ADHD and Sleep
Despite popular belief, most ADHD medications do not cause sleep problems. In fact, methylphenidate and the long-acting atomoxetine can actually improve sleep.
Adults with ADHD can still struggle to fall asleep. They twirl and change positions and wake up often. Even when they do finally go to sleep, their minds are still active.
Medicines
A large percentage of adults suffering from ADHD report sleep problems. These issues are not often mentioned in the scientific literature, but they are quite common. Parents, patients and healthcare professionals often describe difficulties falling or staying asleep, waking at night and nocturnal activities, as well as sleepiness throughout the day. Objective measures, including polysomnography and actigraphy and subjective measures (eg, self-rated questionnaires and diaries) have demonstrated statistically greater sleep problems in people with ADHD compared to controls.
The most frequently prescribed medication for ADHD is stimulant class medication. These can improve focus and concentration, but may interfere with sleeping for some patients. In fact, it is recommended that the main sleep disorder, such as narcolepsy, be ruled out prior to starting these medication (Spruyt and Gozal 2011).
Stimulant-class drugs can trigger an abrupt increase in wakefulness and an increase in the efficiency of sleep. The sleep disturbances may be caused by a decrease in the production of melatonin or directly affecting the nervous system. Additionally, stimulants may trigger a sedating side effect, which can cause paradoxical agitation in some people.
A controlled, randomized study of ramelteon, an agent that stimulates the melatonin receptor, and is believed to regulate circadian rhythms, found that insomnia was reduced in those suffering from ADHD treated with this drug compared to placebo. This was a tiny preliminary study with only a small amount of power and very only a few controls, but it could inspire future studies to further explore dosing, timing, studying the sleep patterns and levels of blood during the daytime of ramelteon and its metabolites.
Clonidine, mirtazapine and trazodone are other medications that have been used in the treatment of insomnia among some people with ADHD. However, they aren't as well studied and many clinicians prefer to avoid them in people who suffer from ADHD due to their potential for sedation that can last into the next day.
If someone who suffers from ADHD has insomnia, they should make an effort to maintain good sleep hygiene. They can also take their ADHD medication 45 minutes prior to the time they go to bed. In my practice this method is generally successful for most people with ADHD and sleep issues. If it doesn't work, the melatonin supplement may be tried.
Diet
The kind of food a person eats can have an immediate impact on their mood. A balanced and nutrient-rich diet can help improve ADHD symptoms, including those associated with sleep. Foods should be low in processed fats and sugars and rich in nutrients, such as fruits, vegetables lean proteins, whole grains and healthy fats, including omega-3 acid fatty acids. Cooking at home is an excellent method to ensure that meals are filled with all the essential ingredients for good health However, many people suffering from ADHD have trouble planning meals and cooking difficult. In these instances the majority of people rely on take-out or restaurant meals which are high in sodium artificial ingredients, as well as sugar.
People with ADHD are unable to fall asleep at night. In fact, sleep problems are the most common complaints that people with ADHD report. These sleep problems can cause an improvement in the quality of life as well as an increase in stress, depression, anxiety, and, in women over age 40, menopausal symptoms including hot flashes.
Sleep problems may be caused by a variety factors including signs of ADHD or other causes. Certain medications used to treat ADHD like methylphenidates could cause sleep issues in some people. Additionally, those with ADHD tend to have smaller pineal glands, that can affect how the body regulates its circadian rhythm.
Doctors usually recommend a mix of treatment option to help people with ADHD sleep better. This includes creating an established routine for sleeping, optimizing your sleeping environment (such a creating a quiet and dark bedroom) and limiting time spent on screens prior to going to bed. Adults should also make sure they get enough sleep, which typically is 7-9 hours a night.
Exercise can help people with ADHD sleep better. Before bed taking a few minutes of gentle stretching and deep breathing exercises can to relax the body and mind. This will result in an improved night's sleep.
Exercise
Some individuals who suffer from ADHD struggle to maintain a fitness routine. A personal trainer can provide the structure, motivation, and accountability while incorporating the person's preferred type of exercise into a fitness routine. Aerobic exercise can provide physical and mental advantages. Strength training and mind-body exercise such as Tai Chi, yoga, or breathing exercises can be incorporated into a daily routine for a holistic approach in managing ADHD symptoms.
In addition to helping people shed weight and build muscle mass, exercise can also have other positive effects on the brain, like increasing levels of norepinephrine as well as dopamine. Norepinephrine, a neurotransmitter, aids in self-control and concentration, and dopamine is a neurotransmitter that boosts levels of norepinephrine. Exercise also stimulates the development of neurons and strengthens connections between them. This is particularly evident in the cerebellum, an area that may contribute to fidgeting among some ADHD people. Research has shown that the sport of judo can increase dopamine and norepinephrine in the cerebellum. This is greater than running on a treadmill.
Medications used to treat ADHD can have adverse side effects, including decreased sleep. It's important that a person discuss their medication with a physician or health professional, and establish healthy sleep habits.
Many people with ADHD struggle to fall asleep. They may wake often, toss and turn, or slip into what some call "the sleep of the dead." Their minds restlessly wander from one thought to another until they finally close off their day-to-day activities and drift into a peaceful sleep.
In my practice, I've observed that at least 80 percent of my patients who have sleep issues have this pattern. These issues aren't a result of ADHD they are a major component of the disorder. Adults suffering from ADHD may have difficulty maintaining an accurate internal clock and this could be a contributing factor to their difficulty falling asleep. Additionally they may have difficulty determining the amount of time they've spent in the bed. In reality it is common for a sleep study to requires several nights of nightly sleep logs and is difficult for someone with ADHD to do accurately.
Sleep Environment
Getting quality sleep is challenging for all people, but it's especially difficult for those who suffer from ADHD. It is difficult to fall asleep or relax because of the agitation and racing mind that are associated with ADD. Many of the medications prescribed to treat ADHD have negative side effects that can disturb sleep, like insomnia. Therefore, it is essential that those suffering from ADHD practice good sleep hygiene and set a regular schedule. They should also establish an energizing, peaceful bedroom environment.
Sleep disorders can also interfere with the ability of those with ADD to get enough restful sleep. a fantastic read include sleep apnea (in which breathing ceases intermittently during the night) and anxiety, depression and for women over 40, menopausal issues like night sweats. People with ADHD must always have their sleep problems evaluated by a medical professional in order to determine the root cause.
Research has proven that those who suffer from ADHD experience poorer quality sleep than their peers, and are more likely to report feeling tired and unfocused during the day. This is due in part to the erratic nature of their sleep, which is exacerbated by their difficulty regulating their internal circadian clock. It is also possible that the sleep issues are a result of medications that cause side effects or comorbid conditions.
Inability to settle to sleep and the frequent awakenings throughout the night are common for those with ADD particularly those who are treated with stimulants. In fact, the latency of sleep onset and sleep efficiency have been reported to be significantly worse for those who are taking stimulants when compared to people who take placebos in a few studies.
Despite this, some people find that taking their ADHD medication prior to bedtime helps to improve sleep. This should be done under the guidance of a doctor as certain medications can trigger sleep disorders. Other methods that promote sleep, like progressive muscle relaxation -- where you relax and tensen your muscles - and deep, slow breathing could be beneficial for people with ADHD. It's also an excellent idea to make your bed solely to sleep or for sex and to avoid using it for a place to talk about problems or argue.