetite and metabolism, and moodiness. Sleep problems also exacerbate executive functioning skills, like memory, concentration, and problem solving, which are already weakened by ADHD. Symptoms like hyperactivity and inattentiveness can also worsen with inadequate sleep.

Theories Explaining the ADHD-Sleep Link

Biological Roots of Sleep Problems

Sleep involves neurotransmitters also implicated in ADHD. GABA, for example, is a neurotransmitter responsible for inhibition. Individuals with ADHD typically have less available GABA, which can make surrendering to sleep difficult. Delayed sleep phase syndrome (DSPS), a circadian rhythm abnormality, is also common among many people with ADHD. Delay in melatonin onset, a hormone associated with sleep, is another issue seen in people with ADHD.

Behavioral Roots of Sleep Problems

ADHD symptoms can conspire all day long to create less-than-optimal environments for sleep later in the evening. Many people with ADHD, however, prefer staying up late because that’s when they focus best. Stimulant medications can also inhibit sleep for some.

Genetic Roots of Sleep Problems

Many adults with ADHD exhibit a gene called catechol-O-methyltransferase (COMT), which suppresses an enzyme that metabolizes dopamine. This makes it harder for the body to regulate sleep.

[Related Reading: Your ADHD Brain Needs More Sleep — How to Get It]

How to Fall Asleep with ADHD: Steps and Solutions

Assess Current Sleep Habits

Begin by faithfully keeping a sleep diary that tracks:

  • Actual hours slept each night, including times (and not just time spent in bed trying to sleep). The National Sleep Foundation recommends 7 to 9 hours of sleep for adults, 8 to 10 hours for teens, and 9 to 11 hours for 6 to 13 year olds. The more sleep that is done when the sun is down, the better.
  • Weekday and weekend sleeping hours. There shouldn’t be too much variation between the two.
  • Sleep locations (bed, couch, etc.)
  • Environment (T.V. on or off? music playing?)
  • Awakenings/nightmares
  • Naps during the day
  • If and how sleep habits affect others in the household

Consider signing up for a sleep study, a test that studies brain waves, oxygen levels in the blood, breathing, and more to see if any sleep disorders are present. If diagnosed with sleep apnea, a CPAP machine helps with breathing.

Anatomical issues, like a deviated septum, can also lend themselves to obstructed breathing and other sleeping problems. A septoplasty and other procedures can correct the issue.

Medication and Supplements to Aid Sleep

  • Stimulants: Studies show that the use of stimulants for treating ADHD can help with sleep by targeting ADHD symptoms that often trigger sleep problems. Depending on the individual, the time the dose is taken can sometimes impact sleep (if taken too late, for example).
  • Melatonin: This hormone is naturally produced in the brain and helps signal to the brain that it’s sleep time. Talk to your doctor about melatonin and whether taking a supplement may be appropriate and helpful.

Sleep Hygiene and Best Practices for ADHD Brains

  • To nap, or not to nap? For some, power naps throughout the day are a must for feeling energized and refreshed. For others, it may mess with sleep later in the evening. Experiment with naps, and note it in the sleep diary.
  • 20-minute rule: If you’re trying to change your sleep time, do it in 20-minute intervals to avoid jarring the brain. For example, if 2 a.m. is your current bedtime and your goal is to be asleep by 11 p.m., aim to sleep at 1:40 a.m. the first night, 1:20 a.m. the next, etc.
  • Relaxation exercises/deep breathing can calm and prep the body and mind for sleep.
  • Unplug from technology. Have an end time to put away your phone, turn off TV shows, or stop playing video games. The light from devices can throw off your sleep cycle.
  • External cues: A warm bath, light music (or a sound machine), dim lights, and changing into pajamas can help shift the mind and body closer to sleep mode. Make sure to have daytime cues as well (bright lights, a cool shower, food, etc.)
  • Climate control: Having a cool room offset by a warm, cozy bed grounds the body and makes you more inclined to stay in bed.
  • Dark room. Use eye masks, close curtains, and make sure to dim lights from clocks and other electronic devices.
  • Don’t stay awake in bed too long. If it takes longer than a half hour to fall asleep, it’s better to get out of bed but engage in a non-stimulating activity or (and this sounds strange) just stand up by the bed until sleepiness sets in.
  • No snoozing. You’re cheating yourself out of deep, restorative sleep by hitting the snooze button. Keep the alarm out of arm’s length so you have to get out of bed to shut it off.

