Key takeaways
- People with ADHD often struggle with getting adequate sleep.
- ADHD often co-exists with specific sleep disorders which may need to be dealt with seperately.
- Having ADHD itself impairs the ability to self-regulate and develop a consistent sleep routine.
- Getting enough sleep is a foundational aspect of managing ADHD, which needs to be addressed.
My personal experience
I am now approaching my mid-forties. Since my late teenage years, I endured frequent and chronic bouts of severe insomnia and sleep disturbances, often going for months on end without more than a couple of hours of sleep a night.
The mental toll this took was extreme at times, resulting in personal and professional consequences, as well as other knock-on health effects that needed to be addressed for a while. I felt completely drained of energy and hope, and I became very detached from reality. Sleep deprivation is a form of torture for a reason.
Sleeping tablets were offered and sometimes taken when it became too much to endure staring at the ceiling for hours on end. However, the quality of sleep I got while taking them often felt worse than having any “natural” sleep at all, brief as it was. I’d given up all hope that it could get better, I'd been going to doctors, trying multiple routines and supplements which promised miracles for years.
A decade after my ADHD diagnosis, things finally changed when I embraced ADHD and managed it in new ways. I was convinced I was a natural “night owl” and would never fix it, but that wasn’t true. I was oblivious to many aspects of ADHD, including understanding the impact on my ability to sleep and led me to new understanding and ways of operating that ultimately improved things drastically.
I now get a fairly consistent 7.5 hours of sleep each night and have done so for over a year, a feat I once believed would never happen after decades of broken and sometimes non-existent rest. There are occasional exceptions when I briefly revert to a few bad nights, but I can pinpoint what caused it and get back on track.
What drives ADHD and sleep challenges
I see this challenge with almost all of my clients, usually for one of two reasons:
1 . ADHD and associated Sleep Disorders
- ADHD is highly associated with one of several sleep disorders. I was diagnosed with Delayed Sleep Phase Disorder (DSPD) years before my ADHD diagnosis. Often, these conditions are treatable, often in natural ways if diagnosed.
2. ADHD Impacts and Sleep Challenges
- Many people with ADHD who could sleep if they tried simply struggle to establish any boundaries or routine around getting to bed in time, as a direct consequence of the impacts seen with a lack of understanding or unmanaged ADHD. They often believe it’s simply not possible to sleep in a “normal” way.
- Some with ADHD report they’d rather stay up late when the rest of the world has left them alone for the day, because they find comfort in that quiet time.
Whatever the cause, the result is a vicious cycle of trying to fit into a world trying to manage and work to improve ADHD challenges, while also coping with fatigue and sleep debt, making it seem like a futile effort.
1. ADHD and associated Sleep Disorders
A recent study, published in the Journal of Attention Disorders, found that 60% of adults with ADHD also had a sleep disorder, with 36% presenting with more than one, specifically:
- 36% had a circadian rhythm disorder, such as Delayed Sleep Phase Disorder (DSPD), which prevents them from initiating sleep for hours due to their internal circadian clocks being delayed.
- 31% reported insomnia, due to an inability to shut down their restless, racing minds at night, even if they go to bed on schedule.
- 29% experienced restless leg disorder (RLD).
Personally, the first two applied to me. Even when I was getting what I considered “good” sleep at the time, it would still be at least 2am before I fell asleep. The combination of my delayed sleep cycle and restless mind, worsening the longer these bouts continued, made it feel like mental torture.
2. ADHD Impacts and Sleep Challenges
Aside from any recognised condition, two of the core ADHD challenges of self-regulating actions (not being able to muster the motivation to do what you intend to, even though you know you should and want to) and the deeply impaired sensing and activating to the passing of time can cause chaos. These core features of ADHD can impact being consistent with sleep routine, even if a formal sleep disorder is not present.
Because people with unmanaged ADHD struggle to form consistent routines and habits, they often find it hard to stick to any regular bedtime. Even if they manage to do so for a while, any disruption can derail them completely. Without an awareness of how ADHD disrupts self-observation and reflection, trying again after a setback can feel futile and spew more negative self-talk that you're just broken.
