By Leigh Anne Hulva, BSN, RN— Women’s Health Educator
For many adults with ADHD, sleep can become a frustrating cycle: exhausted during the day, but unable to wind down at night. Learn about common ADHD sleep problems, why they happen, and practical strategies to get more rest.
Meet Tess: ADHD and Sleep Problems
Tess thinks that there are two versions of herself: the noon version and the midnight version.
They don’t get along particularly well.
Daytime Tess is foggy in the morning, drowsy by eleven, downing a third cup of coffee in desperation by midday, and always feels run down, more than a bit behind on her work, and jittery from the caffeine coupled with stress.
Nighttime Tess feels awake for the first time all day, alert in a way she didn’t feel at work, and alive with a sort of buzzing energy. She has every intention of getting into bed at a reasonable hour— after all, she’s been dragging all day— but as soon as her head hits the pillow, her mind is abuzz with thoughts. Everything she didn’t get done during the day suddenly feels present and pressing, and she feels a kind of wakefulness that she certainly didn’t feel when her alarm went off 17 hours ago. And she’s definitely not going to feel it when her alarm goes off 7 hours from now.
So she lies in bed, remembering with vivid clarity the email she forgot to send. She grabs her phone to remedy that right away, and realizes that she is suddenly desperately interested in a Wikipedia article on that giant underground network of fungi in the forests of Oregon.
She realizes that being on her phone is probably going to make it that much harder to go to sleep, so she turns on the bedroom light and picks up the book on her nightstand. This makes her notice how messy her nightstand is, so she figures now is as good a time as any to tidy it up. As she’s fumbling under the kitchen sink for wood polish, she suddenly understands what needs to be done to the files at work that she had been trying to organize effectively earlier in the day. Tess feels like the energy and clarity of her midnight self is like a shooting star: there one minute and gone the next, impossible to bottle up for later, when the energy and clarity might shine some actual light on what needs to be done during the day.
ADHD and Sleep: A Complicated Relationship
Sleep problems are among the most reported symptoms of people with ADHD. Research suggests that many adolescents and adults with ADHD suffer from some form of sleep difficulty. This isn’t a coincidence; it’s neurology.
The brain’s dopamine system governs the sleep-wake cycle and sleep regulation. This is the same system that suffers from some dysregulation in the ADHD brain. When someone with ADHD has difficulty sleeping, it might be about more than simple sleep hygiene; it might have more to do with how the ADHD brain manages the transition from wakefulness to sleep.
It’s cruel irony that ADHD creates its own feedback loop in this way. Sleep deprivation negatively affects executive function, which can essentially worsen many ADHD symptoms. Poor sleep quality (or quantity!) also affects emotional regulation, working memory, and impulsivity.
Tess’s foggy days are not just caused by her ADHD; they’re made much worse by the lack of sleep that her ADHD is making it difficult to get.
Common Sleep Challenges in Adults with ADHD
Delayed Circadian Rhythm
Many adults with ADHD appear to have a naturally delayed circadian rhythm. This means that their own internal biological clock runs later than what others would consider “normal.” (Even as a child, Tess was considered a “night owl.”) The conventional advice for people who feel tired during the day is to “Go to bed earlier!” But this might not be realistic for someone who doesn’t produce sleep hormones until an hour or two after the neurotypical person does. Any underlying issue of a delayed circadian rhythm needs to be addressed before going to bed earlier will help.
Racing Thoughts at Bedtime
Even for people who don’t have ADHD, the quiet of bedtime can make the brain’s activity seem like the loudest thing in the room. For the ADHD brain, it can be that much more noticeable and distracting. Taking away the day’s structure can leave the ADHD brain scanning its surroundings, looking for something to attach to.
The Phenomenon of “Revenge Bedtime Procrastination”
“Revenge Bedtime Procrastination” refers to the act of staying up late to sort of “reclaim” the time a person feels they were forced to spend at work or school during the day. This isn’t unique to people with ADHD, but it is very common for people (especially adolescents and adults) who feel they’ve been required to spend most of the day doing tasks they find taxing or boring.
