Some research studies indicate that people suffering predominately from inattentive symptoms tend to experience a later bedtime and poor sleep quality. “ADHD adults with combined hyperactive-impulsive and inattentive symptoms have decreased sleep quality as well”.
People diagnosed with the less common hyperactive-impulsive type are more likely to experience insomnia e.g. waking up several times during the night, feeling tired and irritable the next day.
What is the circadian rhythm?
Our bodies relies on an internal clock called the circadian rhythm, which regulates various stages and body functioning. This includes the sleep-wake cycle, digestion, hormone production at specific times. This complicated system operates on a 24-hour cycle, influenced by light, darkness, temperature, food and many other factors.
How does the circadian rhythm disorder manifest in ADHD?
In adults, it can manifest in several ways, often mimicking or amplifying some of the inattentive and hyperactive-impulsive symptoms. Some examples: are concentration difficulties, reduced motivation, cognitive difficulties or increased impulsivity.
More common the symptoms are recognised as delayed sleep onset, waking up late, or experiencing an unpredictable sleep cycle. Quite often some students, report functioning better by studying late at night and sleeping during the day. Although this may work temporarily, can become an impediment when transitioning into employment.
Why do Adults with ADHD experience sleep issues?
Nobody knows the exact cause and may be likely multifactorial. It appears that several factors may contribute to the increased prevalence:
Brain Differences: The brain pathways involved in regulating attention, focus, and impulse control in ADHD may play a role in sleep regulation. Dysfunction in these connections can lead to a disrupted sleep cycle.
Melatonin imbalance: Melatonin is the hormone which is the part responsible for sleep initiation and maintenance. One theory is that with less time spent outdoors, people may experience less melatonin production. Some studies assessed the effect of chronotherapy on circadian rhythm sleep disorder in ADHD.
Genetic Predisposition: Some studies suggest a genetic link between ADHD and circadian rhythm sleep disorder, also known as the “CLOCK master gene”.
Lifestyle Factors: Poor sleep hygiene habits and excessive screen time can disrupt the circadian rhythm in individuals with ADHD. Diet and nutrition may play a role in the onset and quality of sleep, although more research is needed.
Many people may not be aware of the link between narcolepsy and ADHD.
Narcolepsy is a sleep disorder characterised by excessive daytime sleepiness. The experience of feeling sleepy or tired during the day can also be a common symptom of adult ADHD. The ongoing fatigue can sometimes be mistaken for laziness or lack of motivation.
Research suggests a significant connection between the two conditions. Studies show that people with narcolepsy are more likely to experience symptoms of ADHD, with a prevalence rate between 15-30%.
Narcolepsy presents with a range of symptoms, including:
Excessive daytime sleepiness: usually the first symptom of narcolepsy which has a significant impact on the quality of life. Feeling tired throughout the day, and struggling to stay alert affects the performance at work. This can be misjudged by the untrained eye as being lazy or rude.
Changes in (REM) sleep: This can manifest as vivid dreams or nightmares that occur upon falling asleep or waking up.
Sleep paralysis: This temporary inability to move or speak while falling asleep or waking up.
Hallucinations: These can occur during sleep transitions (hypnagogic - when falling asleep) or (hypnopompic - when waking up) and can be visual or auditory.
Cataplexy: This involves sudden attacks of muscle weakness triggered by strong emotions like laughter, anger, or surprise.
In some situations, respiratory medical conditions alongside ADHD may be the reason for disturbed sleep at night. Having a specialist psychiatrist in ADHD working in conjunction with a respiratory consultant and a consultant neurologist may be the appropriate approach to tackle this situation.
Some conditions requiring additional expertise:
We are accepting new patients with a minimum 2hour assessment, beyond understanding the ADHD symptoms, this involves a detailed conversation about your sleep history.
ADHD symptoms: we will develop a deep understanding on how impactful are the inattentive and hyperactive symptoms on your day to day life. Consider your views about trialling a non-medication approach, or consider treatment options which are not impacting your sleep.
Medical history: we will review your history to identify any underlying symptoms or conditions alongside ADHD, that may contribute to your sleep problems, such as anxiety, depression, hypersensitivity to noise.
Sleep patterns: we will ask about your sleep routine, bedroom setup, how long it takes to fall asleep , quality of sleep, how many times you wake up during the night. Where available, with your consent we can enquire about your sleep patterns and quality from your partner.
Daytime symptoms: explore how the sleep issues affect your quality of life, productivity and assess levels of fatigue, focus and how the symptoms may affect your work and relationships.
Suppliments and medications: we will carefully assess the supplements and if applicable medication you take, and how these may affect your sleep patterns, stages of sleep or overall quantity.
If the sleep disorder is linked to an underlying medical or mental health condition, such as anxiety, depression, or is medication induced we may need to address those issues first. This can involve medication adjustments, referring you to a specialist consultant to treat the underlying physical health condition, or therapist referral for treatment.
Our approach towards experiencing a better sleep at night, is to adopt sustainable solutions. Therefore, we prioritise non-medication techniques towards developing a healthy sleep habits.
These strategies may include:
Based on your individual needs, travel schedule, lifestyle and daily challenges we will create a personalised treatment plan. This plan will start with non-medication strategies and medication is considered only if necessary. Throughout your treatment, we will listen to your feedback and adjust the plan as needed.
If your sleep disorder is complex or treatment resistant it may require additional expertise. We can collaborate with other healthcare professionals, such as your GP and recommend a sleep specialist, respiratory consultant, neurologist to ensure you receive comprehensive care.
Sleep is one of the most important factors contributing to good mental health. It is one modifiable factor which can lead to better mental health. While there is no single "magic cure" for all sleep conditions, with a holistic approach, you can be in control and improve your overall well-being.
Note: symptoms adapted from the DIVA-V Manual- The Diagnostic Interview for ADHD in adults.
Medication options adapted from the ADHD Specialist Medication Management Policy.
Disclaimer: The information is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content, and information, contained in this article is for general information purposes only and does not replace a consultation with your own doctor/health professional. Information about mental health topics and treatments can change rapidly and we cannot guarantee the content's currentness.
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