ADHD and Sleep: Puzzling The Pieces

ADHD and sleep

ADHD and sleep.  It’s like any other ADHD-related topic:  complex and variable with the individual. I’m constantly struck by the widespread perception that anything about ADHD is simple—or cookie-cutter. Nothing could be further from the truth.  And, yes, all of it can adversely affect marriage and relationships.

This started dawning on me almost 20 years ago.  My husband and I were lost in downtown San Francisco.  The destination we sought? Our first adult ADHD discussion group.

Heated bickering continued for a few more wrong turns (“You said to turn left!” and “Not that left!”). Finally, though, we found the place, hustled up the stairs, caught our breath, and joined others seated at a large round conference table.

That’s when a worn-out looking man seated directly across from me said something that sticks with me, all this time later:

I’ve blamed a lot of people in my life for my troubles, but when it comes down to it, I finally realize that I am my own worst enemy.

For forty years, I’ve not only opposed what other people want me to do, I’ve opposed what I want to do.

His words hit me almost viscerally. I sensed profound truth—mixed with desperation. What was happening here?  I decided I needed to figure this out!  Hence, my path to becoming an Accidental ADHD expert was paved.

ADHD Affects Your Relationship With Yourself!

We’ve all heard that adult ADHD can create problems in relationships. This man’s epiphany, however, struck some larger foundational truth: Having ADHD can create problems in your relationship with yourself, never mind with someone else.

No matter how much you crave that healthy diet, that uncluttered home, or that comfortable bank account, unrecognized and unaddressed ADHD symptoms mean you can’t always initiate and maintain the necessary steps to get there. (Talk about depressing. No wonder ADHD is so often misdiagnosed as depression.)

Add another person to the equation—in particular, a romantic partner—and the potential for misunderstanding and hurt feelings reaches dizzying proportions.

ADHD Sleep Challenges Affect Both Partners

Take sleep, for example. More than half the respondents to the ADHD Partner Survey identified their mates’ ADHD-related sleep patterns as a big problem. They cite it as a problem almost as challenging as difficulties in listening, remembering, and organizing.

The yellow bars represent the “big” problems, the red “little” problems, and blue “no” problem. As you can see, about half of the survey respondents said their ADHD partner’s sleep habits were a BIG problem, and another 20 percent or so a LITTLE problem.

ADHD and sleep

 

Sleep Deficits Compound ADHD Symptoms

The irony, of course, is that sleep deficits compound ADHD symptoms.

In fact, an amazing number of my friends who have ADHD tell me that they actually fight sleep—actively, resentfully fight it.

  • Brad explains, “Gina, going to sleep is about the most boring thing a person with ADHD can do—just lie there in the dark waiting for nothing to happen.”
  • Miranda says she pushes herself to cross an impossible number of to-do items from her impossibly expanding list each night until she finally collapses into bed, too tired to fight it any longer.
  • Steve says he stays up several hours later than the rest of his household so he can have some “me time” at the end of his frantic day.

There are lots of reasons that many modern Americans, ADHD or not, try to steal extra time in our busy days.  But Glen’s story reminds me of the guy at that first support group. He had finally met the enemy—and realized it was him.

ADHD and sleep

“I Resent Giving Precious Hours to Sleep!”

Glen says that, by age 45, he’d grown weary of the mental battles he’d wage with himself about going to sleep.

Of course, he knew he needed a decent night’s sleep in order to function the next day; he’s not stupid. Yet simply the thought of going to bed at a decent hour triggered the infamous “ADHD oppositionality.”

In his heart of hearts, he fiercely resented spending precious hours sleeping when he is so behind on… everything. So, what did he do?  He staved off sleep by watching TV—while simultaneously scanning every news headline worldwide on the Internet. Finally, he started to accept that more hours spent wasting time instead of sleeping made no sense. He needed a sea-change tactic.

That meant taking ADHD-savvy strategies seriously, starting with getting more sleep.  But it also meant realizing that his stimulation-craving brain tricked him to think it was being productive, by scanning headlines at night instead of sleeping.

ADHD and sleep

A Plan For Outwitting Himself

Finally, on the brink of losing his job for making too many mistakes in his groggy state, he hatched a new plan to outwit his own rebel nature. That is, he started trying to sneak up on himself, so as not to trigger the opposition.

“So,” he says, “now I tell myself, at about 10 each night, I’m not going to bed now. I’m just going to put on my sleep shirt. A few minutes later, I’ll turn on the bed-stand light, all the while assuring myself, I’m not going to sleep now, I’m just turning on the light.”

