ADHD and Sleep - A neverending story?

Did you know that 50-75% of adults with ADHD are experiencing problems with their sleep?

You are not alone and there are many challenges for people with ADHD when it comes to building healthy sleep habits including:

• struggling to get up in the morning

• being unable to fall asleep at night

• “bedtime procrastination” - staying awake to make up for any lost time during the day

• sticking to a regular bedtime schedule

• struggling to follow and stick to “sleep hygiene tips”

• and the list goes on…

I know what you’re thinking. “But I’ve tried so many sleep hacks and none of them have worked for me, I just can’t stick to anything and I will never be able to sleep well, I guess I’m just a bad sleeper”

That is not true!

As someone with ADHD myself, I know that it’s possible to to have a healthy relationship with sleep.

I used to struggle so much with early mornings, hitting that snooze button until the last minute, then getting ready in a rush to get to school or work and feeling stressed before the day even really started.

I was so frustrated that I just couldn’t get out of bed and I would beat myself up for being “lazy” and “lacking discipline” because I saw other people getting up at 5am to go to the gym and I didn’t understand why I couldn’t do the same.

This was before I knew I had ADHD and ever since my diagnosis last year, I have started to realize that comparing myself to the neurotypical standard is only going to make things worse and that I need to build habits and routines that work for ME and my brain.

You might think that you can get by with little sleep and that you’ve “trained” your body to cope with it over the years but consider this:

Sleep is crucial for your mental health.

We process emotions and social interactions and make sense of them when we sleep.

This happens in the REM phase which most people know as the dream stage and it occurs mostly in the latter half of the night and the early mornings.

By depriving yourself of REM sleep, you are going to be more irritable and emotionally unstable the following day.

People with ADHD already struggle with emotional dysregulation and by getting less sleep, you will make it much harder to manage those emotional ups and downs.

Sleep is crucial for memory consolidation

During deep sleep, your brain processes the day and moves any important information that you’ve learned from your short term to your long term memory.

So if you are trying to learn a new skill or build a new habit and you don’t get enough sleep, you’ll make it 10 times more difficult to actually retain the information.

REM sleep will also help you connect any existing memories with new information enabling you to be more creative and improve problem solving the following day.

Sleep improves focus and executive functioning

As you know, one of the biggest challenges with ADHD is managing your focus and attention and either not being able to start or complete an important task or hyperfocussing on the wrong thing and not being able to stop.

It’s also difficult to prioritize tasks and plan how much time and energy they might take.

Sleep improves all of those areas including your ability to focus, your alertness and your decision making making it much easier to get out decision paralysis that we often experience.

Sleep can help make your medication more effective

The last point is more of a personal anecdote but I have also noticed that the quality of my sleep directly affects the effectiveness of my medication.

I’m on a slow release stimulant and on days of poor sleep, I feel like I struggle more with focus and motivation.

I also feel the side effects of the tablet more whereas when I get at least 7-9 hours of good quality sleep, the side effects are barely noticeable and I am more productive, more motivated and feel more stable in my emotions.

So what can YOU do? How do you actually improve your sleep when it seems impossible?

“Quick hacks” are not going to cut it. You won’t magically start to sleep well because you stopped using screens before bed or you sprayed your pillow with lavender scent.

You really need to go back to basics and start by assessing your own habits, behaviours, environment and beliefs and getting to the root of your sleep issues.

Here is a roadmap of what you can do to get started on your sleep journey:

1. Keep a sleep diary for 1-2 weeks ideally.

If you struggle to be consistent, aim for at least 5 days.

This will help you see patterns in your sleep duration, quality and routine to pinpoint specific issues.

There are many free templates online, I do mine in a simple Google spreadsheet.

Make sure you include at least the following:

• What time did you get into bed?

• How long it takes you to fall asleep

• Any awakenings during the night

• What time did you wake up?

• When did you actually get out of bed?

• Did you use an alarm or snooze your alarm?

• How do you feel when you get up?

• Do you nap during the day? If yes, what time and for how long?

If you have a sleep tracker or a smartwatch, you can use it to help you complete the diary but keep in mind that they are not 100% accurate especially when it comes showing how much time you were awake for (they often record light sleep when you’re actually awake) so take it with a pinch of salt.

2. Keep a daytime diary.

This will help you understand habits and behaviours that can influence how well you sleep.

This diary should include:

• Work schedule and type of work (desk based, outside, travelling etc.)

