Adult ADHD and Coping With Sleep Difficulties

“Night guy always screws morning guy.” —Jerry Seinfeld

The original sleep quote by Shakespeare, paraphrased in the title of this post, refers to Hamlet’s contemplation of death, so the Seinfeld line really gets at the heart of the matter for many adults with ADHD.

Sleep difficulties both stem from and magnify symptoms of ADHD. Although primary sleep disorders, such as obstructive sleep apnea, may co-exist with ADHD (or, at times, be mistaken for ADHD), many adults with ADHD report fending off sleep despite being tired in order to do other things. These distractions encompass a wide array of “night guy’s” practices that end up sticking “morning guy” with the after-effects of poor sleep the next day.

Sleep issues and ADHD

Sleep problems for adults with ADHD take many forms.

Problems winding down at night

For some, it may start with difficulties “turning off one’s mind” or other troubles “winding down” in the evening, which leads to delays getting into bed until actually falling asleep in the middle of whatever it is they are doing late at night. Such night owl diversions, in fact, may bring on a “second wind” of wakefulness and absorption in any number of projects, such as online shopping or research (“What else did I see that actor in?”), doom-scrolling, or simply enjoying “one more” YouTube video. No surprise, these late-night practices result in difficulties awakening in the morning.

Difficulty awakening in the morning

Apart from wake-up struggles from staying up too late, many adults with ADHD report problems with prolonged asleep-to-awake transitions despite adequate sleep. This morning-time, low-arousal state is deemed “sleep inertia.”¹ This syndrome is much more than an ingrained, “I-hate-mornings” slowness. Sleep inertia manifests as poor cognitive functioning upon awakening, which is a defining symptom of delayed sleep-wake phase disorder.

What sleep inertia means for adults with ADHD is a proneness to sleep through alarms or the experience of obviously having gotten up and crossed a room to turn off an obnoxiously loud sounding alarm—having tried more conventional ones without success—before trudging back to bed for more slumber but without recalling having done so. Other accounts include, once up and out of bed, inordinate time spent in the shower, sitting doing nothing, or otherwise moving sluggishly and half-consciously through a morning routine, partially alert but nowhere near functional, yet.

Patterns of sleep procrastination

Many other adults with ADHD drift into patterns of sleep procrastination despite sleepiness by incrementally staying up later and later. Although their minds may be sufficiently ready for sleep, these adults manage to find things to do, including the proverbial “one more thing,” for which there always is that one thing. These distractions are not necessarily illegal, immoral, or unethical, but create increasing morning stress and frustration at the waking realization that yet another plan to get a good night’s sleep went awry, as they are left to face the day already feeling behind.

Adults with ADHD promise themselves to only do one more thing before going to sleep - but there is ALWAYS one more thing!

Source: Anna Nekrashevich/Pexels

Behavioral Strategies That Can Help

Some of these sleep difficulties, particularly the bookends of a hyperactive, aroused mind at night, and an exceedingly sluggish mind in the morning may be responsive to medications. However, there are some behavioral strategies to help promote getting into “sleep mode,” and cognitive strategies to counteract some of the justifications for sleep procrastination that can help to establish and maintain healthy sleep routines.

Time management

An initial pivot point relates to difficulties common in adult ADHD when facing transitions and task-switching, chiefly shifting to “sleep mode” at an appointed evening time. As outlined above, many adults with ADHD describe getting distracted from plans to ready for sleep, not unlike a tendency to get off track with other endeavors that involve staying on track for a deferred reward.

When asked about their mindsets about preparing for sleep, many clients in psychosocial treatment for adult ADHD report sleep-interfering thoughts, such as, “This is the time I finally get around to doing what I should have done earlier,” “Everything is closed, everyone else is asleep, and no one is expected to be working now, so I can enjoy my ‘guilty pleasures,’” or “Sleeping is boring and going to sleep means that I will wake up and have to face ‘tomorrow;’ I want to make ‘today’ last longer.” With many people being busier at home with remote work and school due to the COVID pandemic, the later hours at night often represent a seductive, safe haven of “my time,” which ends up pilfering sleep time at the cost of one’s energy and functioning the next day.

Some late-night projects are also spurred by guilt, such as catching up on what “should” have been done earlier in the day. A few clients have also described negative feelings about sleep or “sleep guilt” from having being told that they “sleep away” days, nap too much, or that sleep implies laziness, particularly if someone feels they have not met expectations for the day, which is a common feeling among adults with ADHD.

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Late-night compensations for this guilt are self-defeating because they undermine sleep, thereby interfering with daytime functioning, creating a vicious, worsening loop. What is more, there are many excuses for staying up late that are emboldened by giving oneself permission to sleep in the next morning, such as “Work doesn’t care if I’m late,” “I can skip my first class,” or “I don’t have anything I have to do tomorrow,” which can be risky assumptions.