By using this bit-by-bit strategy of “sneaking up on himself,” Glen is getting more sleep. That means he has more “coping” power during the day, including in organizing himself to seek professional help for his ADHD.

adult adhd discussion group

“I’m Not the Only One?”

Until recently, Brad, Miranda, Steve, and Glen assumed that their difficulties around sleep were their own insoluble personal quirk or flaw.

Then they learned about ADHD. They discovered through my Palo Alto-based discussion group that they weren’t alone in their challenges, including the nocturnal kind. We have many, many discussions on this topic, and we all learn a great deal.  (It’s a free drop-in group; open to the public. Plenty of newcomers all the time. Please join us!)

They also learned that people with ADHD are not clones; they are individuals. Each individual does best by questioning their own particular assumptions and habits—why they do the things they do, and how to troubleshoot.

ADHD neurobiology itself is associated with higher-than-average sleep disorders. That includes sleep apnea, delayed sleep phase, and restless leg syndrome. Moreover, these sleep challenges are often exacerbated by other ADHD traits such as disorganization and stimulation-seeking habits that keep many such adults glued to their computers or TVs when they should be dozing.

ADHD sleep couples

Sleep and Sex Challenges Can Go Hand in Hand

If you are romantically involved with someone who has ADHD but neither of you recognizes it—or how it affects sleep, finances, communication, and so forth—it’s easy to take the behaviors personally.

Miranda’s husband, Jeff, used to feel rejected when she’d delay coming to bed. He missed her company, missed enjoying sex with her.  Moreover, “I felt like she was avoiding me, avoiding intimacy—running herself ragged all day, doing chores at weird hours,” Jeff explains. “She couldn’t explain why she did these things, and, what’s worse, she resented my even asking about it. Her defensiveness made me wonder if she might be having an affair.”

Such “couples troubles” could even bring you to counseling, where the clinician might completely miss ADHD and instead find deep, dark reasons why one of you refuses to come to bed.

Fortunately, Jeff and Miranda figured it out: Lifelong struggles with undiagnosed ADHD had left Miranda feeling not only defensive but ashamed of sharing, even with her husband, her embarrassment about not being more organized, more efficient. So, she shut down—and shut him out.

ADHD And Sleep: Problem-Solving

As for Glen, he is not even currently in a relationship. So, he wasn’t opposing a partner’s desires for him to come to bed. As he readily concedes, he was opposing his own desires! If he didn’t start getting more sleep, he risked losing his job.

Finally, after talking with other adults with ADHD at our meeting in Palo Alto, he’s decided to follow up on that long-ago diagnosis. Perhaps getting help for his ADHD symptoms will help him gain better control of his day—and night.

There is no cookie-cutter answer to getting better/more sleep when you have ADHD. There is only each person’s detective work and problem-solving:

  • Some people with ADHD will benefit from medication to help with sleep.
  • Others simply need organizational strategies to get their head on the pillow by a certain hour.
  • Still others will benefit from boosting Circadian Rhythm signals in the morning (a walk in the sunlight) and supporting melatonin release at night—turning down the lights; using a filter for electronic devices, such as F.lux.

 

Take a Two-Minute Anonymous Survey About ADHD and Sleep?

I just finished a draft of the sleep module. It’s one lesson in my online training (anticipated availability: late spring 2020). But I want to make sure I’m covering your questions and concerns.

Please take this two-minute survey.  Thank you!

More than ever, we know how important good sleep is to our physical and mental health. Seriously important.

When you’re living with adult ADHD—yours or someone else’s—accurate information and solid support are absolutely essential.

With my ADHD Roller Coaster blog, I work to shed light on the myriad and surprising ways that ADHD can slip under the radar.  That includes the radar of sleep specialists, who typically are unfamiliar with the rapidly growing literature on ADHD-related sleep disorders.

—Gina Pera

 

15 thoughts on “ADHD and Sleep: Puzzling The Pieces”

  1. Thanks for this terrific post, Gina,

    Although I’d hear your name, there’s so much out there, and only today have discovered your (impressive and thoughtful) site. I have to say, I’m quite impressed! As of now, I’m now 2 years on in my quest for help with my diagnosis with the “Inattentive” form of ADHD. At 52, I’m a bit “long in the tooth” for taking this on: the learning curve is steep and less-than-kind, and the “rollercoaster” aspects, not fun. Also, these have coincided and been compounded by suddenly needing to care for my aging mom’s multiple health crises, as well as the start of graduate school — learning in a completely new field.

