ADHD and Sleep: Your Elusive Circadian-Rhythm Dream?

ADHD circadian rhythm

When I asked Australian writer Matthew Bush to contribute a guest column on his experiences with sleep and ADHD (below), I expected a well-written and engaging piece. What I didn’t expect was a happy ending, too.

ADHD’s potential challenges to sleep include the behavioral (putting off sleep because anything is more interesting than lying in the dark waiting for nothing to happen) and the physiological (Restless Legs Syndrome, Sleep Apnea, dysregulated Circadian Rhythm, etc.). In my upcoming course, Solving Your Adult ADHD Puzzle: Physical Strategies, I explain all the common ADHD-related sleep issues—and what to do about them.

Meanwhile, here is my post on ADHD and Sleep: Puzzling the Pieces. Look to my 2010 article in CHADD’s Attention Magazine: ADHD Never Sleeps, But You Can

Now, let’s get to Matt’s story!  This is an updated post from 2011. You can see how much he was on the forefront in piecing together his ADHD sleep puzzle.

Sleep, Finally.

By Matthew Bush

adhd Circadian Rhythm

I was the 11 year old ninja master.

I had to be awake for school in six hours.

The creaking kitchen floorboards raised the hair on the back of my neck. The house was dark. I could hear snoring. Good. Dad was a heavy sleeper and that meant mum had her earplugs in. Still, there was risk.

The adrenaline pacified me. I inhaled slowly, my pulse pounded through the swell of blood in my ears. I opened the cabinet door slowly and clicked the torch on. I was on a mission.

If I was successful, I’d take my bounty back to my room and quietly self-medicate with caffeine and carbohydrates. Then I’d curl up on my beanbag and read.

My official bedtime was 8:30. I was allowed to read for half an hour, then my dad would tell me to go to sleep. I rarely did. Eventually, my lamp and torch batteries got confiscated. That just added another objective to my mission dossier.

Mum and dad got good at hiding things. During the day, I was clumsy, impulsive, and unfocused. While I was out playing cat burglar, I was the opposite. In retrospect, it seems obvious that I was just adapting to my untreated ADHD. At the time, it was a total mystery to everyone.

No One Believed I Couldn’t Sleep (At Night)

No one was convinced when I said I couldn’t sleep at night. I just was seen as lazy and unmotivated. Occasionally I’d do extremely well at school, but generally I didn’t do anything at all. To make it all the more confusing, I couldn’t sleep at night, but I seemed to have no problems sleeping through the morning.

As I got older, I tried to reclaim my self-confidence by masking my inabilities as outright rebellion. It didn’t really help my case. I’d been diagnosed with ADHD when I was young, but my parents weren’t convinced. Other paediatricians and psychologists suggested that I was simply oppositional and angry. I responded well to therapy, but nothing really changed. Insomnia was on the back-burner. Everyone wanted to know why I was so lazy.

Several Diagnoses Later, Sleeping Pills

Eventually I was diagnosed with an autism spectrum disorder. It was either that or a type of conduct disorder, apparently. After the autism spectrum diagnosis failed to stick, I was diagnosed with depression by my exasperated GP and given Zoloft. But I still couldn’t sleep. For me, that was the most important thing. I didn’t care about grades, I just wanted some rest.

Fast-forward a few months, and I was the only 15 year old that I knew who was on sleeping pills. They didn’t work all the time, so I started taking them more often. I read online that Zoloft could cause insomnia, and it had seemed to have been making me a lot worse. So I stopped taking them. My sleeping habits got a little better, but I was still largely dependent on sleeping pills.

Finally I was diagnosed again with ADHD. My psychiatrist gave a thorough assessment, that spanned several sessions over a month or so. But I remember him remarking that he picked up on it within a few minutes. That was the first step in the right direction.

So slowly I was introduced to stimulant medications. By this point, I’d been expelled from two schools and had picked up a job that I hated in retail. Once the medications became more effective, and I started to get more confidence, I decided to go back to school. The only problem I seemed to be having was still with sleep. I didn’t quit the sales job, I was simply fired because I slept in once too often.