Treatments for adult ADHD often focus on skills for more consistent and efficient management of daytime roles, which allows for more “my time” during waking hours without sacrificing sleep.

Cognitive reframing

Some clients describe sleep as a boring task. Readying for sleep requires the hassle of stopping what one is doing, presumably something that is at least minimally agreeable, and focusing on getting ready for sleep and the prospect of the demands of the next day, which activates stress for many adults with ADHD.

A cognitive reframe for prioritizing sleep issues for adults with ADHD is that the quality of a night’s sleep starts with the wake-up time that morning. A fixed wake-up and get-up time (as these are distinct steps) should be set and kept regardless of the amount or quality of sleep. Once up and on the go, the adaptive mindset is that there will be sufficient focus and energy for adequate functioning for the day. It is common for the thoughts of adults with ADHD to gravitate to a sense of insufficiency, a sense “I’m not enough.”²

Getting-ready-for-sleep script

The implementation of a “wind-down” routine that promotes “sleep mode” includes adaptive thoughts about preconditions for sleep, including dealing with resistance to such plans (“I should be able to ‘wing it’ and just go to sleep when I feel like it.”). Poor self-monitoring interferes with tracking clock time, signs of fatigue, and other sleep cues. Hence, sleepiness is overlooked and realized much later than is healthy, not unlike the fact that by the time someone is thirsty, they are already on a path to dehydration.

That said, discrete signs of fatigue can be viewed as cues for sleep. Apart from physical (yawning) and behavioral cues (mindlessly refreshing a social media page), prompts in one’s environment can be used. Such indications that bedtime is nearing are a designated clock time (11 p.m.), an alarm set as part of a go-to-bed script, or a roommate or partner (or pet) readying for bed, piggy-backing on others’ routines.

A getting-ready-for-sleep script is a useful tool.³ A personalized bedtime routine or script is a sequence of sleep-priming steps, not unlike a bedtime routine for children. The script transforms the end goal of getting into bed with the intent to sleep into discrete actions leading up to that point, rather than viewing sleep as being wholly out of one’s control. The elements are personalized and may include logging off and charging devices, preparing clothes and other items for the next day, meditation, brushing teeth, and/or reading in bed, to name a few. Some people have much briefer sleep scripts, noting that once they get horizontal in bed, they quickly fall off to sleep.

Mindfulness and relaxation techniques

Many adults with ADHD have longer sleep latencies once in bed. There are some simple mindfulness or relaxation skills that can be used, such as counting a few deep breaths, muscle release exercises, and an accepting reminder that one can be lying awake in bed, not yet asleep, but still gaining valuable rest. Writing out thoughts, to-do items, and worries before getting into bed is another proactive way to process and externalize disquieting thoughts as part of closing out a day.

Comfort media

Still, waiting for the onset of sleep is a boring proposition for adults with ADHD. Just as there are “comfort foods” associated with a sense of coziness, individuals can use “comfort media” to promote sleep. Comfort media refers to a book, TV show, video, interview, or anything a person associates as pleasing, non-arousing, and helps them to fall off to sleep.

The characteristics of these media are that they are very, very familiar to the individual, as the media have been watched, listened to, or read many times before and are overly familiar to the individual. Consequently, there are no unwelcome surprises to keep the person engaged with the media, so they can nod off to sleep in the middle of a page without missing anything.

Conversely, at least when falling asleep, media content that is new, including a first-read of a book by a favorite author, news updates, or any content that might stir up strong feelings are best left for daytime hours. The goal is to have the media and other aspects of the script become associated with sleep.

First/second sleep

Middle-of-the-night awakenings and corresponding difficulties falling back asleep are another source of sleep stress. A common reaction to such interruptions is the thought, “My sleep is ruined and tomorrow will be bad.”

However, there is an interesting nugget of knowledge from the annals of sleep history that offers a coping reframe. Historians have found that a single, uninterrupted stretch of sleep is a relatively recent expectation for humans. Before the advent of artificial lighting, there were accounts of “first” and “second” sleep sandwiched around a bout of wakefulness of 30-60 minutes or so, during which people got out of bed, performed light chores, or otherwise quietly passed time until returning to bed and sleeping until morning.⁴ Nowadays, people react to such interludes with “sleep math” (“It is 1:13 a.m., if I fall asleep right now, I can still get 5 hours and 17 minutes of sleep.”). The first/second sleep concept further supports the notion that one can get “enough” rest from even imperfect sleep.

Conclusion

An essential aspect of ADHD is that it interferes with the pursuit of delayed goals. This represents a challenge of bypassing smaller-sooner opportunities in order to achieve larger-later payoffs, which is a fancier way of describing the “night guy” versus “morning guy” battle. Many people, ADHD or not, face many of the sleep issues described above, at least periodically. However, these sleep issues and their effects on daytime functioning and self-regulation are central for adults with ADHD and their potential solutions are worth the effort to implement.

Don’t take my word for it—sleep on it.