    For me, sleep deficit concerns are paramount. Earlier stimulant meds (Ritalin, Adderall/XR, and now, Dexedrine have all had this issue. It seems I’m highly susceptible to this (doh!, I should have known, even coffee after 4pm strongly interferes with my sleep). So, I’ve learned these have to be taken at considerably modest doses (10 mg, cut in half) early in the day, followed some days with a minimal second dose (2.5 mg) around 3pm. Anymore, and I’m easily up until 2am. Before these med, I was a 10pm to bed / early riser. Since, I’m easily up until 11pm, and wake later. I even take Tramadol, occasionally, to assist in my sleep.

    Of all these, the latest attempt, Dexedrine has proven the gentlest, but later in the day, I experience heavy fatigue (actually, since my teens, I’ve had a strong issue with late afternoon exhaustion, even long before such meds. And curiously, I’ve learned this can, in fact, often be the case for those with AD/HD. Vyvanse will be my next attempt in this long odyssey. (I briefly tried Atomoxine / Strattera for a month, both with-, and without a stimulant meds, but strong feelings of uneasiness made me quit it).

    Given my current student-y / low-income status, and the bureaucratic red tape of “prior-authorizations”, my path through this has been considerably slowed (often, simply because I wasn’t informed enough to know what are the right questions to ask, as the larger issues have a lot of context that is *not* easily grasped at the outset). As you can imagine, the lack of sleep, and “hyper-attending” (fixating) on my mother’s illness proved to be a “wrecking ball” to my previously good student record. All of which leads me to say, I was almost was better off *before* such meds came along. (Curiously, my doctor feels I’m among a small subset of people who experience initial benefit but who encounter slow buildup of the deleterious effects, and so require a regular “break” from the meds for 1-2 days, every 2 weeks or so). So, I remain hopeful, but skeptical. I’ve had to ask myself some vari if certain aspects of all this, for eg., the “hyper vigilance”, might not merely be “merely” side-effects from the meds, but could they *also* be functions of re-activated PTSD (much to my surprise, my mother’s considerable health crises reactivated PTSD I’d experienced as a caregiver back in the Nineties, caring for persons during the AIDS “die-off” years).

    All of which makes me ponder: without a brain scan, how does the medical community “know” the accuracy of a given diagnosis, other than “ruling out” *other* potential concerns)? On the whole, I’m a positive, eager person. And I certainly don’t seem to present any severe clinical depression, bi-polar, or other concerns. So I find myself grasping at straws, and a bit frayed in patience when these meds, and the medical establishment that doles them, seem so “mixed” in their results. I miss my “early to bed” / sunny morning disposition lifestyle! Thus, I’ve seriously wondered whether or not “other” factors, such as any potential “delayed onset” concerns (from a pre-frontal cortex bashing in my 20’s, or effects from non-viral meningitis through Chickenpox at around the same age might not, in time, have mimicked, or compounded my ADD-like struggles with concentration, distractibility, hyper-focus, etc.

    It’s been “a journey”, to say the least: One thing above all has stood out: the vital need for both self-education, *and* for self-advocacy. Without these, those seeking to navigate the “ADHD Ocean” aren’t merely “adrift”; often, we find ourselves tossed overboard, lost on a tempest sea. (OK, that was dramatic, wasn’t it? Did I mention humor helps?) 😉

    Thanks for all you do, Gina! I hope my “late bloomer” / “still a scrapper” story helps you help others. And I’m truly grateful for any “life saver” advice you might be able to toss my way!

    Kind best,

    Robert

    1. Hi Robert,

      I haven’t forgotten you! Thanks so much for your comment, for visiting my blog, and sharing your “late bloomer”/”still a scrapper” story!

      I need to give a response some thought. Will be back soon!

      g

    2. Dear Robert,

      I don’t fail to keep my promises often, but I did in this case.

      I never got back to you, and I realize it’s probably too late to be useful.

      But I’ll give it a try. I hope that in the meantime you have found information useful to your journey through this blog and my books—and that your scrappiness has held strong!

      1. You wrote: without a brain scan, how does the medical community “know” the accuracy of a given diagnosis, other than “ruling out” *other* potential concerns)?

      A thorough history should be taken during an evaluation, going back to childhood and even infancy, if records are available.

      It’s not guaranteed but this is the best way we have until some miracle diagnostic arrives (not holding my breath).

      A brain scan cannot evaluate for ADHD, though it might indicate some type of neuroanatomical issue or injury.

      2. To your specific challenge regarding sleep:

      I’ve heard this story so many times, it’s shocking.

      A person is diagnosed with ADHD and given a stimulant. Let’s set aside, for now, problems with poor titration and failing to monitor symptoms with each increase.

      Let’s imagine this common scenario: The stimulant helps with ADHD symptoms but it exacerbates anxiety, which interferes with sleep.

