How ADHD Can Affect Your Sleep

Q & A with Our Clinic ADHD Specialist Dr. Meghan Van Vleet

As many of you know, Dr. Meghan Van Vleet is a naturopathic doctor at Boulder Natural Health who specializes in ADHD and other neurodivergent issues.  She has studied mental and cognitive health for the last 15 years. She has mentored with Dr. Walsh, PhD with the Walsh Research Institute, Dr. Bredesen, MD and colleagues at Apollo Health and Dr. Greenblatt, MD at Psychiatry Redefined. She has completed a 2-year fellowship with Psychiatry Redefined including an ADHD Intensive. She is also a mother of a neurodivergent child. In this newsletter Dr. Van Vleet shares some important and useful information about how to optimize your sleep for people with ADHD.

Q: Why do people with ADHD struggle to sleep?

It isn’t clear necessarily. We know that 30% of children and 60-80% of adults with ADHD have a sleep disorder.  That can result in excessive daytime sleepiness and fatigue. We also know that as little as 30 minutes of sleep deprivation degrades school performance and emotional regulation. Sleep is so important for developing children and they require far more hours than adults do.

Q: How much sleep does a child, teenager or adult need per night?

The National Sleep Foundation recommends toddlers who are ages 1-2 years need 11-14 hours of sleep per day (night hours plus daytime naps). Preschool aged children ages 3-5 need 10-13 hours of sleep per day (night hours plus daytime naps). School aged kids ages 6-13 years need 9 – 11 hours of sleep per night. Teens ages 14-17 need 8-10 hours of sleep per night.  Adults need 7-9 hours of sleep per night.

Q: What are the underlying causes of insomnia with ADHD?

People with ADHD have a busy brain. When distraction and stimulation of the day quiets away, thoughts can come quickly. Their minds are always overactive. In children there can be fears that arise at night.  In adults it can be anxiety and rumination that develops before bed. There can be OCD and rumination in kids too. ADHD as a condition often co-exists with other mental health conditions such as OCD, anxiety, depression, sensory integration issues, giftedness and more.  There can also be issues with sleep quality. Obstructive sleep apnea can often be the cause of poor sleep quality in kids and adults with ADHD. There is also research that shows chronic swollen tonsils can obstruct airflow and cause snoring and sleep apnea, which can be worsened for kids with ADHD. Snoring in all ages is associated with altered cognitive function. Blood sugar dysregulation, common in people with ADHD, can contribute to insomnia or poor sleep quality.

Q: Could stimulant medications be the cause of sleep problems?

There is research that suggests that stimulant medications cause delayed sleep onset and worse sleep quality and duration. That is not universal. I have seen some stimulant medications help people with sleep problems. It depends on the individual.

Q: How can you calm an ADHD mind at night?

Mindfulness techniques can be helpful for kids, teenagers and adults. It’s not about shutting the brain down, it’s more about turning the focus and mental engagement to other topics. Visualization and “Jedi mind control” exercises can help the person refocus their mind and calm their nervous system. I teach my patients in my office appointments how to do these techniques. We also talk about how to manage blood sugar levels during the day which can help stabilize blood sugar levels at night and improve sleep. Good sleep hygiene includes a bedtime routine such as a bath or shower followed by story time or reading, make sure screens are off a minimum of 1-2 hours before bed, keeping the room you sleep in cool and dark. Going into a cold room helps the body to shut down.

Learn more about how to optimize sleep here: https://bouldernaturalhealth.com/how-to-optimize-your-sleep-environment/

Q: Is restless leg syndrome associated with ADHD?

It would depend on the status of certain minerals. I suspect that RLS involves poor mineral absorption and/or higher rate of mineral need for this condition. I generally test for mineral deficiency in people with RLS. People with ADHD have a higher rate of disordered breathing, daytime sleepiness and restless leg syndrome. 

Q: Should patients with ADHD be tested for sleep apnea?

Yes. In the past I haven’t often recommended that children get tested because the procedure of a sleep study can be scary. However, now we have at home sleep studies available. There are bracelets and rings that are FDA approved for sleep studies that people can easily get.  There are rings sized specifically for children. These devices are different than the Oura ring or a Garmin watch.  While those are helpful, they are not approved sleep studies.

Q: Are there natural treatment options for people with ADHD and insomnia?

The number one supplement that I recommend for ADHD clients is magnesium. This mineral can be helpful for sleep, calming the nervous system, and most people are highly deficient in this mineral. My patients with ADHD have a higher need for this mineral because they have an overactive nervous system that burns through magnesium quickly. Beyond that, I like to find out what the person is experiencing at night. I tailor my treatments based on their specific sleep issues. If they have difficulty staying asleep we might discuss how they can manage blood sugar levels before bed. If they have a hard time unwinding at night I might recommend soothing herbs such as chamomile, skullcap, California poppy, or lemon balm. If they have ruminations and OCD, that is a more elaborate conversation that I have with the patient.