Sleep issues can be an ongoing problem for adults with ADHD, and the sleep deprivation that results from this lack of rest can worsen ADHD symptoms.

But a dietary supplement called melatonin can help. The supplement uses the same compound that occurs naturally in the body. And some people — with and without ADHD — have found it can help them sleep.

Still, if you have ADHD and sleep problems, you need to consider the possible pros and cons of using melatonin.

ADHD and Sleep Problems

Difficulty falling asleep because of an overactive mind and delayed sleep-phase syndrome are common sleep impairments among people with ADHD, says Dr. Chester Wu, psychiatrist and sleep specialist in Houston and medical reviewer at Rise Science. Other problems include:

• Delayed sleep onset, meaning it is difficult to fall asleep until significantly later than the conventional bedtime.
• Difficulty waking up at the desired time in the morning.
• More awakenings during the night.
• Poorer overall quality of sleep.

“A lack of sleep can induce ADHD symptoms, and having ADHD makes you more likely to experience sleep disturbances,” says Dr. Rebecca Jackson, a chiropractic doctor and brain wellness expert. “A tired brain has difficulty paying attention, recalling information, overriding impulses and controlling emotional reactions. Individuals with ADHD already struggle with one or more symptoms and a lack of sleep only exacerbates these challenges.”

Quality sleep is a necessity for productivity and overall well-being.

“Research has shown that shifts in sleep and wakefulness patterns for someone with ADHD can come from differences in the timing and amount of natural melatonin being released, setting the brain’s pattern of sleep and wakefulness,” Jackson says.

Natural Melatonin in People With and Without ADHD

Everyone’s body makes melatonin naturally. Darkness prompts the pineal gland to produce melatonin at night. However, behavior impacts whether melatonin production is successful.

Light causes the natural production of melatonin to stop, which means the circadian rhythm and the sleep-wake cycle of the body go unsynchronized and interfere with the sleep transition.

And humans often interrupt natural darkness with unnatural light — especially from the overuse of mobile phones and tablets at night. These devices produce blue light than interrupts that darkness and can affect sleep.

And, in adults with ADHD, the natural production of melatonin gets interrupted in additional ways.

“There is a substantial association between ADHD and delayed sleep phase disorder, a circadian rhythm sleep disorder prevalent in approximately 73 to 78% of individuals with ADHD,” says Wu. “Individuals with circadian rhythm sleep disorders often experience a delay in the natural production of melatonin, leading to difficulty falling asleep at conventional bedtimes.”

The result: The alteration in melatonin secretion can result in a shifted sleep phase.

That means that people:

• may feel more alert in late evening.

• face challenges in being able to wake up early.
• often have lower quality and duration of sleep.

Wu says experts still don’t know why people who have ADHD and circadian rhythm sleep disorders have a more difficult time falling asleep than people without such difficulties. One scientific theory, he says, is the brain’s synapses have a reduced responsiveness to melatonin.

When this responsiveness to melatonin is low — even if melatonin levels are adequate — the neural response may be subdued. As a result, this potentially “impacts the regulation of sleep-wake cycles and circadian rhythms, leading to difficulties in initiating sleep or maintaining regular sleep patterns,” Wu says.

Pros and Cons of Melatonin Supplements for the ADHD Brain

Even though melatonin is a natural element in the body, melatonin supplementation isn’t for everyone. It’s critical to consult with a doctor to discuss appropriate dosage and timing, especially if you take medication for ADHD or other conditions.

“Melatonin is often taken in excessive amounts and at incorrect times,” says Wu.

That can impact restfulness and cause grogginess upon waking, he says.

Also, as with any supplement, there are pros and cons to melatonin and how it affects the ADHD brain.

Here are some benefits to taking melatonin supplements if you have ADHD:

• Helps shift sleep schedules

Melatonin supplementation is effective in shifting sleep schedules for people with ADHD. If you stay up too late, melatonin could help fix this daily pattern.

“If your sleep struggle involves challenges with falling asleep, melatonin is a low-risk option that may reduce this time and increase the time spent sleeping,” says Jackson.

Melatonin can shift the time a person goes to sleep forward by approximately 1.5 hours.

