By Josh Habansky, MSN, APRN, PMHNP-BC
Attention-deficit/hyperactivity disorder (ADHD) is a common neuropsychiatric condition characterized by symptoms of inattention, hyperactivity, and impulsivity. While its effects on occupational, academic, and social functioning are well recognized, the relationship between ADHD and sleep disturbances remains under-discussed despite being profoundly impactful.
Up to 50% of individuals with ADHD experience sleep disturbances, including delayed sleep phase syndrome (DSPS), restless legs syndrome (RLS), and obstructive sleep apnea (OSA) (Hvolby, 2015). Untreated sleep disorders can worsen ADHD symptoms, and in some cases, sleep issues may even mimic ADHD, leading to misdiagnosis or delayed treatment. Therefore, thorough sleep assessments should be part of any comprehensive ADHD evaluation (Sadek, 2023).
The Interplay Between ADHD and Sleep Disorders
ADHD and sleep disorders are often comorbid, creating a challenging vicious cycle. ADHD-related neurotransmitter imbalances, particularly in dopamine and norepinephrine (Shen et al., 2020), can disrupt circadian rhythms, while hyperactivity and impulsivity make winding down for sleep difficult. Late-night screen time or irregular schedules can further complicate this dynamic.
Conversely, untreated or undiagnosed sleep disorders can worsen ADHD symptoms (Yin et al., 2022). Poor sleep impairs attention, emotional regulation, and executive functioning—core areas of difficulty in ADHD. In children and adults alike, inadequate sleep can lead to behaviors that look strikingly similar to ADHD, such as irritability, hyperactivity, and an inability to concentrate.
Despite their significant overlap, sleep disorders often go unaddressed in ADHD treatment plans, resulting in a missed opportunity for symptom improvement.
Integrative Strategies to Address Sleep and ADHD
A comprehensive, integrative psychiatry approach can provide relief by addressing the root causes of both ADHD and sleep disturbances.
1. Lifestyle and Behavioral Adjustments
Consistency is key when it comes to optimizing sleep quality. Establishing regular sleep-wake schedules, reducing evening blue light exposure, and creating a calming bedtime routine can help regulate circadian rhythms. Limiting caffeine and sugar in the late afternoon and evening, prioritizing a nutrient-dense diet, and engaging in calming activities before bed all contribute to better sleep.
2. Targeted Nutraceutical Support
Nutrient imbalances and deficiencies can play a critical role in both ADHD and sleep disturbances:
- Melatonin: A well-known circadian regulator, melatonin can reduce the time it takes to fall asleep, particularly in children with ADHD (Masi et al., 2019).
- Magnesium: Magnesium has calming effects on the nervous system, supports relaxation, and may ease symptoms of restlessness or insomnia (Rawji et al., 2024). It is thought that stimulant medications may deplete magnesium levels, making supplementation even more critical in some cases.
- Iron: While low ferritin levels are associated with both RLS and ADHD, the underlying mechanisms are still being explored (Cameli et al., 2023). Correcting iron deficiency can significantly improve sleep quality.
- Zinc: Zinc supports dopamine regulation and can enhance sleep quality and depending on zinc levels and dietary intake, supplementation may be beneficial (Cherasse & Urade, 2017) (Jazinaki et al., 2024).
- Omega-3 Fatty Acids: Omega-3s, including EPA and DHA, have been shown to improve ADHD symptoms (Königs & Kiliaan, 2016). They may also support sleep by reducing inflammation and promoting brain health.
3. Mind-Body Interventions
Techniques that address hyperarousal and stress are invaluable. Mindfulness meditation, yoga, and progressive muscle relaxation can help individuals transition to a restful state before bed. Cognitive Behavioral Therapy for Insomnia (CBT-I) is particularly effective for breaking patterns of sleep disturbance and can be tailored for those with ADHD (Jernelöv et al., 2019).
4. Addressing Comorbid Conditions
Conditions such as OSA, RLS, and anxiety are frequently overlooked in ADHD populations. Screening and treating these disorders can dramatically improve sleep and, consequently, ADHD symptoms. Untreated OSA, for example, is linked to fatigue, difficulty concentrating, and even mood disturbances, all of which may be mistaken for ADHD-related challenges.
A Note on Stimulant Medications and Sleep
While stimulant medications can be highly effective in managing ADHD, they can negatively impact sleep in some individuals due to their stimulating effects. Timing and dosing of stimulants should be carefully managed to avoid sleep disruption.
Managing Inflammation for Better Sleep
Chronic inflammation is another factor that can perpetuate sleep disturbances and worsen ADHD symptoms. An anti-inflammatory diet rich in whole foods, omega-3 fatty acids, and antioxidants, along with stress management techniques, can support both sleep and mental health.
Concluding Thoughts on ADHD and Sleep Disorders
ADHD and sleep disorders are intricately connected, and addressing sleep as part of an ADHD treatment plan is essential for long-term success. An integrative approach that includes lifestyle changes, targeted supplements, mind-body therapies, and management of comorbid conditions provides a comprehensive framework for improving both sleep and ADHD symptoms.
Want to learn protocols and personalized interventions like these to help your patients with ADHD? Enroll in the upcoming ADHD Intensive Training led by Dr. Greenblatt!
References
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