Finally, a Stimulant

Being able to excel at school, and attending a university with an adult education program meant that I could get away with a lot more. My teachers didn’t mind when a straight-A student would show up half an hour late, and then not wake up properly until after the lunch break.

I was sleeping less, but I was doing better. My weekend job was as a nightclub DJ. I felt suited to the work because I was always more awake than everyone else in the club, whether or not I had indulged chemically. I was depressed too, but hey, wasn’t everyone?

During the day, I’d yawn my way through school, do all my studying at night, and on weekends, enjoy my job. My new GP didn’t like the idea of prescribing sleeping pills every other week, so I took to stockpiling them for test times.

I thought I was functioning. Getting things done for the first time in my life. Doing well at school. I had my own place, and I had a job that I really enjoyed. Then a relationship that I found myself in took a serious turn. My then-girlfriend and I decided to move in together.

Greater Functioning, Little Understanding

Her bipolar disorder, and my ADHD, combined with our mutual ignorance resulted in me paying our first month’s rent on my own, while desperately looking for a housemate. In the first three weeks of living with someone, I’d learned something. I didn’t sleep like normal people did. Being ignorant of circadian rhythm disorders and how commonly they occur with ADHD, I wrote it off as insomnia.

At first, I thought that maybe it was the stimulant medication that was keeping me awake. It wasn’t. My psychiatrist had monitored me very closely for the first year that I was taking it and prescribed me a rigorous schedule that I stuck to. There were no stimulants in my system by normal bedtime. I just assumed that perhaps my ADHD was keeping me awake.

A year went by. It was my first year of university. At first, it was really easy. Actually, most of it was really easy. I had trouble organizing my life around the work, and so I didn’t do so well. No problem, my tutors said, we’ll just help you work something out. High on their list of things I needed to work with was my inability to attend mourning lectures and tutorials. So we worked out a schedule whereby I could begin classes after lunch.

Trying Co-Habitation—Again

Then another relationship took a serious turn, and I moved into an apartment with the girl who I considered the love of my life (based, of course, on my twenty years of accumulated wisdom). I told her about my ADHD. But it didn’t prepare her for the experience of living with it. We had a lot of problems, both directly to do with my ADHD, and indirectly from the havoc that a lifetime of failure and anxiety had wrought upon my self-esteem.

So we did the normal couple thing. We fought like crazy, blamed each other, then blamed ourselves, and must have broken up at least once a fortnight. It wasn’t all bad. We went on holidays, we had a fantastic love life, and we would have done anything for one another. Though very much in love, we weren’t very good at managing it rationally.

My sleeping habits became a problem again. I couldn’t sleep, and I’d get bored. That’s when it took a more destructive turn. Some nights, I’d keep her awake with pointless, highly emotional arguments. I was in many ways the typical ADHD-partner-in-denial. But, being on medication, I assumed that I had no problems. It just goes to show that medication only goes so far.

Asking Deeper Questions

In the last few months of our relationship, I had begun to question why I acted out in the ways that I did. I realized that my depression was clinical. I tried to fix my sleeping pattern with various herbs and teas. Then I just resorted to ill-gotten prescription painkillers and sleeping pills. That actually made things worse.

Prior to the break-up, my psychiatrist had decided to monitor my depression more closely.  At my then-girlfriend’s behest, I decided that my sleeping patterns where more of a problem than I was willing to admit to him. The day after the relationship finally broke, my psychiatrist told me that he’d found the drug for me. Then he made me wait for the shock of the break-up to disappear before he could start me on the medication.

My first two months on Mirtazapine were unbelievable. Mirtazapine is an antidepressant drug that acts as a sedative eight hours after it is administered. It sounded perfect. At first, I could get to sleep right on midnight. Thereafter, my body took charge and had me asleep at around two a.m., regardless of when I took my medication. But I could sleep, and when I got to sleep, I stayed asleep.