• Can be especially effective with light therapy

Melatonin taken at a low dose in late afternoon or early evening combined with light therapy early in the day can advance sleep schedules and shorten sleep onset for those with ADHD and circadian rhythm disruption, Wu says. Bright light therapy used consistently first thing in the morning has shown to improve shifting sleep patterns, signaling to the brain that it is time to be awake and resetting circadian rhythms of sleep and wakefulness, Jackson says. Some research shows the combination of melatonin and light therapy can be more effective than melatonin supplementation alone.

Here are some disadvantages to melatonin supplementation for people with ADHD:

• Some side effects

Melatonin is generally considered low risk for side effects, but that doesn’t mean they’re non-existent. Jackson says common side effects include daytime sleepiness, headaches, nausea and
dizziness.

“Less common but more severe side effects include reports of depression,” Jackson says,

• Inconsistent results

Melatonin can be helpful for some people with ADHD, but it does not always deliver the same results. Though the sleep aid can shorten the time it takes to fall asleep and increase the total time spent asleep, its effects are inconsistent across multiple studies and classified as “preliminary evidence,” says Jackson.

Are Melatonin Supplements for Everyone?

Sleep issues are common — in people with and without ADHD. Sleep issues can be a symptom and side effect of ADHD, and can exacerbate other ADHD symptoms.

For many, taking melatonin supplements can deliver good results.

But melatonin is not a cure-all for sleep issues. And, as with all over-the-counter supplements, you should take melatonin only after you’ve discussed it with your doctor.

How these people deal with those issues — or their failure to successfully deal with them — has a major effect on their ADHD symptoms, and their overall health.

In a recent episode of “Refocused: A Podcast All About ADHD,” hosted by Lyndsay Guentzel and sponsored by ADHD Online, ADHD and sleep expert Stephen Lange, PhD, talked about sleep issues in general and for people with ADHD. Lange is a psychologist who focuses on sleep and ADHD and provides healthcare services to the U.S. Coast Guard as a Coast Guard auxiliarist.

The ADHD and sleep podcast is just one of the recent Refocused podcasts that tackled some important issues for people with ADHD. Here are highlights of three recent podcasts:

Episode 76 — ADHD, Sleep Hygiene and the Recipe for a Good Night’s Sleep Lyndsay and Lange talk about why people with ADHD are more likely to have sleep problems. And they talked about expert tips on improving sleep — including fostering good “sleep hygiene” that can help people sleep. And the challenges in putting in place some of those good sleep hygiene rules.

Lange: “The problem with sleep hygiene is we all know it works and we all know it’s good for us. And we don’t do it. Anything in the list of good sleep hygiene, people resist. For example, ‘No caffeine after 2:00 PM.’ It’s relatively easy to do, except people don’t want to do it. … ‘No nicotine after 2:00 PM.’ Very difficult if you’re a smoker. ‘Getting sun on your face,’ I think, is pretty easy. If I were working in a place that was very negative about taking breaks and stepping away from your desk, I would make a point of talking to my supervisor about a need for that. And maybe get a doctor’s note as a disability accommodation, especially if having ADHD. If I were running a company with employees, I would insist that people take your lunch away from the office, don’t eat lunch at their desk.”

Episode 80 — The Power of Movement: Identifying the Why Behind Exercise

Lindsay talks with Alli Cost, an occupational therapist and a managing partner of Foundation Training, a group that helps people relieve chronic pain through special exercises. Lindsay and Alli talked about how basic and uncomplicated exercise can help anyone, and can be especially helpful to combat symptoms of ADHD.

Alli: “One thing is we start too big (in trying to start exercising). Meet yourself where you’re at. No one starts marathon training running 14 miles. They literally start by getting their pair of shoes and going for a five-minute walk. So start, literally, as small as possible. Smaller than you think, so it’s almost embarrassing. So if your goal is to get out and do some amount of exercise, say, ‘Okay, I’m literally going to go for a two-minute walk. Two minutes. I’m just going to put on my shoes, walk out the door, take five breaths, walk around the block, come back in.’ And getting consistency, because what you want is that routine. … The same way that showering most days becomes part… You just want it to become routine.”

