Never-Never-Ever Land
Why don’t people with ADHD sleep well, long, or easily? We surveyed more than 3,000 ADDitude readers to find out what keeps them up at night, and what helps to quiet their ADHD brains.
To function reliably, your brain and body need seven to eight hours of sleep each night. Yet one in five adults with ADHD sleeps less than half that much. On average, they get just five hours and 51 minutes of continuous sleep each night. And it shows.
According to a recent ADDitude survey of 2,156 adults with ADHD, poor sleep is as common as it is deleterious.
What Happens If You Don’t Get Enough Sleep?
- 91% of respondents said they experience changes in mood, concentration, memory, and/or energy level due to poor sleep quality.
- 85% of respondents said they worry about the consequences of poor sleep quality on their work, academics, and/or relationships.
- 80% said they suffer from fatigue every day.
- 68% said they have experienced an adverse event (e.g., job loss, car accident) due, at least in part, to poor sleep quality.
- 49% said they wake up at least once every night.
- 36% said they have difficulty waking up each morning.
Do Kids with ADHD Have Trouble Sleeping?
The scorecard is scarcely better for children with ADHD. They sleep just seven hours and 28 minutes each night, on average, according to 940 caregiver survey responses. Children aged 6 to 12 should get at least nine hours each night, and teenagers should sleep at least eight hours. Less than half of teens with ADHD hit this benchmark, according to the survey.
About one in five children and teens with ADHD go to bed after midnight and 73 percent take 30 minutes or more to fall asleep each night, according to the survey. What keeps kids awake? Screens, racing thoughts, and anxiety, their parents report.
[Get This Free Download: Sound Sleep Solutions for Kids with ADHD]
Nearly half of caregivers said their child has always been a bad sleeper and one-third said their child’s sleep has gotten worse, not better, with age.
“Our kiddo has been a poor sleeper since birth,” wrote one parent. “He would fuss for hours or take at least 60 minutes to settle down, and bath time would rev him up not calm him down. We even hired a sleep coach, but it didn’t make a difference. Now, at age 10, bedtime causes him severe anxiety. He gets violent (punches, ruins things, dumps shampoo and stuff on the floor, swears, threatens, throws things and purposefully hurts us, and refuses to go to bed).
“He also purposefully wakes himself up during the night so he can’t wake up for school in the morning (drinks too much water so he has to use the restroom, sets alarms for the middle of the night, sneaks Legos into his room and stays up late playing or reading, etc.). We’ve tried medication, meditation, back rubs, stories, wall climbing a few hours before bed, setting up a blow-up bed in our room, changing the bedtime routine, sticker charts, rewards, books on tape, sleep music, etc., and nothing works. We’ve had to strip his room of all toys, objects, shampoo, toothpaste, and books. After the meltdowns come shame and remorse, but no sleep.”
Sleep Disorders and ADHD
The scope and severity of the adverse ADHD-sleep relationship is clear, but its causes are murky – and myriad.
[Get This Free Download: The Sleep Disorders Linked to ADHD]
Research shows that several diagnosable sleep disorders show up more often in people with ADHD. Here are the disorders most frequently cited by respondents in our survey.
| Sleep Disorder | What Is it? | Symptoms | Treatment/Management |
|---|---|---|---|
| Chronic Insomnia Adults: 34% Kids & Teens: 26% |
Ongoing difficulty falling or staying asleep | Trouble sleeping and/or early waking, leading to daytime fatigue, impaired memory, irritability | Cognitive behavioral therapy for insomnia (CBT-I), sleep hygiene, medication |
| Delayed Sleep Phase Syndrome Adults: 28% Kids & Teens: 32% |
Circadian rhythm sleep-wake disorder typified by bedtimes/wake times that are much later than desired | Difficulty falling asleep at a typical bedtime, leading to late wake times and/or daytime sleepiness, trouble concentrating | Resetting sleep routine with sleep hygiene, melatonin supplements, and light therapy |
| Obstructive Sleep Apnea Adults: 25% Kids & Teens: 9% |
Breathing disorder in which throat muscles relax, blocking airway, causing breathing lapses during sleep | Heavy snoring, choking or gasping during sleep, morning headaches, excessive daytime fatigue | Continuous positive airway pressure (CPAP) device, oral appliances including mandibular advanced splint, medication, surgery |
| Restless Legs Syndrome Adults: 21% Kids & Teens: 13% |
Discomfort in legs that worsens at night or when lying down and disrupts sleep | Itching, prickling, pulling, or crawling sensation in legs, creating urge to move | Pneumatic compression devices, exercise, sleep hygiene, medication |
An important point: These comorbid conditions were no more common among people taking stimulant medication than they were among those taking no medication at all. In fact, the survey showed that children prescribed stimulant medication were less likely to experience delayed sleep phase disorder than kids taking no medication (28% vs. 42%). Adults taking stimulants were slightly more likely to experience delayed sleep phase disorder (30% vs. 26%), but slightly less likely to experience chronic insomnia (33% vs. 37%) and restless legs syndrome (20% vs. 23%), plus they sleep 11 minutes longer.