Over time, the depression began to lift and I slowly developed a new lease on life. I enrolled into another university, stopped abusing illicit chemicals, lost my codependent tendencies, and decided to realize my ambition of becoming a writer.

Dr. Wikipedia Had Answers

Then, in the midst of a writing project, I began to monitor my body clock and weigh up the data with what Wikipedia had to say about sleep disorders. After a discussion with a new GP (who I stuck with), my insomnia was confirmed as a simple circadian rhythm disorder. I re-arranged my life around my weird body clock, and my GP prescribed me with some melatonin capsules that I could use to reset it when I needed to.

Circadian rhythm disorders are quite common among adults with ADHD. I’ve found that under medical supervision, they can be effectively managed with relative ease. My psychiatrist has finally stopped asking me to schedule monthly appointments.  We only really catch up when my prescriptions are running low.

I’d had problems with getting to sleep since I was a small child. My mother told me that I rarely slept as a baby. That made me the black sheep of the family. My dad likes to tell me that he can sleep anywhere, at any time, and for as long as he wants. Sleep, it seemed, was perhaps the most devastating factor of the impact that ADHD has had on my life. I only really got a handle on my life when I addressed it.

Now, I sleep when my body wants me to sleep. And, with Mirtazapine, methylphenidate, and a healthy lifestyle, I can function–to the extent where people are genuinely surprised to hear that I have ADHD.

Your comments welcome! 

42 thoughts on “ADHD and Sleep: Your Elusive Circadian-Rhythm Dream?”

  1. Pingback: ADHD Roller Coaster: "Is It You, Me, or Adult A.D.D.?" · Picture It: Sleep

  2. Dear Gina,

    Your book was recommended to us by my ADD psychiatrist (still in the diagnosis phase). We just bought the MP3 version of your book by accident, but actually it turned out well since my husband would not have read the book. We are listening to it together. Usually I skip through books, so this is forcing me to listen to everything and at a pace that I can follow, instead of fast-forward.

    Long story short: I was referred by the ADD psych for a sleep study and am now diagnosed with narcolepsy (extremely fragmented sleep, EDS, etc). I’m still in the care of the sleep specialist psychiatrist, taking modafinil (stimulant) for alertness during the day, and a temporary trial of a sedative to help consolidate my sleep. What a difference it has made!

    Anyway, what I wanted to say is that an online friend with bi-polar disorder and ADD sent me a link to some information about bi-polar, sleep and light. If you ignore the references to bi-polar disorder, it still has relevance, for anyone. I bought the amber safety glasses mentioned in the article, as well as some amber lightbulbs, and amber booklights, and it really does help. I use them an hour or so before I go to bed. I still need my meds, they don’t replace that.

    My ADD psychiatrist mentioned he met someone in Berlin who is studying sleep & ADHD, and that apparently sitting on the computer late at night destroys melatonin production. I find I can still use the computer with the glasses if necessary, they completely eliminate the blue light which is associated with summer sun.

    I’m not selling or associated with any of the products mentioned. Here’s the link http://www.psycheducation.org/depression/LightDark.htm

    1. Hi Susan,

      Thank you so much for sharing this! Any information that promotes sleep (whether one has ADHD, bi-polar, or simply trouble sleeping) is so helpful.

      I had heard about the blue light of computer monitors; I think it applies to the older monitors, not the new flat-screen types, but I’m not sure about that. And yes, absolutely, lowering the light sources at night triggers melatonin release (just as sunlight in the morning triggers the cycle of production). I had not heard about the amber glasses — cool!

      There are many researchers studying ADHD and sleep, thank goodness. I interviewed several of them for an article I wrote for CHADD’s Attention magazine. If you are a member, you can access the article in the archives.

      Thanks for contributing the info!

  3. To Matthew: I can soooooo relate to your discovery around the amazing results a little “Melatonin” can bring! I learnt the hard way – it cost me my marriage – all because my husband couldn’t handle the fact that I came to bed anything up to three hours after him!