Episode 81 — The Adderall Shortage: Looking at America’s Mental Health Crisis with Michael A. Cohen

Lindsay sits down with Michael A. Cohen, a columnist for MSNBC who has ADHD and wrote an April 29 opinion piece for The Daily Beast news website titled: “The Adderall Shortage is the Mental Health Crisis No One’s Talking About.” Adderall is a prescription medication that is used by millions of people with ADHD. There has been a severe shortage of the medication in the U.S. since the fall of 2022.

Cohen writes in the piece, and reiterates in his conversation with Lindsay, his dismay that the U.S. government and others aren’t taking the ongoing Adderall shortage more seriously.

Cohen explains why he decided to write the opinion piece:

“I saw other people talking about this issue and I realized I wasn’t alone in struggling with trying to find a medication that I usually take. I went through this last winter — where I had like a two-week period where I did not have medication. I couldn’t get the medication I usually use. And it was terrible. It was really difficult to do anything.”

He believes the limited reaction to the shortage from leaders and others without ADHD is because they don’t understand ADHD.

“It’s one of these things where people who don’t have ADHD, it’s hard to understand it. I think for a lot of people, it may not seem like a real crisis. It may not seem like a real problem, because it’s hard to sort of understand what it’s like when you don’t have this kind of medication, and when you suffer from this affliction.”

He says he’s been disappointed in the lack of urgency to the problem in the federal government and on Capitol Hill.

“Millions of Americans take these drugs. Millions. And except one congresswoman from Virginia, the focus on the Hill was non-existent. People just didn’t want to get involved in it. This is a serious issue, and it affects millions of people. And it was striking to me … that in the corridors of power, this wasn’t seen as something that was more important.”

Take a listen to these podcast episodes, and many others, at the Refocused podcast website.

Dr. Stephen Lange is a psychologist who focuses on sleep and ADHD and provides healthcare services to the U.S. Coast Guard as a Coast Guard Auxiliarist.

Dr. Sanford Auerbach is the director of Boston Medical Center’s Sleep Disorders Center and an associate professor of neurology, psychiatry, and behavioral neurosciences at Boston University Chobanian & Avedisian School of Medicine.

Learn more: Why Does White Noise Help People Sleep?

Tune in now to learn more about ADHD and impulsivity from Melissa Orlov!

Affected by the stimulant medication shortage? #AdderallShortage us too! Melissa’s latest post Adderall Shortage Hacks for Adults with ADHD offers up ideas on how to deal with the dysregulation, tips for dealing with the pharmacy and even has non-medicinal ways to help alleivate some of the side effects. Check it out now!

Highlights

• What is rejection-sensitive dysphoria? 
• Emotional dysregulation in the ADHD partner
• Parent-child dynamic in ADHD-impacted relationships
• People pleasing and over-committing 
• Addressing ADHD, shame, and rejection 
• Establishing routines with ADHD 
• Sleep hygiene and disorder 
• Impulsivity and distractibility in ADHD
• Handling finances in ADHD-impacted relationships 
• How the non-ADHD partner can help nurture the ADHD-impacted relationship

Do you have problems falling asleep at night? Or staying asleep? Ever wonder if it’s related to your ADHD? You’re not alone; 70% of individuals with ADHD have mild to severe problems with sleep and daytime wakefulness/alertness. 

Dr. Stephen Lange explains the different sleep issues ADHD Inattentive Types, Hyperactive-Impulsive Types, and Combined Types experience and how medications, alcohol, and caffeine can wreak havoc with getting a good night’s sleep. 

In this webinar, you will learn:

• General Principles for improving your sleep
• Habits that interfere with sleep
• Sleep Hygiene Training
• Benefits of Phototherapy 
• Parent-Child Therapies 
• Cognitive behavioral therapy for insomnia 

It isn’t your imagination: Going to bed, falling asleep, awakening easily and feeling well-rested may seem like they’re out of your reach, while your friends or relatives without ADHD don’t have similar problems. Some of the hallmark behaviors of ADHD may prevent you from getting the rest that you need, despite your best efforts.

“ADHD self-regulation impairment creates problems in all lifestyle routines, including sleep,” says Daniel Wysocki, EdS, a psychological examiner and therapist based in Jonesboro, Ark., who diagnoses and treats patients with ADHD.

