Sleep problems are common in adults with ADHD, and the research points to two things: longer sleep onset and a body clock that runs late in many people. A meta-analysis found adults with ADHD took longer to fall asleep and slept less efficiently on movement sensors, and a small study found delayed melatonin onset in those with sleep-onset insomnia. [diaz-roman-2018-adult-adhd-sleep] [vanveen-2010-delayed-rhythm] This guide covers why sleep is hard, what the evidence shows about a late body clock, what helps, and how medication fits in. Our overview of ADHD covers the condition itself.
Why is sleep so hard with ADHD?
Adults with ADHD report more sleep problems, and on movement sensors they take longer to fall asleep and sleep less efficiently. A meta-analysis of 13 studies found that sleep onset latency was longer, with a standardised difference of 0.80, and sleep efficiency lower, at -0.68, in adults with ADHD than in adults without it. [diaz-roman-2018-adult-adhd-sleep]
The same review found that seven of nine subjective sleep measures differed significantly, but that laboratory sleep recordings, called polysomnography, showed no significant differences. [diaz-roman-2018-adult-adhd-sleep] That gap matters. It suggests the problem is real in people’s experience and in movement data, but that the exact underlying sleep changes are not yet pinned down. The authors concluded that sleep problems should be screened for during clinical interviews.
Is a late body clock part of the picture?
For many adults with ADHD and sleep-onset insomnia, it appears so. In a study of 40 adults with ADHD, 31 reported sleep-onset insomnia, and those 31 had a delayed melatonin onset compared with adults with ADHD and no insomnia and compared with healthy controls. [vanveen-2010-delayed-rhythm]
Compared with controls, both ADHD groups took longer to fall asleep and had lower sleep efficiency, and the adults with insomnia also had a weaker 24-hour rest-activity pattern. [vanveen-2010-delayed-rhythm] The authors suggested that the benefit of measures to improve rhythm should be tested. That is a call for more research, not a proven treatment, and it is a study of 40 people.
What helps with sleep when you have ADHD?
CBT for insomnia has good evidence in chronic insomnia generally, and it is a reasonable thing to ask about in ADHD. A review of 20 studies with 1,162 participants found that it shortened the time to fall asleep by about 19 minutes, the time awake in the night by about 26 minutes and improved sleep efficiency by about 10 percentage points, with changes that seemed to last and no adverse outcomes reported. [trauer-2015-cbti]
Those trials were not specific to ADHD, so the evidence in ADHD is thinner. The main elements of CBT for insomnia are a consistent sleep schedule and keeping the bed for sleep.
| Element | What it asks of you | A common snag with ADHD |
|---|---|---|
| Consistent wake time | Get up at the same time every day, including weekends | Evenings feel productive, so bedtime keeps slipping |
| Bed for sleep | Use the bed for sleep, and get up if you cannot sleep | Phones and tasks follow you into bed |
| A wind-down | A fixed stretch of calm before bed | Hard to stop a task in the middle |
The first two rows are the core of the approach. The third column is an illustration of where ADHD can get in the way, and is not a research finding. Our guide to sleep hygiene covers the basics.
A ten-minute shutdown
Pick a time about half an hour before bed. Write down the first task for tomorrow, so it is out of your head, then dim the lights and stop starting new things.
5:00
The point is to hand the open loops to a page so your mind can stop holding them. If you feel wired afterwards, do something quiet and low-light and try again tomorrow at the same time.
Done. Notice whether it was easier to stop tonight.
Can ADHD medication affect sleep?
Yes, timing and type can matter. A stimulant taken too late, or a long-acting one in someone who clears it slowly, can disturb sleep, and insomnia from medication can look like worsening ADHD. Our guide to stimulant and non-stimulant medication covers how the choices differ, and ADHD medication explained covers what medication does and does not do.
Raise sleep problems with the person who prescribes your medication, and do not change the dose or the timing yourself. They can look at whether the dose, the formulation or the time you take it is part of the problem.
When to seek help
Speak to a doctor if you have trouble sleeping most nights over a few weeks, if you are exhausted in the daytime, or if sleep problems are affecting your work or mood. Loud snoring with pauses in breathing needs a different assessment, so mention it. Our insomnia self-assessment is a screener and not a diagnosis, and it can help you decide whether to have that conversation. Our guide to ADHD in adults covers what an ADHD assessment looks at.
No screener on this site measures ADHD, and we would rather say so than point you at one that measures something else. If you feel unable to keep yourself safe, contact your local emergency services or a crisis helpline.
How MyFreud can help
Whether a change to your evenings is helping is hard to judge from memory. Daily mood tracking in MyFreud shows the pattern across weeks, so you can compare days after better and worse nights. It does not diagnose ADHD or a sleep disorder, and it does not replace speaking to a doctor.
Download MyFreud and start today: App Store or Google Play.