    It was awful. I so desperately wanted to be normal and just snuggle up in bed with him each night. But every time I did so, my relentless tossing and turning in my failed attempts at sleep would drive him crazy. I would just get up again and sit mindlessly in front of the TV until, at some ungodly hour of the morning, I would finally be tired enough to go to sleep properly.

    It wasn’t my doctor who told me about Melatonin – it was a motivational speaker at a sales conference I went to. I can’t recall his name off-hand but he had just written a book about “self-improvement” and one of the big things he talked about was the need for a solid 8 hours sleep each night. When I challenged him on how a person with ADHD could ever hope to enjoy a decent night’s sleep, he siad: “Oh, that’s a no-brainer… start taking Melatonin.”

    Honestly, after more than 30 years of enduring a nightmare existence with sleep-deprivation, it took me less than two weeks to start enjoying my first really good, deep sleeps – and going to bed at a normal hour (unless there was something on TV I really wanted to watch!).

    I agree with Charles – Gina, this is a wonderful blog 🙂

    Christina Malaga

    Tender Proposal Specialist

    1. Hi Christine,

      Thanks so much for sharing your story. I am working on a short book for adults with ADHD on sleep (“The ADHD Roller Coaster Guide to Sleep”), and I will be looking for helpful strategies such as this. Stay tuned!

      I’m glad you’re finally getting good sleep!

      best,
      g

  4. Pingback: CHADD Helps Those With ADHD On So Many Levels | CorePsych Blog

  5. I have a client that is one of the leading doctors in the state where I live specializing in ADHD and Autism. While obviously I don’t get into his actual work too deeply, during the process of doing research for the project of getting his site good search engine listing, I’ve learned so much about ADHD and Autism.

    Reading through these comments is difficult. It’s one thing to be helping a client help more people. It is quite another to read first hand accounts of people and parents who have struggled with ADHD on the most personal of levels.

    I’m going to make sure he knows about your blog. I’m sure he will be interested and perhaps can contribute some of his expertise here.

  6. Hi Gina…. I just thought I’d share my own experience with you – or rather, my observations of my step-son’s experience with Autism, ADHD and Obsessive Compulsive Disorder.

    As a man who has suffered with Sleep Apnea most of his adult life, I have first-hand experience with ‘lack of sleep’ – not because I can’t go to sleep, but unless I am wearing my CPAP machine mask I wake up gasping for breath many times a night.

    I used to think this was as bad as it gets. However, not long into my last relationship I learned that my partner’s 7 year-old son had a sleeping disorder far worse than mine 🙁

    His brain is not wired the same as most people – he simply doesn’t experience “tiredness” the same as most people. When most 7 year-old boys would normally be in bed by 8pm, this lil fella wouldn’t have a bar of it. He would lie wide awake through his nightly story-reading sessions – often resulting in us parents falling asleep while reading to him!!!

    He just could not go to sleep 🙁

    He would get straight back up out of bed as soon as we left the room…and because of his many other issues there was no point in locking the bedroom door or punishing him for “misbehaving”… he would just scream non-stop until either the police arrived or we would give in and allow him to get up.

    No treatment or medication or countless sessions with child psychologists ever helped him one iota. In the meantime, my health was deteriorating due to this boy making it almost impossible for me to get ANY sleep.

    Then there was the OCD issue. He would get up out of bed as early as 4am (after maybe 3 hours of sleep) and yell at us to get up until we couldn’t take it any more… and then he’d demand food because, as he used to say… “I’m starving”.

    We’d stagger out of bed… make him something to eat in the desperate hope that it would calm him down and let us all go back to sleep… and then discover that he’d changed his mind entirely and DIDN’T want anything to eat after all :(:(:(

    Instead, he’d want to stay up!!!

    I can still remember the night that ‘every single time he got back out of bed, we put him back into it’…and between 10pm and 5.am we repeated this tiresome charade 122 times!!!

    I am sharing this with you, even though it’s slightly off-topic, because at the end of the day it’s still a terrifying example of a chronic sleep disorder.

    All the best 🙂

    Gary Bottomly

    Digital Dictation Technician

    1. Hi Gary,

      Thanks for sharing your story. That poor child. The poor people who sleep around him (or try to)!