This type of procrastination generally involves mindless activities (such as scrolling on a phone) that take place around the time that a person would otherwise be going to bed. It also tends to involve delaying sleep in spite of feeling tired. This, of course, leads to limited sleep and daytime fatigue. Add to that the fact that the light from screens delays the release of melatonin that much more, and you have a perfect storm for poor sleep quality.
Difficulty Transitioning to Sleep
The difficulty that the ADHD brain has with task initiation extends to initiating the task of winding down at the end of the day. Transitioning from wakefulness to a state where sleep is close can be especially difficult for the ADHD brain. Another aspect of ADHD that can make this transition difficult is the state of hyperfocus that can be especially hard to turn off at the end of the day.
ADHD Medication and Sleep
Stimulant medications are often used to treat ADHD. Stimulants work by increasing the availability of dopamine and norepinephrine, neurotransmitters involved in alertness and arousal. For this reason, taking stimulant medication too late in the day can lead to sleeplessness later.
One of the first practical steps toward solving the sleep problem for someone on stimulant medication is having a conversation with their provider about timing their medication appropriately.
ADHD Sleep Strategies: What Actually Helps
Working WITH Your Natural Rhythm
For adults with ADHD who genuinely have a sleep cycle that naturally runs later than conventional schedules allow for, trying to force sleep is likely to backfire. Lying awake for hour after hour isn’t just unpleasant, it also tends to be a self-reinforcing cycle. The stress of unwanted wakefulness can compound that same wakefulness. The body and brain will also learn that lying awake is “normal,” rather than getting the message that lying down in a dark room means it’s time to sleep.
If your circumstances allow, by all means try to get your best sleep when your body wants it. If you naturally wind down after midnight, sleeping from 1 a.m. to 9 a.m. might give you much more rest than trying to force sleep at 11 and being jarred awake by an alarm at 7. Of course, this isn’t going to work for everyone. Even in our remote-work and remote-learning society, there are plenty of reasons someone might need to wake up before their natural cycle wants them to. This is where other strategies might help.
Managing Light and Stimulation in the Evenings
The blue light from screens suppresses melatonin, which is the hormone the brain releases to help your mind and body wind down at the end of the day. Avoiding screens for at least an hour or two before you plan to sleep is an important step toward avoiding late-night wakefulness.
Switching from screens to a book is a common way to transition from more to less stimulating activity. Other strategies that have been suggested are listening to a calming podcast or music while doing something manual, like knitting or washing dishes. If in doubt, just think about boring yourself to sleep!
Create a Nighttime Transition Ritual
As mentioned above, give yourself time to transition from the day’s stimulation to the quiet of sleep. The ADHD brain struggles with transitions in general, so it helps to have a structure to your evenings. Externalize this structure whenever possible, meaning get it out of your head and into your immediate environment instead. Use notes on a whiteboard and alarms for reminders.
Your wind-down ritual doesn’t need to be elaborate. Remember to turn off screens at least an hour before you plan to sleep. Beyond that, choose two or three things to do each evening and do them at the same time and in the same order, consistently, to train your brain that it is time to wind down.
Facing Those Racing Thoughts Head-On
When it comes to racing thoughts at night in a brain that just doesn’t want to turn itself off, sometimes it helps to get those thoughts down onto physical paper. Keep a notepad and pen by your bed (to decrease the temptation to use your phone, which can so easily become a distraction), and write down your thoughts as they come to you. Tell yourself that anything that hasn’t been done today can wait until tomorrow. The brain that is coming up with great wee-hours ideas might be keeping itself awake because it doesn’t trust itself to remember those great ideas in the morning. Writing down these ideas can help it wind down.
Considering Melatonin
There is some evidence supporting melatonin supplementation to help with nighttime wakefulness. It is not a sedative but rather a signal to your brain that it is time to wind down. This is something you would want to talk to your doctor about.
ADHD Sleep Strategies: Quick Checklist
- Try working with your natural sleep rhythm rather than fighting it—if going to sleep at 1 a.m. and waking at 9 works for you and your lifestyle, go for it.
