For many kids and teens with ADHD, getting a good night’s sleep is a struggle. In fact, up to 70% of kids and teens with ADHD have ongoing sleep problems. These sleep challenges range from having a hard time falling asleep or staying asleep, to having extreme difficulty getting out of bed in the morning and feeling very sleepy throughout the day. It can seem like sleep problems stem from the fact that having ADHD seems to give kids so much energy at night, but the relationship between ADHD and sleep is actually quite complex and influenced by many factors.
Fortunately, most sleep problems in ADHD can be treated successfully. Developing a clear understanding of your child’s sleep problems is the first step determining which intervention will be most helpful.
- Inconsistent or prolonged bedtime routines. Kids with ADHD often struggle to get to bed on time, and at the same time, each night. For many kids, especially those who struggle with inattention, following a bedtime routine is a challenge. They start their bedtime tasks late, and take a long time to get everything finished, leading to a much later bedtime. Other kids with ADHD who are also oppositional may resist going to bed. They tend to have outbursts and refuse to do things like brush their teeth or turn off their electronics. These nightly battles delay bedtimes, and make it hard for them to settle down once they are in bed.
- Many kids and teens with ADHD also struggle with anxiety. Anxiety and ADHD can both make it difficult for kids and teens to “turn off their thoughts” when it’s time to go to sleep, leading to insomnia. Anxiety can also make it harder to fall back asleep for kids who wake up in the middle of the night.
- Simulant medication side effects. Difficulty falling asleep is a common side effect of stimulant medications. When a child or teen starts a new stimulant medication, increases their medication dose, or takes their medication too late in the day, they are especially susceptible to having their sleep be disrupted.
- Screen time. Research has shown that kids with ADHD spend more time watching screens (television, videogames, tablets, phones) than kids without ADHD. Screen time throughout the day and especially in the evening, around 1 or 2 hours before bedtime, is associated with greater sleep problems.
- Secondary Sleep Disorder. For some kids, a secondary sleep disorder, like sleep apnea or periodic limb movement disorder (similar to restless leg syndrome in adults), may be a driving factor. Studies have consistently shown that sleep disorders occur more often in kids with ADHD than in kids without ADHD, and can exacerbate problems with attention, impulsivity, and hyperactivity. Kids with these secondary sleep disorders often get the recommended amount of sleep, but are not well rested in the morning and feel very sleepy throughout the day.
- Delayed Sleep-Wake Phase. Kids, and especially teens with ADHD, are also more likely to have delayed sleep-wake phase cycles. In these cases, a child or teen’s natural sleep cycle is delayed, so their body doesn’t prepare to fall asleep until late into the night or and isn’t cued to wake up until late the next morning. Kids and teens with a delayed sleep-wake phase have significant difficulty falling asleep and getting up on time in the morning. They also find it difficult to be alert in the morning, and are often much more focused and engaged in the afternoon.
If your child or teen has ongoing sleep problems that make it difficult for them to fall asleep, wake up in the morning, or stay alert throughout the day, then talk to your child’s pediatrician. A thorough sleep assessment will help uncover the cause of the sleep problems, and will help determine which intervention is best for your child.