13. Sleep problems with 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 nonaffected 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 correlates strongly 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 is created.
For more details, see ⇒ ADHD ADHD - treatment and therapy.

• 13.1. Problems falling asleep
• 13.2. Problems sleeping through
• 13.3. Sleep problems as symptoms of stress

13.1. Problems falling asleep¶

Falling asleep problems in ADHD are often a result 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 ADxS.org symptom test, problems falling asleep are slightly 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 may be caused by increased alcohol consumption, which is more common in ADHD, partly to promote falling asleep. Incidentally, sleep-through problems such as low back pain or teeth grinding seem to be influenced by excessive internal 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