Sleep problems are extremely common in people with Attention-Deficit/Hyperactivity Disorder (ADHD). In fact, studies show that over half — and in some samples up to 70% — of people with ADHD experience significant sleep difficulties.
But the relationship is not simple. Sleep problems can make ADHD symptoms worse, while ADHD itself can make sleep harder. Recent research helps explain why this happens and how to manage it.
Common Sleep Problems in ADHD
Sleep issues of any kind can significantly influence daytime ADHD symptoms. Poor sleep amplifies the same cognitive and behavioural challenges already present in ADHD, including:
- Attention and focus
- Impulse control
- Emotional regulation
- Patience and frustration tolerance
- Working memory and organisation
- Daytime alertness and motivation
In children, sleep disruption often appears as hyperactivity, irritability, or behavioural issues, rather than obvious tiredness.
In adults, it contributes to brain fog, low mood, forgetfulness, slower thinking and reduced productivity.
1. Insomnia
Insomnia is the most frequently reported sleep issue in ADHD.
Subjective complaints include:
- Difficulty falling or staying asleep
- Racing thoughts
- Restlessness at night
The meta-analysis by Díaz-Román et al. (2018) found that adults with ADHD consistently report more subjective insomnia symptoms than non-ADHD controls.
Multiple studies show that many people with ADHD experience delayed sleep–wake phase, meaning their natural biological clock runs later.
- Díaz-Román et al. (2018) found that adults with ADHD show longer sleep onset latency (take longer to fall asleep) and reduced sleep efficiency (spend more time lying awake overnight) compared to controls, supporting a pattern of delayed sleep timing.
- Evening alertness and difficulty “switching off” are especially common.
This helps explain why many people with ADHD struggle to fall asleep early, even when they want to.
2. Restless Legs Syndrome & Limb Movements
Several review articles, including Wajszilber et al. (2018), describe a higher prevalence of:
- Restless Legs Syndrome (RLS)
- Periodic Limb Movement Disorder (PLMD)
These conditions cause leg discomfort or involuntary leg movements at night, disrupting sleep and making bedtime more difficult.
3 Sleep-Disordered Breathing (OSA, UARS)
Sleep-disordered breathing (SDB) is more common in ADHD and can mimic or worsen daytime difficulties.
SDB includes:
- Snoring
- Obstructive sleep apnoea (OSA)
- Upper airway resistance syndrome (UARS)
These conditions fragment sleep, reduce oxygen levels, and can significantly impact daytime attention, behaviour, memory and emotional regulation—particularly in children (Wajszilber et al., 2018; Hvolby, 2014).
4. Difficulty Waking
With delayed circadian rhythm + fragmented sleep, people with ADHD often:
- Need multiple alarms
- Wake feeling foggy
- Struggle with morning routines
This aligns with findings from multiple reviews that ADHD is linked not only to sleep-onset issues but also difficulty maintaining and completing the sleep cycle.
Do ADHD Medications Affect Sleep?
- Stimulants (e.g. methylphenidate, dexamphetamine) do not consistently worsen sleep and often improve evening calmness when timed correctly.
- Taking stimulants too late can delay sleep onset.
- Non-stimulants like clonidine or guanfacine may improve sleep and reduce bedtime hyperarousal.
- Atomoxetine may cause early-morning waking for some people.
The literature consistently emphasises timing, not medication type, as the biggest factor affecting sleep.
Evidence-Based Strategies to Improve Sleep in ADHD
Research shows that improving sleep in ADHD requires more than basic sleep hygiene. Targeted, evidence-based approaches are most effective.
1. Treat Underlying Sleep Disorders
Treating sleep-disordered breathing often leads to noticeable improvements in daytime behaviour, learning, and emotional regulation.
Restless Legs Syndrome and Periodic Limb Movement Disorder are also more common in ADHD and should be assessed when there is bedtime restlessness or leg discomfort.
Melatonin may be helpful only when the issue is delayed sleep phase, not when a breathing disorder is present.
2. Morning Light Exposure
Strong evidence supports bright-light exposure (natural sunlight works best) within an hour of waking to help shift a delayed circadian rhythm — a very common pattern in ADHD.
3. Structured Evening Routines
ADHD responds best to predictable, step-by-step sequences instead of vague instructions like “wind down.”
For example:
- Shower
- Prepare clothes or bag for tomorrow
- Low-stimulation activity
- Lights dimmed
- Bed
4. Cognitive-Behavioural Therapy for Insomnia (CBT-I)
CBT-I improves sleep onset, sleep maintenance, and overall sleep quality in adults with ADHD.
It provides structured tools to manage racing thoughts, inconsistent routines, and irregular sleep patterns.
When insomnia is successfully treated, ADHD symptoms often improve (Fadeuilhe et al., 2022).
This highlights the value of screening for sleep issues instead of assuming all daytime difficulties are purely ADHD-related.
What the Studies Agree On
Across the literature, there is consistent agreement on several points:
✔ Sleep problems are extremely common in ADHD
✔ Poor sleep worsens daytime ADHD symptoms
✔ Improving sleep can meaningfully improve quality of life
✔ Not all sleep interventions improve ADHD symptoms
✔ A personalised approach works best
Sleep issues in ADHD vary widely — insomnia, delayed sleep phase, snoring/OSA, restless legs, or wake-time problems each need different treatment.
When to Seek a Sleep Assessment
You or your child may benefit from a sleep study if there is:
- Loud snoring or pauses in breathing
- Difficulty falling asleep or staying asleep
- Restless or uncomfortable legs at night
- Waking unrefreshed despite sufficient hours
- Behaviour difficulties or fatigue affecting school/work
- Complex ADHD + sleep medication interactions
Conclusion
The research is clear: sleep and ADHD are deeply interconnected, and addressing sleep can make a meaningful difference in wellbeing, attention, behaviour and emotional regulation.
Not all sleep problems in ADHD look the same — and they don’t all respond to the same treatment — but with good assessment and targeted interventions, most people experience substantial improvement.
References
Díaz-Román, A., Mitchell, R., & Cortese, S. (2018). Sleep in adults with ADHD: Systematic review and meta-analysis of subjective and objective studies. Neuroscience & Biobehavioral Reviews, 89, 61–71.
Fadeuilhe, C., Cochen De Cock, V., Bioulac, S., Philip, P., Dehail, P., & Sagaspe, P. (2022). The impact of insomnia disorder on adult attention-deficit/hyperactivity disorder. Psychiatry Research, 308, 114356.
Hvolby, A. (2014). Associations of sleep disturbance with ADHD: Implications for treatment. ADHD Attention Deficit and Hyperactivity Disorders, 6(4), 187–199.
Jernelöv, S., Lekander, M., Blom, K., Axelsson, J., Rydh, S., Ljótsson, B., & Kaldo, V. (2019). Effects and clinical feasibility of a behavioral treatment for insomnia in adults with attention-deficit/hyperactivity disorder (ADHD): A randomized controlled trial. BMC Psychiatry, 19, 226.
Larsson, I., Edlund, J., Tynelius, P., Hellström, A., & Almquist, Y. (2023). Sleep interventions for children with attention-deficit/hyperactivity disorder: A systematic review. Sleep Medicine Reviews, 68, 101733.
Stein, M. A., Mendelsohn, J., Obermeyer, W. H., Amromin, J., & Benca, R. (2012). ADHD treatments, sleep, and sleep problems: Complex associations. Neurotherapeutics, 9(3), 509–517.
Wajszilber, D., Santiseban, J. A., & Gruber, R. (2018). Sleep disorders in patients with ADHD: Impact and management challenges. Nature and Science of Sleep, 10, 453–480.