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ADHD and Sleep

by Jennifer Moore, Psy.D. & Zachary Stern, Psy.D.

According to the CDC and the National Sleep Foundation, adults require 7-9 hours of sleep per night for optimal functioning. School-aged children and adolescents require even more sleep, with recommendations ranging from 8-12 hours per night. Despite its absence from the ADHD diagnostic criteria, sleep issues are an extremely common feature associated with ADHD. Research has shown that sleep issues are found more in those with ADHD than in the general population. In fact, some studies have reported that up to 75% of individuals with ADHD experience some type of sleep problem.

Five Facts about Sleep Issues and ADHD:

1. The first category of sleep problems includes formal sleep disorders. This includes Restless Legs Syndrome, Periodic Limb Movement Disorder, Sleep Disordered Breathing, and Circadian Rhythm Disorders.

2. The second category is broader and includes a range of sleep disturbances. Included in this category are trouble falling asleep or staying asleep throughout the night, difficulty winding down at night, nightmares, and poor quality or insufficient amount of sleep. Furthermore, this category includes anxiety around bedtime, and unhealthy sleep-wake reversals.

3. Sleep disorders and disturbances can have serious and persistent negative effects on our overall functioning. These issues can exacerbate many of the primary ADHD symptoms, such as decreased attention span and engagement, increased distractibility, hyperactivity, and poor inhibitory control. Similarly, sleep issues can have a serious impact on mood stability, self-regulatory functions, and various body systems, such as appetite.

4. The relationship between Sleep and ADHD is complex. Sleep problems can be a symptom of ADHD. Sleep problems can make ADHD symptoms worse. And ADHD can exacerbate pre-existing sleep issues. It’s a vicious cycle!

5. Individuals with ADHD often have comorbid diagnoses, including anxiety, depression, or substance abuse. These comorbid disorders often pose a serious threat to healthy and reliable sleep, which only serves as a further challenge to individuals with ADHD.

In order to counteract these dysfunctional sleep issues, individuals with ADHD are encouraged to engage in good sleep hygiene. Sleep hygiene is the practice of engaging in strategies and developing habits that are conducive to sleeping well on a regular basis. A comprehensive sleep hygiene plan includes not only nighttime strategies, but healthy daytime habits as well. Below, we will lay out the Dos and Don’ts for effective sleep hygiene throughout the day:

    Daytime Strategies

Dos:
• Get up at the same time each day
• Expose yourself to sunlight during the day, especially in the morning
• Exercise during the day (up to 3 hours before bedtime)

Don’ts:
• Avoid daytime naps
• Avoid stimulants
• No caffeine past the morning
• Consult with your doctor about your stimulant medication if you’re having sleep problems

    Nighttime Strategies

Dos:
• Develop a routine and set time at which you will start winding down for the night and a target bedtime
• Engage in quiet and relaxing activities before bed
• Make your bedroom environment comfortable (ex. think about temperature, sound, light)
• Use your bed for sleeping and sex only

Don’ts:
• Don’t use electronics one hour before going to sleep
• Don’t eat a large meal before bed
• Don’t drink alcohol or smoke before going to sleep
• Don’t consume an excessive amount of liquid before bed

If you or a loved one has struggled with sleep issues, we encourage you to choose 2-3 new strategies for both daytime and nighttime to try out. Do an experiment, and try engaging in these strategies for two full weeks. Give it an honest try and you might find that your overall functioning is taking a positive turn in the right direction!

(Dr. Moore and Dr. Stern recently presented the above information to a local chapter of CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder)).

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