ADHD-Related Insomnia

Many people who have ADHD have difficulty with sleep, on or off medication.  The problem is, if you can’t sleep, it can make your ADHD symptoms worse.  This article is about basic steps anyone with ADHD can take to address a sleep problem. 

Sleep hygiene

Sleep hygiene sounds terrible, almost like someone is accusing you of not showering enough.  However, it really has nothing to do with that.  You can think of sleep hygiene as healthy sleep habits.  Having ADHD can make it difficult to naturally have sleep habits that are healthy, but they are important to getting a good night’s sleep, so it is worth the extra effort to establish and maintain these habits.

Keep a regular schedule.  Going to sleep and waking up at the same time every day trains your body’s pineal gland (a part of your brain that governs sleep-wake cycles) to make sleep hormones like melatonin at predictable concentrations every day.  It helps to set alarms, but if you find you ignore them, enlist the help of a loved one.

Have a regular bedtime routine.  A consistent ritual before bed will train your brain to be ready for sleep.  For example, a bath, put on pajamas, brush teeth, a short bedtime story and a kiss goodnight would be a simple child’s routine.  With children a regular routine also helps them to know when to expect bedtime, and keeps them from fighting you when the time comes. 

Avoid screens close to bedtime.  The blue light from computers, video games, phones, tablets, and the like can trick the pineal gland into thinking it is day time.  Also, if the activity is engaging enough, you can become hyperfocused and not realize how much you need to go to sleep.

Get plenty of exercise during the day.  Exercise doesn’t have to be boring, either.  If you don’t like to go to the gym, consider martial arts, gardening, hiking, walking a dog, or even shoveling snow for a neighbor.   Exercise in the morning also can help you stay focused during the day.

ADHD Medication Management

If your insomnia started, or clearly worsened within a month of starting or increasing your ADHD medication, you may want to consider the following steps with your doctor:

1)      Move your long acting medication dose to earlier in the day.

2)      If you need more coverage in the evening, consider a booster dose of a short acting medication.  People who struggle with a lot of busy thoughts or need to move during the evening may need their medication to last until after they get to sleep.

3)      Consider adding guanfacine or clonidine at the end of the day.

4)      Consider switching to a nonstimulant.

A Word About Other Sleep Aids

Some research suggests that traditional sleep medicines (like Valium or Unisom) do not work for ADHD related insomnia.  Since many of these medications can have addictive properties, or can result in long term harm to your sleep patterns, it’s best to stay away from them.

Medicines that have been used to help with ADHD related insomnia include guanfacine and clonidine.  Some herbal/natural preparations are also showing promise.  Melatonin has been widely used in ADHD related insomnia for a number of years.  It can be tricky to dose, but is generally thought to be relatively safe in most patients, with a few exceptions.  L-theanine is a product that is generally recognized as safe by the FDA.  It has shown possible effectiveness for mid-night awakenings and restless sleep in patients with ADHD.

Some patients with ADHD may also have a sensory processing issue.   This is especially common with autism spectrum disorder.  However, it can occur with ADHD without ASD.   In these cases, a weighted blanket can sometimes offer needed proprioceptive input.  

Have you already taken all of these steps and you are still having problems?  It is possible that you have a sleep disorder, other than garden variety insomnia.  The next article in this series will examine sleep disorders that commonly occur with ADHD.

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