Sleep disorders in people with ADHD
Attention deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in childhood. The estimated prevalence is around 5.3%, persisting into adulthood in approximately 65% of cases. It is characterized by symptoms of inattention and/or hyperactivity and impulsivity that interfere with social, academic, or occupational functioning and negatively impact the quality of life of the affected individual.
Furthermore, this disorder is associated with a high comorbidity with other psychiatric conditions, including anxiety, depression, personality disorders, substance use disorders, and sleep disorders. It has also been linked to an increased risk of developing medical conditions such as overweight, obesity, diabetes, and autoimmune thyroid disease.
Sleep disorders worsen the symptoms of people with ADHD, causing a decline in cognitive functioning, restlessness, and impulsivity.
In the last decade there has been a growing interest in understanding the relationship between ADHD and sleep disorders, as a high prevalence of insomnia, poor sleep quality and circadian rhythm disturbances has been identified in both the child and adult populations.
People with ADHD often experience difficulties both falling and staying asleep . This exacerbates the disorder's symptoms, causing impaired cognitive function, as well as increased daytime sleepiness, restlessness, and impulsivity. These symptoms, related to a lack of restorative sleep, are also associated with a higher risk of developing other psychiatric disorders such as anxiety or depression.
Therefore, it is important not to underestimate the importance of sleep quality in these individuals, and if a persistent pattern of poor sleep or insomnia is detected, a specialist should be consulted. Treatment for these sleep disorders is usually behavioral, with implementing good sleep hygiene being the first recommended approach.
Recommendations to promote sleep
Implementing good sleep hygiene includes regulating daytime habits and creating conditions that promote sleep. Key daytime habits that are recommended include:
- Try to get up and go to bed at the same time every day, including on weekends.
- Avoid naps during the day, especially after a night with little sleep.
- Avoid excessive intake of liquids or heavy meals, as well as caffeine, nicotine and alcohol, especially before going to bed.
Regarding conditions that promote sleep , the following is recommended:
- Avoid strenuous physical exercise in the 3 hours before going to bed.
- Schedule a gradual reduction of activity before bedtime.
- Use a firm mattress and a comfortable pillow.
- Establish a bedtime routine and perform it every day in the same order (drink something warm, read for a while, brush your teeth, etc.).
- Go to bed only when you are sleepy.
- Maintain a quiet, dark, safe, and comfortable sleep environment.
- If you cannot fall asleep within 30-45 minutes, get out of bed and the room and do a relaxing and monotonous activity until you feel sleepy again, and only then return to bed, repeating this as many times as necessary.
- Use the bed only for sleeping. Do not do other activities in it such as reading, watching television, listening to the radio, etc.
- Avoid using devices with screens in the half hour before going to sleep.
Other strategies that can also contribute to this improvement are psychoeducation, relaxation techniques (which especially promote falling and staying asleep), control of intrusive thoughts or erroneous beliefs about sleep, as well as stimulus control and sleep restriction.
A high percentage of people manage to significantly improve their nighttime rest with these guidelines, and it has been observed that this not only improves well-being and quality of life, but also ADHD itself.
In certain cases, the prescription of hypnotic or chronoregulatory drugs may be necessary, but it is advisable to use these medications for a limited time and always complement them with appropriate non-pharmacological approaches.
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