      The clinician fails to assess and treat the “full range of symptoms.”

      Many people with ADHD will have a second, neurogenetic condition (e.g. bipolar disorder, anxiety, depression, etc.). If that goes untreated, stimulants can indeed exacerbate the condition, resulting in intolerable side effects.

      I wrote the medication chapters in my first book to guide consumers—in guiding their prescribers. They include such important tidbits.

      https://amzn.to/2LsT8Kw

      So sorry for the ridiculous delay. My workload just doesn’t seem to let up!

      g

  2. Joy commented that her partner does not like to cuddle. I have one of those also 🙂
    Is the dislike of cuddling a common trait in people with ADHD ? He has an extremely healthy libido but doesn’t like to be touched as in shows of affection – normal ?

    1. Hi Mac,

      You’re in luck.

      I just wrote about that in my newly published Kindle book, Adult ADHD and Sex.

      If you don’t have a Kindle device, you can download the free app for your phone, ipad, or computer.

      http://amzn.to/2961OFR

      g

  3. “So our troubles, we think, are basically of our own making. They arise out of ourselves, and the ______ is an extreme example of self-will run riot, though he usually doesn’t think so.” While one might want to insert ADD PERSON into the blank, it is actually “alcoholic”. I was diagnosed with ADD/ADHD about 6 years ago at the age of 50-a surprise to only me and no one else in my life-at that time I had been sober 7 years. I always said that the worse part of being sober initially was laying my head on the pillow at night. I hated the rush of toughts-like salmon swimming in a stream-so many that I would be paralyzed to know which to focus on.

    Now, I find that meditation does help quiet my mind and I do it while just laying in bed. I put headphones on and listen to a guided meditation. It has also lessened symptoms of depression. There are many great meditation on you tube, or you can try the UCSD websiite for mindfulness.

    1. Hi Paul,

      Isn’t that amazing? Can you imagine how many other people have been in your situation over the decades (the centuries) and did not have a better way to cope than alcohol?

      I’m really glad you found that meditation helps you. Great suggestion.

      g

  4. I put my 12 year old ADHD daughter on Melatonin chews, and she’s a different person: human in the morning, for starters. Had we known this years before I would have seen to it that she got them. I take them now and again, sleeping is not as big an issue.

    1. Hi Chris,

      I’m glad that melatonin is working for you.

      According to the sleep researchers I’ve interviewed, melatonin should be approached cautiously. It is a hormone, after all. And we want to be very careful with hormones.

      Sometimes the same effect can be achieved by getting sunlight in the morning, and lowering houselights in the evening — to cue melatonin release — and to avoid electronic device screens in the evening. And of course to do all the other things for good “sleep hygiene.”

      And sometimes a medication to address anxiety/depression/serotonin-issues is helpful.

      It just depends on what is the specific issue for the person with ADHD.

      I’m glad your daughter is feeling better.
      g

  5. I have to say this for us ‘Nons’
    out there… but the leg shaking,
    the sleep talking,
    waking up to the laptop light
    (at 3am) have taken such a toll, along with nightly complaining about being short sheeted,
    (” You stole my sheets!” is gonna be on his tombstone)
    I have Given Up sleeping with my ADHD spouse!
    Its been absolutely heaven to me, not waking up to what I think are the rumblings of an earthquake and the Adrenaline/ Fear from the leg shaking.
    Or to hear some negative comment every night before I go to bed.
    Yes – I’m sure theres meds for this but he’s already taking a lot and just not willing to take more.
    BTW he sleeps Just Fine!

    I’m sure its saved our marriage.
    And my sanity.
    he can’t stand to cuddle -so theres no loss for anyone.
    And I get to be in an organized lovely room to myself 😀
    Seriously couldn’t be happier!

    Sometimes being unorthodox is the way to stay orthodox.

    1. Hi Joy,

      Great suggestion! It’s one I make all the time, but people sometimes respond as if I’d said something outrageous.

      I’m very glad you had the gumption to try separate bedrooms, and that it works for you!

      Good for you, for taking care of yourself.

      g

    2. Wonderful! No downside at all, Joy, for those who have room and can get past “conventions.”

      g

  6. Thank you…I was recently diagnosed and have appreciated your insights…tears well up… I love everyone…it is me or my dis-ease I can’t stand….keep posting…thx

    1. Hi Tom,

      Thank you so much for writing. It’s the pesky symptoms, in all their myriad, shape-shifting glory!

      Tears well up for me all the time, when I think of how many adults don’t know they have ADHD, and how they have struggled.

      Which is why I do this work.

      I’m glad we met here. Stay tuned.

      xo
      g

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