Children and Teens

ADHD and Sleep

The importance of developing good sleep habits

Research has shown that it’s common for children with ADHD to have sleep problems.  Many of these sleep problems can be linked to the “core symptoms” of ADHD – like being overstimulated and having trouble paying attention. Your child’s bedtime routines could also be upset if your child has problems with being organized, planning ahead, being distracted, or focusing on a task.  

Getting to bed on time and having healthy bedtime habits can be tough for children with ADHD. It can be hard for them to follow a series of steps to get something done.

How common are sleep problems in children with ADHD?

Sleep problems are common in ADHD, but there hasn’t been much research about exactly how common it is. When you compare children with ADHD to children who don’t have ADHD, though, a few facts stand out. Children with ADHD:

  • Sleep just as long, and fall asleep just as quickly, as children who don’t have ADHD
  • Are more restless than non-ADHD children while they’re sleeping
  • Don’t spend as much time in deep, dreaming (REM) sleep
  • Have slightly more nightmares and bedwetting than children without ADHD

What do sleep problems in ADHD look like?

The sleep of a child with ADHD can change from night to night, depending on how that child is feeling and acting, and by how restless he or she feels. For example, a child who feels anxious or depressed (which often happens in ADHD) may also have trouble sleeping. In many cases, though, sleep problems aren’t seen as having a clear link with ADHD.  Sleep problems fall into a few groups:

Falling asleep 

Many children (and adults) with ADHD say that they’re not able to "shut off” their minds so they can fall asleep at night. Nearly twice as many children and teens with ADHD have trouble falling asleep as those who don’t have ADHD. But this “mental restlessness,” which causes sleep problems for many children (and adults) with ADHD, can be helped. “Thought stopping,” relaxation training, and other cognitive behavioral strategies can make a difference. Your child’s doctor can give you more information.

How you and your child act with each other leading up to bedtime can affect how easy or hard it is for your child to fall asleep. It can be harder for some children to follow a bedtime routine if they’re not able to focus, but children who are tired from their day may already have problems staying alert and focused. That can leave parents feeling frustrated, which can lead to bedtime fights and tension. The added stress doesn’t just drag out the bedtime routine, though – it can also cause strong feelings that make it harder to fall asleep later.

To help solve these bedtime problems, try to avoid stress with your child in the evenings. Make sure that you set up a clear and regular bedtime routine. Ask your child to follow a step-by-step checklist, so that all tasks can get done before bedtime. A routine can keep a child from having to get out of bed many times because “I just need to do one more thing (pee one last time, brush teeth, etc.).”

Parents should be careful not to blame a child’s lack of energy and focus at bedtime as “bedtime resistance.”  Some parents may feel that their child is trying to delay bedtime, or is disobeying them, when he has just run out of mental energy and attention.

Staying asleep through the night 

When people with ADHD finally fall asleep, their sleep can be restless. Tossing and turning is common, along with being sensitive to any noise around them. Sleep may not feel as refreshing. In the morning, it may be hard for them to get up and get moving. 

Children and teens with ADHD can sometimes have a better sleep if they try some special strategies, like relaxation. If the lack of sleep makes it too hard for your child to function the next day, it’s possible for a doctor to prescribe a mild sleep aid at bedtime.

Problems waking up 

It can be very hard in the mornings to wake up some children who have ADHD. It’s like they’re being brought back to life from a “sleep of the dead.” Some children say that it can take hours before they’re totally awake and focused in the morning. For teenagers who are responsible for waking themselves up, a simple two-alarm system may help: place the second alarm across the room, so your child has to get out of bed to turn it off.

Role of stimulants

Children who are treated with stimulants often have more sleep problems, according to their parents, than children who have not been treated with stimulants. These sleep problems are mostly about falling asleep, and they happen most often when a child’s doses are too close to bedtime.

So, do the stimulant medications that are used to treat ADHD cause sleep problems in children? It’s not clear. In general, though, these medications aren’t usually active in the child’s body by bedtime. How these medications affect other parts of a child’s sleep isn’t understood. More research is needed.

In summary

Sleep problems in children and teens with ADHD are common. But many of the front-line providers, like pediatricians and psychologists, don’t give it much thought. If your child’s doctors don’t ask about his sleep, then you should tell them about any problems that you see with your child’s sleep behavior and patterns.

Since problem sleep can get worse over time, it’s important to find ways to help children sleep better when they’re having problems. Your child’s doctor can suggest some ways for your child to sleep better at night. Relaxation training may also be helpful. 

Sleep has a huge impact on how well the family functions, on your child’s success in school, and on other health issues. Getting a good night’s sleep is very important for every child – and for children with ADHD, getting enough sleep is even more important. A lack of sleep can increase ADHD symptoms or make them worse.