ADHD & Difficulty Waking Up: What’s the Link?
Sleep disorders are highly common amongst people with ADHD. Most recent research suggests that anywhere between 50%-80% of adults with ADHD experience sleep problems. This can affect all aspects of people’s lives, leading to difficulties waking up in the morning and increased tiredness throughout the day, known as excessive daytime sleepiness.
These sleep problems have been demonstrated to have specific and separate impacts on quality of life of adults and children with ADHD, potentially greater even than ADHD itself. In this post we will explore some of the most common sleeping disorders associated with ADHD, and suggest some key tips for waking up easier with ADHD.
Why do people with ADHD find it difficult to wake up?
There are several sleep disorders which are comorbid with ADHD. These sleep disorders can severely affect your sleep quality, making it more difficult to wake up in the morning.
Insomnia
Insomnia includes difficulties falling asleep, waking up several times throughout the night, and waking up early and struggling to fall asleep again. Roughly one in ten adults in Europe experience chronic insomnia. Multiple worldwide studies have suggested that rates of insomnia are higher amongst people with ADHD.
For example, a 2017 study from the University of Bergen in Norway found 66.8% of adults with ADHD met their established criteria for insomnia, compared with 28.8% of adults without ADHD. Meanwhile, a 2012 study of Romanian participants with ADHD by Babes-Bolyai University suggested that more than 50% of those with probable ADHD reported insomnia-like symptoms, including shorter sleep durations, longer sleep latencies, and more frequent unwanted awakenings.
Overall, insomnia can drastically reduce your sleep quality, and wider quality of life. People who suffer from insomnia report never feeling fully rested in the mornings, and tend to find waking up a chore.
Circadian rhythm sleep disorders
Circadian rhythm disorders refer to disorders where your body clock is out of sync with society. Research suggests that people with ADHD are more likely to be alert in the evening, and therefore they prefer later bedtimes and wake-times than most. Given that society is particularly centred around a 9 to 5 schedule, this can be very challenging. This delayed sleep onset is particularly common amongst those with the inattentive variant of ADHD.
Types of circadian rhythm disorder can include:
- Delayed sleep disorder – a delayed onset of sleep, whereby you cannot fall asleep until later than you want. This disorder is the most associated with ADHD.
- Advanced sleep-wake disorder – individuals find it difficult to stay awake in the early evening and wake up too early in the morning
- Irregular sleep-wake rhythm disorder – individuals experience several short periods of sleep and wakefulness experienced through the night
Restless legs syndrome
Restless legs syndrome (RLS) is appreciably higher amongst those with ADHD. RLS refers to an overwhelming urge to move your legs. This urge is often associated with uncomfortable sensations in the legs, or other body parts.
Periodic limb movements (PLM) are also common during sleep amongst those with RLS. PLM involves repetitive movement of arms and legs during sleep, and has also been shown to be common amongst people with ADHD. Both these sleep disorders can worsen insomnia, decreasing overall sleep quality.
Hyperactivity and restlessness
Studies suggest that there is a relationship between hyperactivity seen in forms of ADHD and sleep disorders. This can materialize in the form of boredom while trying to fall asleep, struggling to turn your thoughts off, and difficulty lying still. All of this can lead to insomnia. Similarly, people who are hyperactive and stimulus-seeking may resist going to bed, worsening circadian rhythm disorders.
Studies also suggest that transitioning to attention demanding activities, such as work or school, can be challenging. Thus, waking up can be difficult in and of itself, regardless of overall sleep quality.
Top tips for waking up easier with ADHD
There are many ways you can improve your sleep hygiene. Firstly, prepare yourself well for sleep. Avoid completing any stimulating tasks before bed (such as work-activities or chores), and focus instead on relaxing activities, such as having a hot bath, listening to an audiobook, stretching, or practicing deep breathing. It is useful to have a time in the evening after which you stop looking at any electronic devices, as artificial light can heavily disrupt sleep-wake rhythms.
Try not to force your sleep. Only go to bed when you feel tired, as this will reduce the amount of time you spend alert in bed. If you cannot sleep, get up to complete a relaxing activity, rather than trying to force sleep. Try not to take any worries to bed with you. Complete to-do lists before bed, so you do not have to focus on unfinished tasks while you are trying to sleep.
If sleep problems persist, contact your local GP, who can suggest potential medications or treatments. Some of the following tips are also worth considering:
- Try to wake up at the same time every day, even on weekends and holidays. The human body responds well to routine.
- Avoid alcohol and caffeine late at night
- Exercise regularly during the daytime (can help with mild RLS), but not less than four hours before bedtime (as this can worsen insomnia)
- Avoid daytime napping
- Avoid using your bed for non-sleep activities, such as working, watching TV or browsing the internet
- Try not to watch your clock at night, as this can lead to more stress and panic
- For circadian rhythm disorders, the use of light therapy can be beneficial.
Conclusion
Waking up is a struggle for many with ADHD, due to comorbidities with a range sleep disorders. However, practicing better sleep hygiene and sticking to a more consistent sleep routine can help ease the struggle.
Sources
Restless legs syndrome – Ekbom – 2009 – Journal of Internal Medicine – Wiley Online Library
https://www.bristol.ac.uk/news/2024/may/insomnia-uk-biobank.html
https://www.nhs.uk/conditions/insomnia
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10001099
https://www.nhlbi.nih.gov/health/circadian-rhythm-disorders/types
https://www.tandfonline.com/doi/pdf/10.2147/NSS.S163074
https://www.nhlbi.nih.gov/health/circadian-rhythm-disorders/treatment
https://www.berkshirehealthcare.nhs.uk/media/109514310/7-adhd-guide-sleep.pdf