The Connection Between ADHD and Sleep Problems

A tired student struggling to focus

It’s very common for people with ADHD to have problems sleeping. Researchers have found that “Sleep difficulties and sleep disorders are the most common comorbidities reported in individuals with ADHD, affecting approximately 73% of children and adolescents with the condition.”1 These difficulties range from having trouble falling and staying asleep to clinical disorders like sleep apnea and restless leg syndrome.2

Not surprisingly, these sleep problems tend to make things worse. In some cases, they exacerbate preexisting ADHD symptoms, and in other cases, they simply add another difficulty to the mix. They’re associated with poorer outcomes at school and difficulties for families and caregivers.3

A kid who can’t get out of bed in the morning might be late for school, creating academic or disciplinary problems. And a kid who didn’t sleep well last night might be more prone to space out or doze off in class. And while that’s sometimes the case for students with ADHD, the surprising thing is that kids with ADHD might become more hyperactive when they’re tired – more impulsive and more likely to act out. Some researchers have suggested that this hyperactivity is actually a strategy the brain uses to keep itself awake.2

Medication Issues

Sometimes the ADHD medications themselves are partly to blame. Since these are often stimulant medications, they can lead to difficulty sleeping. “If a child taking stimulant medication is having trouble sleeping, you should consult your doctor, who might reduce the dosage or adjust the timing of her medication so it’s not in effect at bedtime.”1

If you don’t get this right, the “solution” to ADHD can actually become part of the problem. Anyone who has ever drank coffee at 3pm to finish their workday because they didn’t sleep well the night before can relate to this. That afternoon coffee might help you power through the rest of the day, but it will keep you up too late, leading to another night of inadequate sleep.

Treating Sleep Problems

The circadian rhythm seems to have a role to play here. People with ADHD seem to be getting the sleep-inducing hormone melatonin almost two hours later than most people.4 This explains why many of them struggle to go to sleep at what society and school schedules have deemed to be the normal bedtime.

a girl watching an iPad in bed

The good news is, melatonin is available as an over-the-counter supplement, and it has been shown to help many people with ADHD – not just with their sleep, but also with their symptoms.2 And as far as drug-based interventions go, melatonin is a pretty mild option. However, since there can be negative side effects and since the dosage of over-the-counter options may be inappropriate for children, this should only be done under the guidance of a doctor.

Also, if sleep apnea or any other clinical sleep disorder is suspected, you should definitely consult your doctor for diagnosis and treatment.1

But whether or not you seek out professional help, you should certainly adopt “sleep hygiene” behaviors5 – the good habits that give you your best chance of getting a restful night of sleep:

  • Exercise regularly.
  • Don’t eat within three hours of bedtime (because you want to get a good brain flush).
  • Avoid stimulating activities before bed.
  • Instead, do something relaxing.
  • Avoid screen time before bed6(and in bed).
  • Use blue-light-blocking software or glasses if you must use a device.
  • Dim the lights in your house.

(I take this to a pretty extreme level: I tape my mouth shut at night so I breathe through my nose because this leads to better sleep. But that’s for serious sleep-nerds only, and you should definitely ask your doctor first.)

the author with his mouth taped shut, ready for bed

A Chicken and Egg Problem

The fact that sleep problems are so common for people with ADHD has led to a debate among researchers and clinicians about which comes first. Does ADHD cause sleep problems? Or does difficulty sleeping cause ADHD?

At present, there are four competing theories:

“First, it may be that sleep problems are a fundamental characteristic of ADHD … Second, sleep problems may mimic or cause symptoms that are characteristic of ADHD. Sleep difficulties have an impact on attention, executive functioning, and inhibition consistent with the symptoms of those with ADHD. Thirdly, ADHD and sleep problems may have a reciprocal relationship in that one disorder exacerbates the other in a vicious circle. … Lastly, it is possible that sleep and ADHD may share common etiological neurobiological pathways.”7

It all makes you wonder if our culture’s general lack of sleep hygiene just makes it seem like loads of otherwise neurotypical children have ADHD. Does this connection between ADHD and sleep problems mean your child’s ADHD symptoms are really just the outcomes of a sleep disorder?

Probably not. I think it’s more likely that there’s a feedback loop at play here, where ADHD makes it harder to sleep and poor sleep exacerbates ADHD:

a feedback loop showing how poor sleep leads to worse ADHD and, in turn, to poor sleep

And they may also share a common underlying cause that has yet to be identified.2

Either Way, Address Both

But regardless of whether poor sleep is a cause or an effect of ADHD, the connection between ADHD and sleep problems means that parents of children with ADHD symptoms or an ADHD diagnosis should make sleep a high priority for the whole household.

If poor sleep is a cause of ADHD, then improving sleep should reduce ADHD symptoms in a virtuous cycle:

And if poor sleep is an effect of ADHD, then people with ADHD will have to go above and beyond to get adequate, quality sleep, which we know is very important for all students.