If you don’t get the sleep that you need, you may adopt habits to feel alert during the day. Often, these strategies backfire.

“You might… take a nap, (or) you might drink more coffee,” says Amy Marschall, PsyD, a licensed psychologist based in Sioux Falls, S.D., who treats patients with ADHD, anxiety and depression. “The ways that you compensate to stay alert during the day causes you to not feel as rested and ready for bed the following night. It becomes that ongoing cycle.”

Feeling tired during the day may have negative consequences, making it more challenging for you to accomplish things.

“Not getting restful sleep can have devastating effects on work, school and home responsibilities, leading to even more stress,” Wysocki says. “Lack of sleep can worsen ADHD symptoms. And solving sleep issues can help improve symptoms.”

Why people with ADHD may have sleep problems

Some people with ADHD have difficulty going to bed when the time approaches, either because they’re absorbed in an activity or because they aren’t good at transitioning from one activity to another.

“People with ADHD experience hyperfocus periods — get really into what they’re doing — and not realize how late it’s gotten,” Marschall says. Marschall says others may say: “’I’m doing (this, so) I might as well keep going.’ It’s harder to shift into that rest, getting ready for bed.”

For those who make it to bed at a reasonable hour, constant thoughts may make it hard to relax.

“Sometimes you have what we call cognitive hyperactivity, which is the racing thoughts,” Marschall says. “It’s really hard to fall asleep because you lay down and your thoughts are still going on.”

Waking up can be a challenge for people with ADHD, especially if you didn’t sleep for long enough. If you stay up too late or lie awake with your thoughts, your total sleep time may be shortened.

Strategies that help people with ADHD go to bed on time

If you experience time-blindness — becoming so absorbed in what you’re doing that you don’t realize how late it’s gotten — you may miss bedtime, even if you don’t mean to. Adding cues to your schedule may provide the nudge that you need to go to bed.

Some people hang more clocks in their home. Others set a nighttime alarm on their phone when they want to get ready for bed. If you spend time in the same room every evening, consider plugging a lamp into a timer, so that the light goes off when you should go to sleep.

You may learn to go to bed on schedule by depending on others, even if you don’t ask anyone for help.

“Cues in the environment could include following the schedule of others,” Wysocki says. “Find a routine-oriented roommate or even adopt a pet. Each of these will encourage you to follow a more regular schedule.”

Following a set bedtime routine every night should help your brain associate those behaviors with winding down and falling asleep.

Some people spend the last half hour of the day in dim lighting. Other people take a warm shower. Still others lie down and read a book. (Opt for a real book with paper pages, not a tablet or smartphone, to avoid light stimulation from the device.) Personalize your bedtime routine so that you’ll follow it nightly.

“It’s less about what you do and more about doing the same thing,” Marschall says. “Your brain pairs it, like, ‘Okay, when I do this, that means it’s starting to be time to get ready for bed.'”

Tweaking bedroom habits may improve sleep

Once you’re lying in bed, eliminating distractions may help you fall asleep more quickly. For many people, an ever-present smartphone is a temptation at bedtime, and alerts may awaken you in the night. Do-not-disturb settings may help somewhat, but sleep experts recommend that you ban your phone from the bedroom.

“Replace the smartphone alarm (and) start using a digital or analog alarm clock,” Wysocki says. “This will unchain our brain (from) the common, unhealthy habit of excessively scrolling through the night and waking to being stuck scrolling in bed.”

Sometimes, noises in a sleep environment make it challenging for someone with ADHD to drift off. Whether you’re distracted by traffic or your partner’s snores, a constant sound, like a running fan or a white-noise machine, may help.

Some people with ADHD who experience racing thoughts at bedtime prefer to sleep with background noise, such as music or television. Marschall, who has ADHD, finds it helpful to put on TV reruns that she’s seen multiple times, which serve as distraction from her thoughts.

“My brain is saying, ‘Nope, we’re focused on the storyline. We’re listening to the show,'” Marschall says. “It’s something that is familiar enough, because I’ve seen it many times, that it’s not stimulating me to stay awake.”

If you like it quiet at bedtime but you have trouble falling asleep because your mind is racing, try to focus on something relaxing.

