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New Theory: Chronic Sleep Disturbances May Trigger ADHD Symptoms, Not Vice Versa

New evidence linking sleep-related disorders to ADHD symptoms may pave the way for new treatments that focus on sleep habits as a cause, not an effect, of attention deficit.




September 14, 2017

A new theory hypothesizes that ADHD symptoms may be caused by a lack of regular circadian sleep, positing that attention and sleep troubles may be “two sides of the same physiological and mental coin” — not just two sometimes-overlapping conditions.

The theory was presented by Professor Sandra Kooij at the 30th European College of Neuropsychopharmacology Congress, held in early September in Paris, France. There, Kooji outlined extensive research linking ADHD to sleep problems, and offered new evidence that distorted circadian rhythms and ADHD symptoms may be interrelated for many people with the disorder.

“There is extensive research showing that people with ADHD also tend to exhibit sleep problems,” Kooij said. “What we are doing here is taking this association to the next logical step: pulling all the work together that leads us to say that, based on existing evidence, it looks very much like ADHD and circadian problems are intertwined in the majority of patients.”

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Evidence suggests that people with ADHD are 75 percent more likely to have delayed sleep patterns — including a later bedtime and delayed core body temperature changes — than are people without ADHD, Kooij said. They’re also more likely to be alert at night, or be diagnosed with sleep apnea, restless-leg syndrome, or other sleep-related disorders.

Lack of sleep — or fitful sleep — can decrease focus, worsen mood, and hamper productivity; the same symptoms are frequent hallmarks of ADHD. The connection between ADHD and sleep has never been fully understood, said Kooij, but current research is aiming to answer an important question: “Does ADHD cause sleeplessness or does sleeplessness cause ADHD?”

If it’s found to be the latter, she went on to say, it could open the door for non-pharmological treatments for ADHD. Light therapy, melatonin, and other easy-to-apply sleep interventions could make great strides in the face of challenging ADHD symptoms.

“We are working to confirm this physical-mental relationship by finding biomarkers, such as vitamin D levels, blood glucose, cortisol levels, 24-hour blood pressure, heart rate variability and so on,” she concluded. “We don’t say that all ADHD problems are associated with these circadian patterns, but it looks increasingly likely that this is an important element.”

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  1. I understand that the coping mechanisms that I use are far less successful when they are stressed by inadequate or poor sleep. In particular my Low frustration tolerance is infinitely lower after a few nights of 6!instead 8 or more hours of sleep. Similarly my forgetfulness and working memory are apt to take the day off and leave me without keys, wallet and the groceries I promised to bring home after work. As for controlling my blurting out the wrong thing at the wrong time, that seems to be in overdrive.
    All this exacerbates my ADHD combined type, rather than causes it . Nevertheless it manifests many of the symptoms that we might otherwise do a decent job of suppressing when we receive adequate sleep. Since retirement I have concientiously made a point of emphasizing 8hour minimum sleep and closer to 9 if i can. This regime combined with meds and a diagnosis and all the suggestions on this and other websites has seen marked improvement in my ability to overcome some but not all of our pecadillos that make us so unique. Those relatd to memory and dealing with frustration in particular.
    Of course all is not perfect. Yesterday was my grandsons birthday and his mom my daughter planned a family dinner at his favorite eatery. In the past I have often attended birthdays of my grandchildren and forgot to bring the card. I have worked hard of late to overcome this habit using various means, my favorite of which is putting it in the car before the event so it will be there. Somehow this year in the rush of starting up many new fall and winter activities it remained on my dresser. Although i followed all my backup routines of placing it right beside the door in its brightly colored envelope, you guessed it. I picked it up, then decided i should wear a jacket for rain, put it down and forgot it. Foiled again . Lots of sleep but perhaps that nasty sciatic pain distracted me. No it was just our reason for being here.
    All was not lost though. I was 15 minutes early, a new first. I was able to ignore the constant urge to go.home due to the pain and waited the Half hour until they appeared. I managed to avoid all but one oppportunity to blurt out a comment. Of course that was to have a glass of wine and then when my Daughter decided to join me changed it to a bottle of as there would be othe adults that would join us . What might have been a trial for me turned out very enjoyable. I did remember to text a pic of the forgotten card to my grandson when i arrived home. Without a doubt my good sleep habits are due a lot of the credit for this.

  2. In partial answer to your query, prior to retirement and discovering I was Adhd I regularly drank copious quantitees of Coffee, most of a 12 cup pot at work and all of a 10 cup pot at home.in addition if I had aluncheon meeting 2 or three cups for lunch, if no meeting a large coke. It was an all day habit an occasionally involved evening cuppas. Slee for me however was instantaneous. From the moment my head hit the pillow i no more
    Could count backward from 10 than i could fly off a cliff. For many years I would automatically wake up before 7 with no need of an alarm clock. As i grew older the alrm became more of a necessity, particularly on golf fridays.
    I suspect the caffeine was my version of self medication. It worked to a point but eventually my LFT interfered with my work performance and I retired at 60. That action exposed all of my trials of timeliness, forgetfulness, and others that I had delegated to staff members. They didn’t follow me into retirement.