After years of this, many simply decide they’re natural “night owls” who’ll never be able to establish a sleep routine, so they stop trying altogether.
Some report a different obstacle: their ADHD is not well managed during the day, so late-night hours feel like their only chance to be alone. Often referred to as “bedtime procrastination”. Even if they have a busy morning schedule, they might stay up far longer than they know they should because that quiet window is so comforting, they finally get time to engage in activities purely for themselves, making it the only relaxing part of their day.
How might you try to get the sleep you need with ADHD?
If any of the above patterns ring true, you might wonder what practical steps you can take. The good news is that various methods can make a real difference, even if it may feel daunting.
The temptation can be to try what the internet prescribes such as self-medicating with melatonin or supplements such as magnesium, only for no results to be seen, it may be more useful to pinpoint the cause of the sleep challenges before trying to solve anything alone.
1. If you can’t sleep, even when you try
- If you suspect a sleep disorder of any kind, such as delayed sleep phase disorder, insomnia, or restless leg syndrome, consult a medical professional.
- A discussion with a doctor or a sleep specialist can confirm whether there is an underlying condition that needs specific treatment, and is unlikely to magically resolve itself.
- Many of these conditions have highly effective interventions that can dramatically improve your night-time rest and daytime energy, giving you more control over moving ahead with your ADHD challenges.
2. If you struggle to establish a routine or don't want to get into bed on time
If your sleep challenges are behavioural, there are several interventions that can help. If you’ve tried all the usual “sleep hygiene” tips without success, consider the following:
- Learn about ADHD
- Many people with ADHD do not fully understand how the condition sabotages them. In my view, ADHD education is the single most important aspect of managing ADHD, allowing you to take steps to make changes on your own terms.
- Other interventions, such as setting boundaries around what you do in the evening, exercise and exposing yourself to sunlight in the morning, are useful to experiment with, but without understanding the root of the behaviours, it’s easy to fall into a cycle of usual negative self-talk people with ADHD are prone to assault themselves with, “I tried, I failed, I am hopeless.”
- Learning about the condition can free you from that loop and help you see new possibilities and take action to do something different with some clarity.
- Consider working with specialists
- Professionals such as cognitive behavioural therapists or sleep specialists can help address both the physical and psychological aspects of sleep difficulties.
How ADHD Coaching can help with sleep
I often work with individuals who are caught in an endless cycle of not sleeping and being exhausted the next day.
While coaching is not a replacement for more specialised interventions where needed, it can help identify and improve the behavioural aspects of sleep, particularly in developing an understanding of how ADHD may be robbing them of perspective, and in putting systems in place to regulate how their evenings wind down.
At times, clients are simply unaware of everything that is happening around them, including the unfiltered noise they allow to creep into the end of their days. This impedes their chances of sleeping on schedule, or they may not yet believe they could trust themselves to establish new routines, never mind figure out how to do it.
They often say, as I once did, that they can never change or form any good habits at all, with sleep being just one of them.
In fact, the part of the brain associated with habit formation isn’t the issue in ADHD. Instead, frontal lobe differences seen with ADHD make it difficult to establish these habits in the first place, particularly when you lose sight of any progress over time.
A solid sleep routine is frequently a core building block for supporting other areas. Simply put, ADHD is challenging enough, and being exhausted only fuels more self-doubt and pain.
Building awareness and introducing supports on your own terms, which prove you’re capable of achieving what once felt impossible, can be the different approach that starts to work for you. Through support, you can begin to build new ways of operating, on your own terms.
ADHD Coaching is not about being told “what to do”, that will never work. Prescribing knowledge to someone with ADHD is a complete waste of time; the problem isn’t knowing what you should be doing, it’s understanding your challenges and how you might start doing what you already know you want to do.
Coaching provides a collaborative space to explore the condition and how it shows up for you. With help and support, you can begin to see things differently and can be guided as you experiment with clarity, pragmatically tackling your challenges with support.
Routines, including how the day starts and ends, are often at the core of managing this condition day to day and moving forward in a more holistic way.