• Exercise routine

• Meals

• Alcohol and caffeine intake

• Your emotional state

• How rested or tired do you feel throughout the day?

• Do you use the bed for any activities outside of sleep (like working, watching TV, scrolling your phone)?

• Social activities (+timings)

• Anything else worth mentioning (medications, special activities and trips, sickness)

Schedule some time in your day to complete both sections.

For example, I update my sleep diary in the morning and the daytime diary in the evening but if you don’t have much time in the morning, just make sure you do it at least once a day.

3. Look at both diaries and identify any red flags. 

These could be:

• Irregular bedtime and wake up time

• Using the snooze button multiple times

• Low sleep efficiency (too much time time spent in bed vs time asleep)

• Lots of disruptions at night

• Doing “daytime” activities in bed

• Not getting enough daylight in the morning

• Heavy meals late in the evening

• Alcohol or caffeine late in the day

• Working late at night

• Feeling worried, overwhelmed, anxious

These are just some examples but you want to look for things that can negatively affect your ability to sleep and stay asleep.

There are 3 main mechanisms that influence your ability to sleep:

• Sleep pressure: the chemical that builds up in your brain the longer you are awake and depletes when you sleep. If you go to bed too early (because you feel like you need to catch up on sleep), sleep pressure will be low and it will be more difficult to fall asleep. You’ll end up lying awake for longer and reducing your sleep quality.

  
  

• Circadian timing: your internal clock that influences when you are alert and productive and when you’re not. Exposure to light (amongst others) is the main influencer here and getting natural light in the morning as well reducing bright lights in the evening can help reset your clock to a more natural schedule.

  
  

• Arousal system: In order to sleep, you need to be able to calm your nervous system and any kind of arousal will increase stress and anxiety levels and keep you from sleeping. For example, scrolling on your phone or checking your work emails in bed might activate your arousal system making it much harder to fall asleep.

Prioritize these areas and identify some small changes you can make to your schedule or habits. Don’t try and change everything at once!

I know with ADHD we tend to have an all-or nothing mindset but if you try too many things, you’ll be overwhelmed quickly and give up before you see any real changes.

Pick ONE area you want to focus on and start there.

For example:

• My main struggle used to be getting up in the morning, feeling like I was being dragged out of a deep slumber and feeling like I just wanted to go back to sleep immediately.

  
  

• I always set my alarm for an earlier time than I needed in the hope I would get up and have a more “productive” morning routine.

  
  

• It never worked and instead I would hit snooze for about 5 times and getting up 30-45 mins later than planned and then feeling super rushed and stressed.

  
  

• I tried various different alarms, even putting it on the other side of the room but I would actually get up and then get right back into bed because I was so desperate for sleep.

What I’ve changed since then:

• Picking a more realistic time for me to wake up rather than forcing myself to be up at 6am just because it’s what other people do.

  
  

• Having a morning routine that doesn’t involve 10 steps but just sets me up for a positive day and feels doable. For me, that involves going out for a walk with my dog as soon as I wake up to get fresh air and sunlight, followed by a few basic chores like empying the dishwasher, emptying the trash and making a simple breakfast and coffee and watching a Youtube video or listen to some music before starting work.

  
  

• Using a daylight lamp and a gentle alarm. This was a very small change but has made such a difference, especially in the winter months! The lamp mimics sunlight and comes on 30mins before I need to wake up and gradually gets brighter. My smartwatch has a gentle vibrating alarm and wakes me up when I’m in a lighter sleep phase so I don’t feel like a zombie.

  
  

• As soon as I wake up, I drink some water and take my ADHD meds. They kick in about 40mins after waking up so if I happen to stay in bed for a bit longer, they help me get up and get me started on my morning routine.

  
  

See how I’m not trying to implement a perfect morning and bedtime routine straight away?

Just by making a few small changes to my mornings, I was able to start the day being less overwhelmed and frustrated which also positively impacted the rest of my day and my evenings.

So start using this framework today:

• Keep a sleep and daytime diary for at least 5 days

• Identify your “red flags”

• Pick 1 area of focus

• Implement a small change immediately

• Keep going and track any improvements!

I would love to hear how this framework has helped you and what areas you are working on.

Next week, I’ll dive deeper into a critical aspect of improving your sleep for good:

Identifying and overcoming negative and dysfunctional perceptions you hold about your own sleep. Until then,

Sleep well!

Anne

The Sleep Nerd 🌟🛌