In other words, these survey results offer no evidence that stimulant medication use significantly helps or hurts sleep among people with ADHD.
3 Secrets to Sleep with ADHD
So what does promote sleep among children and adults with ADHD? The survey data suggest solutions you’ve likely heard but not adopted before.
1. Exercise More
The CDC recommends at least 2.5 hours of exercise weekly for adults, but half of ADDitude survey respondents do not meet this goal. At least 86% of adults surveyed said they exercise less than one hour each day; meanwhile, average daily screentime is 5 hours and 49 minutes.
And here’s the rub: Adults who exercise more, sleep more. They also stare at screens for 2 hours less each day than those who don’t or barely exercise, according to the survey.
2. Reduce Screentime
Children and teens with ADHD spend 5 hours and 24 minutes on screens each day — nearly three times the recommended amount. But, wait, it gets worse: Kids who get little or no exercise spend a staggering 6 hours and 37 minutes each day on screens. Those who get the recommended amount of daily exercise spend half as much time on screens and get more sleep each night.
The data suggests that kids who swap screentime for physical activity enjoy better sleep and overall health.
3. Keep a Consistent Bedtime Routine
“How would you rate the effectiveness of your child’s bedtime routine on a scale from 1 (terrible) to 5 (fantastic)?”
Caregivers who assigned the highest rating to this survey question reported that their children sleep 8 hours and 36 minutes each night, on average. This is 15 percent longer than the average for all kids with ADHD, according to the survey, and 25 percent longer than the kids with the worst-rated bedtime routines. This finding does not prove causation, but it does add credence to existing studies on the power of reliable routines for children with ADHD.
Highest and Lowest Rated Sleep Solutions
We asked: How effective are the following approaches at improving the quality of sleep for the person with ADHD? Please rate each on a scale from 1 (Not Effective) to 5 (Very Effective):
| Sleep Solution | Caregiver Rating | Adult Rating |
|---|---|---|
| Physical exercise | 3.4 | 3.31 |
| Sticking to a set bedtime | 3.34 | 3.21 |
| Environmental adjustments (e.g. white noise machine, black-out curtains, bedroom temperature, etc.) | 3.2 | 3.58 |
| Supplements (melatonin, magnesium, etc.) | 3.15 | 2.72 |
| Prescription sleep medication | 3.13 | 3.27 |
| Mindfulness/relaxation exercises | 2.81 | 3.09 |
| Medication for a comorbid condition | 2.6 | 2.7 |
| Reducing/eliminating caffeine intake | 2.49 | 2.49 |
| Adjusting eating times | 2.43 | 2.68 |
| Sleep apnea treatment | 2.43 | 3.14 |
| Talk therapy | 2.4 | 2.55 |
| Apps (Headspace, Calm, etc.) | 2.38 | 2.48 |
| Over-the-counter sleep medication | 2.25 | 2.45 |
| Light therapy in the morning | 2.24 | 2.96 |
| Reducing/eliminating stimulant medication usage | 2.16 | 1.71 |
| Increasing stimulant medication usage | 1.77 | 1.7 |
| CBT-i (for insomnia) | 1.67 | 2.22 |
| Reducing/eliminating alcohol intake | 2.87 |
ADHD and Sleep: Reader Factoids
Adults with ADHD
- 35% are not treating their ADHD with medication
- 86% are exercising less than 1 hour each day
- 43% are getting 0 to 2 hours of exercise each week
- 36% have a diagnosed sleep disorder
- 75% consume at least one cup of coffee each day
- 36% consume at least one caffeinated soda each day
- 14% consume at least one energy drink each day
Kids and Teens with ADHD
- 28% are not treating their ADHD with medication
- 75% are exercising less than 7 hours each week (the CDC recommended amount)
- 27% are getting 0 to 2 hours of exercise each week
- 16% have a diagnosed sleep disorder
- 20% consume at least one caffeinated soda each day
- 10% consume at least one energy drink each day
Tired But Can’t Sleep? ADHD Sleep Solutions
- Free Download: How to Sleep Better with ADHD
- Read: How to Fall Asleep with a Rowdy, Racing ADHD Brain
- Read: ADHD and Sleep Problems — This is Why You’re Always Tired
Anni Layne Rodgers is General Manager at ADDitude.
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