Achieving Sleep with ADHD

Author: Ella Lym

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Introduction
Sleep plays a vital role in every person’s mental health and physical well-being. Individuals with Attention-Deficit/Hyperactivity Disorder (ADHD) in particular often face difficulties with quality sleep, which leads to daytime challenges as well. Research displays a reciprocal relationship between the neurodevelopmental disorder and sleep cycles. As a result, the “perfect storm” of the two compromises focus, impulse control, and emotional regulation. Understanding the connection between Attention-Deficit/Hyperactivity Disorder and sleep is key to supporting healthier routines and better functioning for those with ADHD.

The Cycle
ADHD is the most prevalent neurodevelopmental disorder, most common among adolescents, and includes symptoms such as inattention, hyperactivity, and impulsivity. The disorder interferes with cognitive function and affects daily life from school and work to relationships. 
Sleep, in turn, supports the cognitive functions that ADHD affects. These include, but are not limited to, memory, emotional regulation, and executive function. Therefore, disrupted sleep exacerbates ADHD-related symptoms. Further. ADHD affects sleep as well, and the combination forms a tiresome cycle.

The Link
ADHD affects the quality of sleep that individuals receive throughout the night through various means. As explained in a review titled, “The ADHD and Sleep Conundrum: A Review,” “Prolonged sleep onset latency, manifested clinically as difficulty falling asleep and/or bedtime resistance, and restless or fragmented sleep are especially problematic for children with ADHD and may result in significantly shortened sleep duration and insufficient sleep as well as decreased total sleep efficiency,” (Owens, 2005). From the moment individuals with ADHD close their eyes, they experience countless sleep disturbances. Notably, as Owens emphasizes, individuals with ADHD, namely children, struggle to achieve quality rest essential for healthy neurodevelopment and cognitive function. 

Furthermore, the consequences of poor sleep extend well beyond the night. Owens explains that “insufficient and poor-quality sleep result in daytime sleepiness and behavioral dysregulation and affect neurocognitive functions in children, especially those functions involving the prefrontal cortex,” (Owens, 2005). Therefore, ADHD disrupts nighttime regulation, and as a result, a poor night’s sleep lingers throughout the daytime as well. In addition to common side effects of a restless night, such as mood instability and difficulties with attention, it further impedes an individual’s ability to manage ADHD-specific symptoms. Together, ADHD and sleep can form a cycle of mutual disruption.

Solution
Beyond restful purposes, sleep acutely mediates mental wellbeing, from emotional stability to attention. Therefore, for individuals with ADHD, healthy sleep habits are particularly essential. 
Research identifies pharmacological and nonpharmacological solutions to a better night’s rest. Among the non-pharmacological options, four core areas that support strong sleep routines, improve sleep quality, and reduce ADHD symptoms.

Firstly, follow the same sleep and wake schedule every day. The article, “Benefits of a bedtime routine in young children: Sleep, development, and beyond,” highlights “a bedtime routine is associated with positive sleep outcomes, including an earlier bedtime, decreased sleep onset latency, reduced nighttime awakenings, increased sleep duration, and enhanced caregiver-reported sleep quality,” (Mendell & Williamson, 2017). Regular sleep patterns improve restfulness and allow individuals with ADHD to experience more stable sleep and stronger daytime focus.

Second, design a non-disruptive sleep environment. Sleep in a dark room with minimal noise and a comfortable temperature. Such conditions support deep, restful sleep. Research also highlights the benefits of weighted blankets, especially for children with ADHD. In the article, “Experiences of Using Weighted Blankets among Children with ADHD and Sleeping Difficulties,” it’s stated that “weighted blankets have a calming effect through sensory pathways, reducing hyperarousal, stress, and anxiety and reducing fear responses through safety signals of deep pressure,” (Lönn et al., 2023).

Third, try to reduce pre-sleep tension or stress. Relaxation methods, such as meditation and non-screen activities, before bed calm the mind and prepare the body for sleep. Additionally, as written in “Screen use before bedtime: Consequences for nighttime sleep in young children,” the authors advise you to “...omit screen use at least thirty minutes before bedtime. Screen use results in less melatonin production …increases sleep onset latency and shortens nighttime sleep duration” (Lönn et al..  2021). To explain, reduced screen exposure before bed supports melatonin release, allows quicker sleep onset, and improves sleep depth.

Lastly, follow helpful dietary and lifestyle changes. Consume healthy meals at regular times, avoid caffeine, alcohol, and large meals before bed, and exercise daily (Cusick et al., 2020). All in all, individuals with ADHD who incorporate such changes may experience improved sleep habits and better quality life day-to-day.

Works Cited and Additional Links
Cusick, C. N., Lisdahl, K. M., Kooij, S. J., Becker, S. P., & Stevens, M. C. (2020). Caffeine use and associations with sleep in adolescents with and without ADHD. Journal of Pediatric Psychology, 45(6), 643–653. https://doi.org/10.1093/jpepsy/jsaa033

Gooneratne, N. S., & Vitiello, M. V. (2014). Sleep in older adults. Clinics in Geriatric Medicine, 30(3), 591–627. https://doi.org/10.1016/j.cger.2014.04.007

Lönn, M., Gustafsson, L., Hermansson, L., & Larsson, A. (2023). Experiences of using weighted blankets among children with ADHD and sleeping difficulties. Occupational Therapy International, 2023, 1–12. https://doi.org/10.1155/2023/1945290

Mindell, J. A., & Williamson, A. A. (2018). Benefits of a bedtime routine in young children: Sleep, development, and beyond. Sleep Medicine Reviews, 40, 93–108. https://doi.org/10.1016/j.smrv.2017.10.007

Owens, J. A. (2005). The ADHD and sleep conundrum: A review. Journal of Developmental and Behavioral Pediatrics, 26(4), 312–322. https://doi.org/10.1097/00004703-200508000-00011

Sharon, D. (2015). Nonpharmacologic management of restless legs syndrome (Willis-Ekbom disease). Sleep Medicine Clinics, 10(3), 263–278. https://doi.org/10.1016/j.jsmc.2015.05.018

Staples, A. D., Bates, J. E., Petersen, I. T., & Schermerhorn, A. C. (2021). Screen use before bedtime: Consequences for nighttime sleep in young children. Infant Behavior & Development, 62, 101522. https://doi.org/10.1016/j.infbeh.2020.101522