How to Fall Asleep with ADHD: Next Steps

The content for this article was derived from the ADDitude Expert Webinar “Time for Bed! Sleep Solutions for the ADHD Brain” webinar (ADDitude ADHD Experts Podcast episode #262) with Roberto Olivardia, Ph.D., which was broadcast live on September 25, 2019. Dr. Olivardia is a member of ADDitude’s ADHD Medical Review Panel.


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Sources

1 Gruber, R., Xi, T., Frenette, S., Robert, M., Vannasinh, P., & Carrier, J. (2009). Sleep disturbances in prepubertal children with attention deficit hyperactivity disorder: a home polysomnography study. Sleep, 32(3), 343–350. https://doi.org/10.1093/sleep/32.3.343

2 Lee, S. H., Kim, H. B., & Lee, K. W. (2019). Association between sleep duration and attention-deficit hyperactivity disorder: A systematic review and meta-analysis of observational studies✰. Journal of affective disorders, 256, 62–69. https://doi.org/10.1016/j.jad.2019.05.071<

3 Srifuenfung, M., Bussaratid, S. et. al. (2020) Restless legs syndrome in children and adolescents with attention-deficit/hyperactivity disorder: prevalence, mimic conditions, risk factors, and association with functional impairment. Sleep Medicine (73) 117-124. https://doi.org/10.1016/j.sleep.2020.05.037

2 Comments & Reviews

  1. My biggest issue is turning off the screens at an appropriate time because I get sucked into FB or some other online vortex. But the rest of these practices I’ve maintained for years and sadly I still require an extensive rX regimen to regulate my sleep. I’ve had the apple watch for about 6 months now and I’ve been diligently using the sleep tracking app and it’s been very illuminating. I can see where my sleep disruptions are, how little actual restful sleep I’m getting and I’m going to take this information and get a formal sleep study. I’ve already had apnea ruled out medically due to a heart condition but I’d like to know what’s going on with the highly inconsistent quality of sleep.

    And the morning fatigue whether I’ve had 5 hrs of sleep or 11 hrs is brutal. It takes several hours for me to fully wake up and be alert. I pretty much function on auto pilot until the Adderall and vitamins kick in. *Sigh* I’d just like to sleep WELL for a change!

  2. I understand about turning off “screens” before bedtime. However, some of these “screen” devices are useful for tracking or aiding one’s sleep! (How ironic!) I used to listen to certai podcasts from my smartphone each night to help me fall asleep and get back to sleep if I woke in the night. It helped, but, of course, before actually GOING to sleep, I had to fiddle with my phone and set the device to play–at BEDTIME–thus, I was looking at a screen and doing the “wrong thing”.

    Lately, I’ve slightly modified the former practice. I keep my small laptop in the bedroom, but find a 10-hour track on Youtube of certain (relaxing for me) “nature sounds”.
    First, I locate and set the track to play (after skipping the noisy ads at the beginning!).
    Second, I fold the screeb so that it’s not tilted back, but at an acute angle to the keyboard, and cover (the screen of the laptop) with a dark cloth–so the screen is dimmed by quite a bit.
    Third, I adjust the volume–not too loud, but just barely audible, and,
    Lastly, I position the laptop facing the wall, away from my line of sight when I’m in bed, and the room is darkened.

    After setting up my “sound environment”, I gather my things (pajamas), dim the lighting in the room (the bedside lamp has only a dim, “pink” bulb and shade–not so much light as to over-stimulate my eyes when I’m preparig to sleep). After that, I do the bath and related “bedtime rituals”. When I return to the bedroom, it’s dimly-lit, and the “night sounds” are turned on. I find this helps me fall asleep fairly easily. Once I get the “scheduling” (WHEN to start all this routine) down pat–it seems to work MOST of the time,

    BTW, my favorite “nature sounds” are the sounds one might hear on a summer’s evening where I live. I often have the windows open and enjoy the sounds of crickets, night insects or night-birds, and “katydids”. This is truly relaxing and, now that it’s winter where I live, I can play the summer night’s sounds to help me fall asleep!

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