  3. I find it interesting to connect sleep issues w ADHD.
    First diagnosed in my late 40’s, then bullied into discontinuing meds, I have just recently been professionally dignose w combined type and am taking Stratera. Very happy with changes taking place. I notice my own frustration increases with less sleep and I cannot always function as I want to. More sleep, more satisfied with myself.
    I have restless leg with painful cramping that frequently awakens me unpleasantly and urgently to do something to stop psin.
    I too am out as I contact my pillow and no sign of sleep apnea . Great article but I think it is neurological with co-occurring sp? Sleep problems as a child I was terrified to close my eyes and more afraid of losing consciousness .
    My faith in God helps me with that now.

  4. Does ADHD cause sleeplessness or does sleeplessness cause ADHD?” This is rubbish by my reckoning! Yes ADHD certainly keeps your mind on overdrive and falling asleep is a major issue but this is flawed and insulting research!!! Try living with it and then dare to write your article. Unimpressed!

  5. I have to agree. While I’ve no doubt that sleep disturbance and ADHD often go hand in hand and are most likely linked, it is quite absurd to make the statement: Dies ADHD cause lack of sleep or does lack of sleep cause ADHD. “Cause” ADHD? Do we really need another misleading subtitle in the face of too much misunderstanding about what ADHD even IS in the first place?! Something like this, while possibly drawing more people into reading the article (which does not claim that lack of sleep causes ADHD but rather that there may be a link between the two), simply promotes more confusion for the masses about what ADHD is and isn’t. Most of your readers could only HOPE that having and living with ADHD everyday was caused by simply not getting enough
    sleep!! It is a rather insulting statement to be found in this
    emag. If it was only that simple–this forum wouldn’t even
    exist!!!!

  6. I found this interesting as my son has improved amazingly since taking small amounts of melatonin. He currently takes 5mg Ritalin LA and is 27kg.
    My father has a sleep disorder that he has been medicating for years with caffeine. He drinks coffee and coke all day, then hits his pillow and is out. The thing is he constantly flinches and spasms – not enough to wake him up but enough that he doesn’t get proper sleep. He has never required an alarm clock. As he has got older he started falling asleep during the day, mid sentence and was worse when he was not smoking. He went off and did sleep testing and they discovered his sleep disorder.

    We are getting my son checked to see if he has the same thing. Though there is very little we can do to help him.

    Sleep is an amazing thing and the way it can change how we manage ourselves. Chronic low level sleep deprivation is hard to tell you’ve if you are asleep but not getting PROPER sleep

    1. My daughter who works as a GN in a pediatric clinic was convinced that melatonin would do wonders for me when i was first diagnosed . My FP explained to her why Serotonin was necessary and why melatonin would not address all the issues. Psych was correct in that my new meds Ven la Faxine and no more caffinated coffee instantly addressed the sleep issue and a couple of nights of 15 hours sleep slowly tapering to 12 hours then to 10 and finally 9 hours sleep were the result.
      I am an adult in fact a senior so i dont know if the results are different for children. My med is a Norepinephrine and seotonin reuptake inhibitor. ( It slows down my kidneys and other filtering functions from removing these neorotransmitters from my brain.)
      I am sure if we had some expert medical opinion on this it would explain why we need serotonin not melatonin. Pity that this article doesnt seem to attract any professional opinions.

      1. I hope professionals havent just dismissed this as another supermarket tabloid headline and dismissed this org as another source of misinformation FAKE NEWS. More sleep does everyone a lot of good . It doesnt cure ADHD it just makes it somewhat easier to cope.

  7. Dr. Kooji is a very reasonable ADHD expert and is asking an important question. What if ADHD could be minimized by observing sleep patterns in toddlers/preschoolers and intervening while the brain is still developing? I hope the answer is ‘yes’, although I suspect that any improvements would be partial at best.

    Those of us old enough to post in this forum have so many years of lousy sleep and ADHD dysfunction that the thought our symptoms would go away with sleep medicine is ludicrous. I don’t think many research dollars should go to “curing” adult ADHD with sleep interventions, but I don’t think that is what Dr. Kooji is proposing.

    Oren Mason MD
    Attention MD

    1. Dr Mason Its not the theory we are concerned about. It is the Headlines’ propensity to make an ill informed public moreso. It is also the logical conclusion that to test the theory our toddlers at some stage will be turned into guinea pigs.
      James Cochrane

      1. Exactly! None of us would despite their is s coonection between poor sleep and ADHD, but that the “headline” implies some NEW discovery that poor sleep “causes” ADHD. And that is both erroneous and insulting. If it were truly that simple, we’d all be cured and our loved ones or the general public would be satisfied that ADHD is really just a ‘problem’, not a true ‘disorder’, caused by us simply “not sleeping well enough”.

  8. It’s so easy to be a curmudgeon… The title is just fine…

    I loved this article and I am very interested in this topic because of my familial Medical History of both ADHD and Narcolepsy. I have a Dx of Narcolepsy with Cataplexy as does my mother, and sister. My Son has ADHD with Narcolepsy. My husband has ADHD and poor sleep quality. (Yes, I understand that my husband is not a blood relative, but his medical history does have an impact on my son’s Dx).

    I have often wondered where one Dx begins and the other ends, and that the Meds we use are almost identical. It wasn’t until recently that I realized how much my Sx from Narcolepsy (Issue regarding memory, concentration, organization, etc) mirror ADHD. So I find this Article of great interest!

    Would love to hear more!
    Thanks!

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