Sleep and Stress
Learn why stress is keeping you up at night and how to reclaim your sleep.
Medically Reviewed By Dr. Brandi Bolling: Triple Board-Certified pediatrician, psychiatrist, and child & adolescent psychiatrist and ADHD expert currently working at Rudolph Bolling Psychiatry.
Physicians recommend anywhere from 7 to 9 hours of sleep each night to avert daytime fatigue and maintain focus, energy, and clarity. Yet, for those with attention deficit hyperactivity disorder (ADHD), efficient and consistent rest can be hard to come by.
To address the lack of sleep in some individuals with ADHD it is important to understand the different factors contributing to these sleep problems. This guide will address the factors that lead to sleeplessness among people with ADHD and will give practical ways to alleviate these problems.
Let’s start at the beginning: What is ADHD, and what are its symptoms?
ADHD is a common condition that affects children and adults. The basic symptoms associated with ADHD include:
While researchers have not yet pinpointed the exact cause of ADHD, it is generally assumed to have a strong genetic component.
Both ADHD itself and the medications used to treat it can be linked with insomnia and sleeplessness, and while many people with ADHD have a hard time sleeping, it’s not always for the same reason. The good news is that no matter the root of insomnia, there are treatments or lifestyle changes that can make a huge difference. The first step is identifying the specific cause of sleeplessness.
Stimulants are activating substances that tend to give an energy boost, and we prescribe these to be taken in the morning specifically because they cause difficulties with falling and staying asleep. - Dr. Patricia Celan”
According to one study, “circadian rhythm delay and greater evening alertness disrupts sleep (i.e., difficulties initiating and maintaining sleep), results in accumulating sleep debt and daytime sleepiness, and interferes with the timing of meals and activity patterns, which in turn may increase ADHD severity.”
However, some simple steps can help restore a proper circadian rhythm, including the use of supplemental melatonin as well as a decrease in blue light exposure.
ADHD can cause different kinds of sleep disruptions based on age demographics. One study affirms that there are “complex and probably multidirectional” connections between ADHD and insomnia in children.
There are several mitigating factors here. For example, children are often prescribed medications that have a stimulating effect. Simple modifications to the treatment plan can help alleviate symptoms of insomnia. Additionally, because kids with ADHD are often faced with a disrupted circadian rhythm, it is important to create a very dark environment in which they can sleep; this may mean unplugging any lights or electronics that are in their room.’’
“Simply put, just as ADHD causes children’s bodies to move throughout the day, it also causes their minds to continue moving at night. Many children use sleep aids to help initiate sleep induction and maintenance. Without proper sleep, children can have daytime sedation, which further worsens inattention as seen in ADHD, and that can lead to poor academic performance, lowered self-esteem, and irritability.” – Dr. Brandi Bolling, Rudolph Bolling Psychiatry
Adolescents with ADHD may also encounter difficulties falling asleep or staying asleep. One study finds that 74 percent of adolescents with ADHD also experience “initial insomnia, nocturnal awakenings, and non-restorative or restless sleep.” Meanwhile, other studies show that teens who have ADHD may need extra sleep to curb some of their symptoms and ensure greater clarity and focus.
If your mind is running a mile a minute during the day, it may not want to shut down at 9:30 each night,” the article notes. “For some, quiet time amps up the noise levels inside their head. -ADDitude ”
Again, there are plenty of suggested treatments and remedies, including: managing stimulant medication levels, ensuring a consistent bedtime routine, investing in a comfortable mattress, and limiting evening media consumption.
In many cases, ADHD can last into adulthood, and so can the sleep problems associated with it. As many as half of adults with ADHD say they don’t get enough sleep at night. The specific factors that lead to sleeplessness include many of the issues highlighted above, including an increased risk of sleep apnea, RLS, and hyperfocus. Adults can combat these problems with soothing and consistent bedtime routines, scrupulous monitoring of stimulants and alcohol, and treatments for comorbidities (for example, a CPAP for sleep apnea, or antihistamines for constricted breathing).
In general, the impact of ADHD on sleep changes as the child ages. Younger children with ADHD tend to be more hyperactive, and therefore are more likely to move about and show signs of restlessness as they attempt to fall asleep. Adolescents with ADHD tend to have less hyperactive symptoms during the day but still have problems staying asleep through the night. Because of their age, adolescents can stay awake longer; however, later bedtimes may complicate the picture of a child who has trouble falling asleep. Developmentally, adolescents often brag about needing less sleep than younger children but a full night’s rest is still important for them. – Dr. Brandi Bolling, Rudolph Bolling Psychiatry
One of the best ways to improve your restfulness is to limit the consumption of alcohol and caffeine. Caffeine, of course, is a well-known stimulant; meanwhile, alcohol can make sleep less productive, increasing restlessness throughout the night. The best practices are to avoid caffeine beyond the early afternoon and to not drink any alcohol within an hour or two of bedtime.
Sugar can disrupt sleep on a number of levels: It reduces sleep quality, stimulates cravings, increases inflammation, and agitates the digestive system. Maintaining a low-sugar, high-fiber diet, and minimizing processed foods can help curtail these ill effects.
Those with ADHD typically need some time to let their minds wind down before bed. Too much media consumption and mentally/physically engaging activities may lead to hyperfocus and lead to a lack of sleep. To combat this issue, seek a relaxing bedtime routine that helps prepare the mind and body for rest.
The blue light emitted by electronic devices can have a disruptive effect on circadian rhythms. It’s best to remove all electronics from the bedroom and turn off all devices an hour before bed to ensure a good night’s rest. Leave time at the end of the day for relaxation, whether its low-intensity yoga, a hot bath, or just some time spent reading a book.
It’s always harder to sleep in a room that’s uncomfortable. Some tips include keeping the temperature reasonably low, ensuring the room is dark, and making sure you have a good mattress supports your preferred sleep position.
A little bit of daily exercise (30 minutes to an hour) helps tire the body and mind, preparing them for rest; it’s essential to get this exercise earlier in the day if possible, as exercise right before bedtime will only cause excitement and may be counterproductive. Avoid exercise in an hour or two before bedtime.
Finally, note that there are many sleep supplements that can help induce drowsiness naturally and holistically. One good example is Melatonin, the hormone that regulates sleep. In addition to taking supplements, there are also steps you can take to regulate your body’s natural melatonin production better.
ADHD can sometimes cause sleeping problems, but these challenges don’t have to be insurmountable and can often be addressed with a few lifestyle changes and your doctor’s help.
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Triple Board- Certified pediatrician, psychiatrist, and child & adolescent psychiatrist and ADHD expert currently working at Rudolph Bolling Psychiatry.