How Does ADHD Make You Tired?
Attention-deficit/hyperactivity disorder (ADHD) can be a common neurodevelopmental disorder that tends to be associated with a high prevalence of accompanying sleep disorders. These can include circadian rhythm sleep disorders, sleep apnea, and restless legs syndrome (RLS).
Many people with ADHD experience sleep disturbances and report feeling tired throughout the day. According to CHADD, four out of five adults with ADHD may live with sleep disorders that affect their daily functioning. Improving daily routines and sleep hygiene may be helpful, and working with a licensed therapist can provide you with individualized insight and guidance.
How does ADHD make you tired?
ADHD may cause fatigue due to neurochemical imbalances in the brain. Research also suggests that, when compared to the combined type of ADHD, those with inattentive ADHD may experience more sleep problems and fatigue.
In addition, obstructive sleep apnea (OSA) and sleep-disordered breathing (SDB) tend to be more prevalent in those with ADHD. These conditions may worsen core ADHD symptoms, such as difficulty focusing and forgetfulness.
Some researchers also point out that “poor sleep quality and quantity play an important role in cognitive functioning deficits.”
According to the theory of circadian rhythm dysregulation, a person with ADHD may have an internal clock that is less able to judge the passage of time. This may be partially attributed to a delayed melatonin release in those with ADHD.
Sleep disorders associated with ADHD
Some people with ADHD are also diagnosed with autism spectrum disorder (ASD).
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) generally allows for a simultaneous diagnosis of ADHD with another disorder, such as ASD. Both ADHD and ASD tend to be linked with a high prevalence of sleep disorders listed in the International Classification of Sleep Disorders, 3rd edition (ICSD-3).
Sleep issues can include insomnia, circadian rhythm sleep-wake disorders, sleep-related breathing disorders (SRBD) like obstructive sleep apnea (OSA) and sleep-disordered breathing (SDB), and delayed sleep phase syndrome (DSPS). DSPS can be considered a circadian rhythm sleep disorder that sets back the sleep-wake cycle by two hours or more.
Some studies indicate high apnea/hypopnea and nocturnal motor activity in the sleep of children with ADHD, while other studies suggest alterations in REM sleep in those with ADHD. However, the exact results of these studies may contain inconsistencies, with some findings suggesting "an increase in total sleep time in ADHD" while "others report a decrease in total sleep time due to intermittent awakenings."
Regardless of the exact cause, sleep deprivation may lead to one feeling tired during the day, as well as experiencing other symptoms, such as irritability, restlessness, and difficulty focusing.
The effects of sleep difficulties
Many people with adult ADHD find that they are better able to concentrate at night, a time when they may be more awake and energized. It may take them a long time to fall asleep, or they may experience insomnia and restlessness. When they do fall asleep, it may be much harder to wake up rested in the morning, which can impact school or work performance.
Studies indicate that sleep deprivation can impair attention, and young adults with ADHD tend to perform worse on continuous performance tasks.
Sleep deprivation can also be associated with the following:
- Impairments in the processing of facial expressions
- Increased likelihood of depression, anxiety, and other mental health disorders
- Hyperactivity
- Inattention
- Increased vulnerability to physical illness
- Fatigue
- Restlessness
Tips for better sleep
Common symptoms of sleep deprivation can include difficulty paying attention, mood changes, and reduced cognitive ability. For those with ADHD, these issues can become even more challenging, exacerbating ADHD symptoms.
Sleep-related difficulties can be addressed, however. Some helpful suggestions may include the following:
- Stay away from technology (cell phones, TV, video games, etc.) an hour before bedtime.
- Consider taking melatonin supplements or using bright light therapy to regulate the sleep-wake cycle. Always consult your doctor before adding a supplement to your regimen.
- Aim to have a consistent sleep routine and do relaxing things at night, such as reading a book or taking a bath shortly before bed.
- Avoid doing projects that require intense focus at night, as this might induce hyperfocus and keep you awake.
- Exercise during the day.
- Consider using a weighted blanket.
- Keep your bedroom comfortable, quiet, cool, and dark.
- Avoid naps during the day.
- Avoid caffeine at night.
- If you take stimulant medication, discuss the best time of day to take it with your doctor.
Therapy to manage ADHD and improve sleep
Sleep disturbances and fatigue can greatly impair functioning and make it more challenging to manage ADHD symptoms. The support of a licensed therapist in managing stress and fatigue-related symptoms may help you find ways to address these challenges.
If going to in-person sessions is inconvenient or adds another demand to your schedule, you may want to consider online therapy. A platform like BetterHelp can connect you with a licensed therapist, allowing you to attend sessions via video conference, phone call, or online chat.
One 2020 study looked at the effects of an online therapy program for stress, coping skills, and sleep quality. According to researchers, “These results suggest that a brief, 6-week, cognitive-behavioral internet-based stress management program improves coping skills, sleep quality, and well-being.”
Studies suggest that online therapy can be effective for treating adult ADHD as well.
Takeaway
Many people with ADHD experience sleep disorders, but it can be possible to manage symptoms and get a restful night’s sleep. You might try staying away from technology an hour before bedtime, taking melatonin supplements, using bright light therapy to regulate your sleep-wake cycle, and developing a consistent sleep routine. If you take stimulant medication, it might also be helpful to discuss its effects with your doctor. Online or in-person therapy can be helpful for addressing symptoms of both ADHD and sleep disorders.
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