This is similar to the relationship between anxiety and ADHD. One can cause the other, so reducing one should reduce the other. Plus, anxiety and poor sleep may also contribute to one another, further complicating the picture.1 In other words, some people have all three issues.

Such cases call for an all-hands-on-deck approach. If you have ADHD and sleep problems and anxiety, you should not be thinking there will be a simple, single intervention that will make everything better. Rather, you should be running a full-court press on yourself, doing everything you can to make improvements on all fronts.

But please don’t make the mistake of thinking that you have to do it all, all the time, perfectly. You don’t. Every step in the right direction is worthwhile.

1 Martinelli, Katherine. “ADHD and Sleep Disorders: Are Kids Getting Misdiagnosed?” The Child Mind Institute.

2 “The Overlooked Connection Between ADHD and Sleep.” SciShow Psych. Apr 16, 2020

3 Sung V, Hiscock H, Sciberras E, Efron D. Sleep problems in children with attention-deficit/hyperactivity disorder: prevalence and the effect on the child and family. Arch Pediatr Adolesc Med. 2008 Apr;162(4):336-42. doi: 10.1001/archpedi.162.4.336. PMID: 18391142.

4 Van Veen MM, Kooij JJ, Boonstra AM, Gordijn MC, Van Someren EJ. Delayed circadian rhythm in adults with attention-deficit/hyperactivity disorder and chronic sleep-onset insomnia. Biol Psychiatry. 2010 Jun 1;67(11):1091-6. doi: 10.1016/j.biopsych.2009.12.032. Epub 2010 Feb 16. PMID: 20163790.

Sciberras, E. et al. “Sustained impact of a sleep intervention and moderators of treatment outcome for children with ADHD: a randomised controlled trial.” Psychological Medicine 50 (2019): 210 – 219.

6 Walker, Matthew. Why We Sleep: Unlocking the Power of Sleep and Dreams. Scribner, 2018.

7 Margaret D. Weiss, MD, PhD, Nicole M. McBride, MPH. “ADHD: A 24-Hour Disorder.” Psychiatric Times, Psychiatric Times Vol 35, Issue 10, Volume 35, Issue 10. October 29, 2018.

The Connection Between Anxiety and ADHD

A frustrated student snapping their pencil over a pile of books. Having both anxiety and ADHD is hard.

Your big research paper is due on Friday. It was assigned weeks ago, but you haven’t started yet. You didn’t mean to procrastinate, but each time you try to sit down and work on it, you can’t focus. Plus, whenever you so much as think about tackling this project, it overwhelms you. Too big. Too many steps. And none of your ideas seem good enough anyway. Now, with the deadline looming, you’re starting to panic. This, of course, only makes things worse. As your anxiety ramps up, your ability to focus diminishes even further, and knowing that you can’t focus enough to get the work done makes your anxiety even worse.

This can be what it’s like to have anxiety and ADHD: Your ADHD makes your anxiety stronger, and your anxiety makes your ADHD symptoms worse.1

They feed off of each other in a vicious cycle:

A feedback loop showing that worsening ADHD leads to increased anxiety, which leads to worsening ADHD

Another common experience for students with ADHD and anxiety is to struggle taking tests, and here they feed off of each other too. If you have trouble staying focused during exams, then you know that you’re not going to do as well as you otherwise could. And thinking that you’re not going to do well is likely to trigger anxiety, which makes it even harder to focus because rather than thinking about what the questions are asking, you’re thinking about how poorly you’re doing. Whereas most test anxiety is simply about being unprepared, this is a case where clinical issues are relevant. (Though studying effectively in order to be well prepared would still help.)

A Common Comorbidity

An anxious student working on a laptop and in a notebook

Having both of these conditions is very common. About 30 percent of children with ADHD also experience anxiety, according to The National Resource Center on ADHD, and around half of adults with ADHD have an anxiety disorder, according to the Anxiety and Depression Association of America.1

Thus, any parent of a child with ADHD should be aware of the increased likelihood that their child will also struggle with anxiety.

What is Anxiety?

“A person with an anxiety disorder is likely to experience long-lasting feelings of nervousness, fear, and worry. … They may have difficulty identifying and controlling their specific fears and worries. These feelings tend to be out of proportion to the situation, and can interfere with people’s daily lives and relationships with others.”1

This is distinct from the normal fears, worries, and nervousness that most people experience from time to time. If you feel butterflies in your stomach before giving a presentation, it doesn’t mean you have an anxiety disorder.

This is also distinct from ADHD, which is characterized by difficulty paying attention, hyperactivity, and poor impulse control.1 However, anxiety can lead to increased mind wandering, which may look similar to difficulty focusing.2 And both anxiety and ADHD can lead to apparent difficulties with executive function, such as not getting things done on time, failing to keep appointments, and otherwise struggling to play the game of school.