“Fill that space with thoughts related to simple but fulfilling tasks or hobbies you enjoy,” Wysocki says. “If your mind drifts back to worries or concerns, return it to your mindful thoughts about something you find enjoyable.”

Morning strategies may make it easier to wake up

Sleeping in a dark room encourages sleep, but arising in a dark room may make it hard to feel awake and alert. If you’re groggy every morning, consider adding morning light to your routine, even before you get out of bed.

Instead of using room-darkening blinds, choose window coverings that let in natural light. Or invest in a sunrise alarm clock, which gradually brightens during the 20 or 30 minutes before the alarm goes off, so that you awaken in a pleasantly lit space.

“Having light come in can help your brain to make that adjustment,” Marschall says. “Sunlight can help your brain to say, ‘Okay, it’s time to be awake. It’s time to be alert.'”

Forcing yourself to get out of bed when it’s time to wake up may also get you in the habit of arising when it’s time.

“If you’re able to, have the alarm across the room from you, so you have to get up to turn it off,” Marschall says.

See a therapist for suggestions

If you change your bedtime habits and still have trouble falling asleep or waking up, ask your doctor or therapist for guidance.

“Sleeplessness and somnolence (feeling sleepy) throughout the day could be a by-product of depression,” Wysocki says. “This is one of the reasons it’s best to speak to a specialist for a full treatment plan.”

According to the non-profit group Children and Adults with Attention-Deficit/Hyperactivity Disorder, or CHADD, nearly three out of four children and teens and up to four out of five adults with ADHD have sleep problems. “Often in ADHD, sleep cycles may be shifted, with people generally falling asleep later and then waking later,” says Jake Behrens, M.D., a psychiatrist and medical director at Envision ADHD in Milwaukee, Wisc.

In fact, sleep disturbances and sleep disorders are the most common comorbidities (conditions that are present at the same time) reported by people with ADHD. Adults with ADHD walk around bleary-eyed and fatigued, unable to focus well or concentrate. Sleep-deprived kids with ADHD may be even more impulsive and hyperactive.

The ADHD-Sleep Connection

Adults with ADHD tend to have difficulty falling asleep, staying asleep and waking up in the morning. In kids, ADHD-related sleep problems like these don’t usually happen until they’re around 12 years old. However, 10 to 15 percent of kids with ADHD have difficulty falling asleep before they hit puberty, William Dodson, M.D., a member of ADDitude magazine’s ADHD Medical Advisory Panel, writes in the magazine. Many experience nightmares and bedwetting too. By the time they’re 12 years old, 50 percent of kids with ADHD have trouble getting to sleep almost every night.

Experts aren’t sure why these sleep issues happen in people with ADHD. One possible reason is that ADHD can goof up your sleep-wake pattern, called your circadian rhythm. When your circadian rhythm is delayed, as it tends to be with ADHD, you may go to sleep and wake up two hours or more later than what’s considered traditional. This pattern of sleep deprivation does not necessarily cause lethargy but in turn can mimic ADHD symptoms of hyperactive and unfocused.

“Sleep disturbances are often seen with untreated ADHD,” explains Behrens. When your ADHD isn’t treated, this can lead to a cycle of trying to stay on top of everything during the day, staying up late, a spinning mind when you’re trying to fall asleep, and then trying to function on less sleep the next day. Experts have found that treating ADHD can improve sleep and treating sleep problems can improve ADHD.

The Role of ADHD Medication

ADHD medications are often blamed for poor sleep, and they certainly can cause sleep problems. Stimulants typically keep people awake, so depending on how they’re used, Behrens says, they can affect people’s ability to fall asleep. The medication may be lasting too long in your system, or you may be taking it too late in the day for it to wear off by bedtime.

“There is often an inverse effect seen, though — where treating ADHD may actually help people with sleep overall,” says Behrens. One theory on this is that if you’re more awake during the day, thanks to the wake-promoting effect of your medication, “this helps to build the sleep drive over the day to hopefully make it easier to fall asleep at night,” Behrens says.

Being able to focus and stay in control of what you need to get done during the day should help reduce the amount of time you spend with your mind spinning through your mental to-do list at night too, Behrens says. As your ADHD symptoms improve, you should feel more confident about getting your tasks done, which in turn should improve your sleep.

