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Sleep Strategies for Adults with ADHD

By MARGARITA TARTAKOVSKY, M.S.
Associate Editor

Sleep disturbances are common among adults with attention deficit hyperactivity disorder (ADHD).
“I don’t know anyone with ADHD who does not have an issue with sleep,” said Roberto Olivardia, Ph.D, a psychologist who treats ADHD and a clinical instructor in the department of psychiatry at Harvard Medical School.
In fact, in the past, sleep disturbances were considered as a criterion for defining ADHD, according to psychiatrist William W. Dodson, MD, in the book Gender Issues and AD/HD: Research, Diagnosis and Treatment. However, they “were dropped because they were felt to be too nonspecific.”

Adults with ADHD have a range of sleep issues. They struggle with getting to sleep, waking up in the morning and staying alert during the day. They also struggle with sleep disorders, such as
sleep apnea, restless leg syndrome and narcolepsy, Olivardia said.
Sleep problems tend to remit when adults with ADHD are taking the right medication for them, said Dodson, who specializes in treating adults with ADHD in Denver, Colo. Unfortunately, finding the optimal medication and dose can take time.
Also, medication isn’t a cure-all. It’s important to engage in behavioral strategies that promote sleep. Here are suggestions for getting enough sleep (and waking up on time).
Realize the value of sleep.
First, it’s important to realize that getting enough sleep is critical,Olivardia said. Many adults with ADHD don’t. They “report getting by on little sleep, partly because they are often engaged in jobs that they are stimulated at.”
Sleeping better offers the benefits of sharper focus and attention, he said. Plus, sleep deprivation has serious consequences, such as a lower threshold for stress, impaired memory, trouble concentrating and lower immune function.
Get to bed.
Many adults with ADHD find that they’re most productive at night. They tend to hyperfocus on tasks and don’t want to break their momentum. According to Dodson, after the sun goes down, they feel especially energetic and think more clearly. Plus, distractions tend to be low.
Olivardia cited neurological research that found that the “ADHD brain is prone to a delayed sleep phase syndrome (DSPS).” Instead of having a typical circadian rhythm – with sleeping hours from 11 p.m. to 7 a.m. – people have an irregular pattern of 2 a.m. to about 10 a.m., he said.
So stopping what you’re doing, heading to bed and turning the lights off can go a long way, Dodson said. He also noted the importance of having a set bedtime.
Engage in routine tasks before bed.
“[A]dults with ADHD often engage in high-arousing activities, like watching videos or movies of high interest, or playing videogames, that make their brains unable to transition to sleep well,” Olivardia said.
That’s why it’s important to stop engaging in these kinds of activities at least 2 hours before bedtime, he said. Dodson suggested avoiding vigorous exercise within 4 hours of bedtime.
Olivardia also suggested engaging in routine tasks, such as washing the dishes, folding laundry, putting out clothes for the next day and packing lunch.
Try noise-canceling options.
Sounds can be incredibly distracting and stall sleep. To block them, Olivardia recommended using sound machines that create “white noise” or listening to light music.
Try an ADHD-friendly alarm.
For adults who find it difficult to wake up on time, Olivardia suggested exploring ADHD-friendly alarms. Then, once you’re up, turn off the alarm and throw the covers off your bed, he said. Leave your bedroom right away, and take a shower.
Use the two-alarm system.
In his book chapter Dodson suggests setting two alarms – an hour apart – and placing your first dose of medication with a glass of water by your bed. Specifically, set your alarm to go off one hour before you have to be out of bed. When the first alarm rings, take your medication and go back to sleep. When the second alarm rings an hour later, the medication is at peak blood level, which helps with alertness.
“Sleep is often a battle for those with ADHD,” Olivardia said. But making sure you have effective treatment and engaging in behavioral strategies can help tremendously.