      This reminds of people who are not “wired” to feel pain. The parents of these children have to watch them constantly because they can severely injure themselves but not know it.

      Your step-son’s example is one that illustrates how one disorder can exacerbate brain function, by depriving it of sleep.

      I hope you’ve come up with a solution to help him get sleep. Some people with ADHD will sleep better with a stimulant in the system. Just a thought.

      best,
      Gina

  7. I have ADD and have always had an awful time going to sleep. As a child (around 8 or 9) I was prescribed anti anxiety medication on top of my ADD meds. Talk about crazy-making. Before the anti anxiety meds were prescribed my mum used to give me Benadryl to help me go to sleep…. But even then I would wake up at least three to four times at night.
    My dad is a psychologist but back then the affects of ADD on sleep were not as well documented so the correlation was never made. Same with my younger brother who was (and is haha) ADHD. While I had trouble going to sleep and staying asleep, my brother had trouble going to sleep. He would stay up until an hour before school reading, playing games or eating pilfered candies and then when morning came and it was time to get ready for school none could budge him. Once he went to sleep he would just stay asleep. He probably would have sleep well into the next evening if left to his own devices.
    I am currently unmedicated, but I deal with my evenings by adhering to a routine. I am ADD-lite and have the most success when I make follow a predictable schedule (naturally, when something unpredictable occurs I have panic attacks, but oh well!) I try to not watch TV or be on the computer an hour before my projected bed time (typically around 10 p.m.) and then do the same “bed time” routine every night: potty, brush teeth, wash face and then jammies. Sometimes my hubby and I will talk a bit before turning off the light, if not I read for a bit. I tend to read the Bible right before I try to sleep because it gives me something specific to focus on. Some nights are still really rough but for the most part things are better than they were when I was a kid.
    I’m glad I am not the only one who struggled (and continues to struggle) with sleep. Loved the post and hope to see more from you=D

  8. Wow, this has been a fascinating read; Matthew’s article and everything following. There is so much I’m relating to. I don’t have trouble falling asleep or sleeping until morning, its the going to bed, as another commenter shared. I’ve always been like this. And, I do find myself seeking carbs in the evenings. Crunchy carbs. And the comment of lee’s, not spending time on herself because there is so much to do – that is me also. Yet cognitively I am well-aware that the better I take care of myself the better I can function and do my job. I know all about getting enough sleep, eating write, exercising, etc. Yet, I find myself putting off the task due the next morning even if I have arrived home with plenty of time to complete it. I will set my alarm an hour early and wake up and do it in the morning, which then often makes me a little late for work, which is a very bad thing especially if it was at that early morning meeting that the report was due. I so often function on 5-6 hours of sleep as a norm. And yes, self-esteem and self-confidence are in the toilet as well. Especially since missing a deadline resulted in everyone else having a hard time too – I impacted my team. Not good. Luckily when it happened once again, I had already been recommended for rehire. So I have a second year, but woah – it will be my make it or break it year! My prescribing doc (Vyvanse, Lexapro) insists it is not a medication issue but that I must use an ADHD coach. But woah, the cost! One I did find and use was too adhd herself to be able to help me – what a disappointment. The year is ending now, all I can do is hope that I will and do use the summer productively. I must set the stage for a successful 2nd year or I’ll be job hunting yet again…

    1. Hi MK — thanks for stopping in. Matt did a nice job, eh?

      Do you think your doc is right? Some people with ADHD have the worst time at night because that’s when the stimulant is wearing off, so ADHD symptoms come to the fore at bedtime. Meaning, procrastinating about going to bed, etc.

      Some people find that a low dose of stimulant in the evening helps them to better plan the evening (and next day) and also get to bed when they need to. Something to consider.

      Good luck!
      g

  9. Hi Daniel,

    I’m so glad you found the information useful. Don’t be surprised if your therapist has never heard of this. Most haven’t. Same for psychiatrists.

    I am working on a short guide to ADHD and Sleep. Stay tuned….

    Gina

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