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13. Sleep problems in ADHD


13. Sleep problems in ADHD

About 70% to 80% of all ADHD-affected children1 and 11.3%2 to 29% of ADHD-affected adults (vs. 2.3% of unaffected2 = 5-fold to 12-fold risk) have sleep problems. We estimate the incidence of sleep problems in adult ADHD sufferers to be about the same.

75% of all ADHD sufferers are said to have problems with the circadian sleep rhythm.3 Nevertheless, we cannot follow the conclusion that ADHD is a mere consequence of sleep problems. We assume that ADHD causes sleep problems and that sleep problems increase ADHD symptoms. However, sleep problems alone cannot cause ADHD.

A large study (n = 4,109) of children 0 to 7 years of age found that ADHD sufferers have more sleep problems and subsequently more problems with emotional dysregulation and attention than do nonaffected individuals. At the same time, sleep problems were also found to lead to emotional dysregulation and attention problems in non-affected individuals. However, sleep problems are not the trigger of later attention problems.4

In depression, sleep-through problems are a typical symptom of the internalizing depression subtypes (melancholic or psychotic depression) while daytime sleepiness is strongly correlated with the externalizing subtype of atypical depression. In ADHD, the various sleep problems do not seem to correlate as clearly with specific ADHD subtypes. Data from the ADxS symptom test (as of June 2020, n = 1,889) show that daytime sleepiness is the most common sleep problem in adults with ADHD (about twice as common as problems falling asleep or staying asleep) and is slightly more common in ADHD-I than in ADHD-HI and ADHD-C. Falling asleep problems are more common than sleep-through problems. Both falling asleep and staying asleep problems are also more common in ADHD-HI and ADHD-C than in ADHD-I.

Sleep problems should be treated with special attention and priority in ADHD. If sleep problems occur together with (or are caused by) ADHD, a mutually reinforcing vicious circle develops.
For more details, see ADHD - Treatment and Therapy.

13.1. Problems falling asleep

Falling asleep problems in ADHD are often a consequence of a constant rumination, a never-ending stream of thoughts. This is likely to correlate with inner restlessness.
Several sufferers report that they can fall asleep better with audio books. Furthermore, a small unretarded stimulant dose (1/4 to 1/2 of a single daily dose) can help a small but not insignificant proportion of sufferers to fall asleep.
At times, limb twitching (restless legs), reminiscent of restless legs, also occurs.

13.2. Problems sleeping through

Problems sleeping through the night are said to be among the most common sleep problems in ADHD.5 However, according to our personal impression as well as according to the data of the symptom test, problems falling asleep are somewhat more frequent and daytime sleepiness occurs about twice as often (at least in adults).
Sleep-through problems in toddlers 1 to 3 years of age were a stronger predictor of later ADHD diagnosis than sleep duration.6

Sleep-through problems can be caused by increased alcohol consumption, which is more common in ADHD, among other things to promote falling asleep. Incidentally, sleep-through problems such as low back pain or teeth grinding seem to be influenced by excessive inner tension.

13.3. Sleep problems as symptoms of stress

Sleep disturbances are very common symptoms of severe stress.7891011

Increased wakefulness and decreased deep sleep is a direct effect of the stress hormone CRH.128

Frequent nightmares are also mentioned as a symptom of stress.1011

  1. Winkler (2016), ADHS Medikation mit Valdoxan versus Methylphenidat; Blog adhsspektum

  2. Schlander, Schwarz, Trott, Viapiano, Bonauer (2007): Who cares for patients with attention-deficit/hyperactivity disorder (ADHD)? Insights from Nordbaden (Germany) on administrative prevalence and physician involvement in health care provision; N.Eur Child Adolesc Psychiatry. 2007 Oct;16(7):430-8., zitiert nach Oehler (2009), Vortrag beim 4. ADHS-Gipfel in Hamburg, 06.-08.02.2009

  3. Bijlenga, Vollebregt, Kooij, Arns (2019): The role of the circadian system in the etiology and pathophysiology of ADHD: time to redefine ADHD? Atten Defic Hyperact Disord. 2019 Mar;11(1):5-19. doi: 10.1007/s12402-018-0271-z

  4. Williams, Sciberras (2016): Sleep and self-regulation from birth to 7 years: A retrospective study of children with and without ADHD at 8-9 years. Journal of Developmental and Behavioral Pediatrics, 37(5), pp. 385-394.

  5. Van Dyk, Becker, Byars (2019): Rates of Mental Health Symptoms and Associations With Self-Reported Sleep Quality and Sleep Hygiene in Adolescents Presenting for Insomnia Treatment. J Clin Sleep Med. 2019 Oct 15;15(10):1433-1442. doi: 10.5664/jcsm.7970.

  6. Carpena, Munhoz, Xavier, Rohde, Santos, Del-Ponte, Barros, Matijasevich, Tovo-Rodrigues (2019): The Role of Sleep Duration and Sleep Problems During Childhood in the Development of ADHD in Adolescence: Findings From a Population-Based Birth Cohort. J Atten Disord. 2019 Oct 16:1087054719879500. doi: 10.1177/1087054719879500.

  7. Rensing, Koch, Rippe, Rippe (2006): Mensch im Stress; Psyche, Körper Moleküle, Seite 96, Seite 151, Seite 156

  8. Egle, Joraschky, Lampe, Seiffge-Krenke, Cierpka (2016): Sexueller Missbrauch, Misshandlung, Vernachlässigung – Erkennung, Therapie und Prävention der Folgen früher Stresserfahrungen; 4. Aufl., S. 45

  9. Hebold (2004): Stress und Stressverarbeitung bei Kindern und Jugendlichen, in: Schluchter, Tönjes, Elkins (Hrsg.), (2004): Menschenskinder! Zur Lage von Kindern in unserer Gesellschaft. Band zur Vortragsreihe des Humanökologischen Zentrums der BTU Cottbus, Seite 86

  10. Satow (2012): Stress- und Coping-Inventar (SCI); PSYNDEX Test-Nr. 9006508; Test im Testinventar des Leibniz‐Zentrum für Psychologische Information und Dokumentation (ZPID).

  11. Gruber: Fragebögen zur Stressdiagnostik; Fragebogen 1: Streß-Folgen

  12. Rensing, Koch, Rippe, Rippe (2006): Mensch im Stress; Psyche, Körper Moleküle, Seite 96, Seite 151