Treating ADHD When You Have Anxiety

It’s important to know whether or not you have anxiety when you determine an ADHD treatment plan.  Children with both ADHD and anxiety sometimes respond differently to ADHD medication than those without anxiety.3 And the stimulant medications that are often used to treat ADHD sometimes exacerbate anxiety symptoms.1

Treatment for Anxiety

As with ADHD, anxiety can be treated with medication, which is sometimes appropriate. However, there are also non-medication treatment options that can be very effective on their own or in addition to a medication plan. And since these are all good things to do even if you don’t have anxiety, they’re a great place to start while you’re sorting out diagnoses and professional treatment options.

Here are some helpful, non-medication interventions for anxiety:

However, starting and sticking with these kinds of healthy habits is challenging, especially if you have ADHD. But you don’t have to use brute-force willpower, and you don’t have to go it alone. I offer strategic habit coaching for adults and older students, and I would love to help you install some of these behaviors to run on autopilot. (For parents of younger students, the best place to start might be adopting these habits yourself and modeling them for your children.)

Treating Both

All of the anxiety-reducing strategies listed above also help reduce ADHD symptoms, so if you’re struggling with both anxiety and ADHD, you stand to benefit greatly from using these techniques.

Just as worsening anxiety leads to worsening ADHD in a downward spiral, treating one often improves the other, leading to a virtuous cycle of improvement on both fronts.

A feedback loop showing that reduced ADHD leads to reduced anxiety, which leads to reduced ADHD

So if you or your child has both of these conditions, there is a good reason to be optimistic. True, ADHD with comorbid anxiety can spiral out of control if left untreated. But if you address them both using a combination of professional help and at-home treatments, you can turn things around and create a great deal of positive momentum.

1 Written by Jayne Leonard. Medically reviewed by Timothy J. Legg, Ph.D., CRNP. What is the link between anxiety and ADHD? Medical News Today. May 15, 2017

2 Tiago Figueiredo, Gabriel Lima, Pilar Erthal, Rafael Martins, Priscila Corção, Marcelo Leonel, Vanessa Ayrão, Dídia Fortes, Paulo Mattos. Mind-wandering, depression, anxiety and ADHD: Disentangling the relationship. Psychiatry Research. Volume 285, 2020, 112798, ISSN 0165-1781,

3 Pliszka, Steven R., M.D. Effect of Anxiety on Cognition, Behavior, and Stimulant Response in ADHD. From the Department of Psychiatry, The University of Texas Health Science Center at San Antonio. Accepted 31 May 1989, Available online 4 January 2010.

4 John J. Ratey, MD. Can exercise help treat anxiety? Harvard Health Publishing. October 24, 2019

5 Uma Naidoo, MD, Nutritional strategies to ease anxiety. Harvard Health Publishing. August 28, 2019

6 Tips for beating anxiety to get a better night’s sleep. Harvard Health Publishing. October 13, 2020

7 Kaczkurkin, Antonia N, and Edna B Foa. “Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence.” Dialogues in clinical neuroscience vol. 17,3 (2015): 337-46.

8 Julie Corliss. Mindfulness meditation may ease anxiety, mental stress. Harvard Health Publishing. January 08, 2014

The Downside of Neuroplasticity

Think about your best kitchen knife. The more you use it, the duller it gets. Eventually, you have to sharpen it. But if you don’t use it, and you just leave it in a drawer for six months, it’ll be just as sharp as the day you put it away.

Now think about your brain. Your brain and that knife have nothing in common.

I often talk about how great it is that our brains can grow and rewire in response to challenges, much in the same way that muscles grow when you exercise. And don’t get me wrong – this is a good thing. It means we’re not stuck the way we are. We can learn, grow, and improve. We can become more skilled, more intelligent, and more creative. But there is a downside that’s rarely discussed.

I’ve hinted at it before. I did mention in my post about brain muscles that cognitive skills, just like the muscles in your arms and legs, can atrophy with disuse. I have highlighted the “use it or lose it” principle of neuroplasticity. And I’ve warned students that the mastery path is a muddy slope. But it’s time to really get clear about this.

You can improve, yes, but you can also get worse. Think about your physical fitness. What would happen if you just stopped exercising? How fit would you be a year from now? Five years from now? Well, your brain works the same way. If you don’t challenge your brain with mental workouts – learning new things, practicing old skills, and solving difficult puzzles – you won’t just stagnate; you’ll actually lose intelligence.

Trust me, I’ve been there. Between the ages of 23 and 27, that’s exactly what happened to me. I didn’t challenge myself intellectually, and my mind got weaker as a result.

This also applies on the micro-level of learning new skills. You can get better, but you won’t stay better unless you keep at it. On the fixed-mindset – growth-mindset continuum, there are people who are growth-minded enough to know that they have to work hard to get good at something, but then they mistakenly believe they no longer need to practice. And then a week or a month or a year later, that hard-earned skill is gone.

So having a growth mindset, isn’t just about believing that you can improve; it’s also about remembering that you can regress.

This is part of the reason I encourage kids to make good use of summer. And it’s a major reason that I personally practice relentless learning. Unlike a kitchen knife left in a drawer, my brain won’t stay sharp automatically. I have to use it to keep it sharp.