The bottom line is this: ADHD experts say that when patients are on the appropriate medication, and following an appropriate regimen, they often feel well rested and ready for bed because they are mentally and physically tired at the end of the day.

If you’re still having trouble getting to sleep when you’re on your medication, talk to your healthcare provider. You may need to take it at a different time or switch medications altogether.

Sleep Disorder or ADHD?

ADHD symptoms are similar to sleep deprivation symptoms. This is why it’s possible for someone to have ADHD-like symptoms when they have only a sleep disorder, or have sleep disorder symptoms that are actually from ADHD, Behrens says. He says it’s always worthwhile to rule out a sleep disorder and get any sleep concerns checked out and treated if needed. And since sleep disorders are more common when you have ADHD, it’s possible that you have both conditions.

People with ADHD, including children, tend to have higher rates of certain sleep disorders. A good example is restless legs syndrome, which affects an estimated 2% of all kids, but affects as many as 50% of children with ADHD, according to the American Academy of Pediatrics.

Sleep disorders that most commonly coexist with ADHD include:

• Circadian rhythm disorders
• Insomnia
• Restless legs syndrome
• Sleep apnea and snoring
• Narcolepsy
• Difficulty falling and staying asleep

How to Improve Sleep

A good night’s sleep is crucial to your mental, emotional and physical well-being. It can affect your mood, behavior, performance at school or work, attention span and your quality of life.

If you’re looking for ways to sleep better, one of Behrens’ most important pieces of advice is to ditch personal devices — phones, electronic tablets, and computers — in the evenings. These devices “are almost like using light therapy to get ourselves activated and more energized in the morning,” he says.

Not only is the blue light close to your face activating your retinas, but “the content of such devices is also engineered to promote user engagement and to keep you clicking, watching, etc.” This is why it’s important to start putting away your devices two hours before bed, Behrens says. If you must use a device in the evening, he recommends using blue light blocking glasses.

Good sleep habits, also known as sleep hygiene, are crucial to improve your sleep. Take a look at your sleep hygiene and work on making any necessary changes. The Sleep Foundation and the American Academy of Sleep Medicine’s Sleep Education (see links below) have plenty of resources to help.

Here are some more tips to help you sleep better:

• Behrens suggests asking your mental health provider about supplements that help promote sleep, such as melatonin. He says to be cautious when it comes to using diphenhydramine (Benadryl) because it can make you groggy and dehydrated in the morning.
• Create a routine for bed time and go to sleep and wake up at the same time every day.
• Use relaxation techniques or cell phone apps to help you relax before bed.
• Bright light therapy may help you go to sleep and wake up earlier. You’ll need a light therapy lamp or box that you’ll use in the morning.
• Try cutting back on caffeine and/or alcohol in the late afternoon and evening. Even better, cut them out altogether.
• Prioritize physical activity every day. It should help you sleep better.
• Consider using a weighted blanket. The heaviness of the blanket helps many people feel more calm and secure.

Sources:

CHADD: ADHD and Sleep Disorders

ADDitude: ADHD and Sleep Problems: This Is Why You’re Always Tired

Sleep Foundation: ADHD and Sleep

Psychiatric Times: ADHD: A 24-Hour Disorder

MDPI Open Access Journals: Managing Sleep in Adults with ADHD: From Science to Pragmatic Approaches

CHADD: ADHD and Sleep Disorders Diagnosis and Management

AAP News: How to Differentiate Sleep Disorders from ADHD

Nature and Science of Sleep: Sleep Disorders in Patients with ADHD: Impact and Management Challenges

The Sleep Foundation

American Academy of Sleep Medicine’s Sleep Education

What is sleep hygiene, and what does it have to do with ADHD? Children, teens, and adults with ADHD are likely to experience insomnia, sleep disturbance, and difficulty sticking to a sleep schedule. This seminar educates about sleep hygiene and how it can help people with ADHD and their loved ones make and keep a healthy sleep schedule.

Dr. Amy Marschall, Psy.D., is a licensed psychologist in South Dakota. Dr. Marschall works primarily with children and adolescents and is certified in Trauma-Focused Cognitive Behavioral Therapy and Telemental Health. In addition to individual and family therapy, she completes psychological assessments for ADHD.