- Avoid screens (and anything particularly stimulating, including bright lights) for an hour or two before you plan to go to sleep.
- Create a simple but calming bedtime ritual that cues the nervous system to “power down.”
- Use a bedside notepad (not your phone) to capture those racing thoughts so that your brain can “release” them— write them down and tell yourself that they can all wait until the morning.
- Talk to your provider about the timing of your medication if you think it might be affecting your sleep, as well as the possibility of taking melatonin in the evenings.
- Treat the ADHD itself, since managing your symptoms during the day will help decrease end-of-the-day chaos that can add to sleeplessness.
Conclusion
Tess still doesn’t consider herself a great sleeper. But she has found that a bedtime ritual helps more than she thought it would. She also— after talking with her doctor— moved her medication to earlier in the morning and noticed a change within a week.
You can be diagnosed with ADHD and seek treatment for it at any point; it’s never too late. If ADHD is holding you back, now is the time to find a healthcare provider with experience treating adults with ADHD. If this article resonates with you, consider talking to your doctor about potential treatments. Find a provider who helps you figure out how to move forward into your best life!
Frequently Asked Questions (FAQs):
Why is it so hard for people with ADHD to fall asleep at night?
There are several factors that might contribute to this common difficulty among adults with ADHD. For one, some people with ADHD have a sleep rhythm that is naturally delayed (according to conventional ideas about when people “should” feel tired). One study found that, on average, children with ADHD had a circadian rhythm delay of 45 minutes (compared to neurotypical children) and adults with ADHD had a delay of 90 minutes.
Another issue with the ADHD brain— difficulty with task initiation— also extends to bedtime. Transitioning from the stimulation and activity of the day to the quiet and sleepiness of night is especially difficult for the ADHD brain. Winding down requires its own kind of task initiation.
Why does my ADHD make it feel like I’m exhausted all day but wide awake late at night?
This uncomfortable paradox is one of the most widely reported experiences of adults with ADHD. During the day— when you’re expected to be alert and active— the ADHD brain sometimes feels overwhelmed and overstimulated. The sleeplessness of the night before adds a feeling of sluggishness or fogginess. This fogginess can feel like it lifts in the evenings, when the day’s structure is gone. This can result in wakefulness just when the body needs to wind down for sleep. Falling asleep later than work or school (or other aspects of life) allows for can lead to sleep being limited by the alarm clock. This results in a drowsy day, then a wakeful evening, and around and around it tends to go.
What is revenge bedtime procrastination?
This is a phenomenon that isn’t limited to people with ADHD, but it does seem to be particularly common in that group. It refers to staying up late not from an inability to sleep but rather from a reluctance to give up the only unstructured part of the day. It is especially common in people with ADHD who spend most of their day managing significant cognitive demands. In the evenings after school or work, people want time to decompress. This can lead to people staying up late—even when they’re tired—in order to claim an hour or three for unstructured activity, like scrolling Instagram.
Author Bio
I’m Leigh Anne Hulva, BSN, RN- a registered nurse, women’s health educator, mother of teenage daughters, and passionate advocate for women navigating perimenopause and menopause. I recently completed the Harvard Medical School course on Women’s Health and in these pages I relish sharing what I learned there alongside what I know from lived experience. I bring to this work not only my training, but also the personal experience of navigating the very transition I write about. It is my privilege to share both, because this work is personal to me. I hope it feels that way to you, too.
I have been on the other side of this conversation, and I understand how much it matters to feel truly heard. At Nashville Concierge Medicines, my work is supervised by Dr. William Conway, MD, and I work directly under his licensure as a nurse educator.
About Leigh Anne Hulva by William Conway, M.D
Leigh Ann is an exceptionally gifted writer in the tradition of American Humanism. To fully learn from Leigh Ann, it is best to read all of her blogs. In her extensive portfolio, Leigh Ann moves past the rather dry medical literature to capture the lived experience of living with both ADHD and perimenopause. Leigh Ann captures the complicated, subtle ways that ADHD can dominate life and make life much more difficult
All of Leigh Ann’s case studies capture the lived reality of life with ADHD. None of the case studies are drawn from an actual patient.
