Sometimes at night, the active mind of an adult with ADHD won’t settle down for restful sleep. What strategies can you use if ADHD is contributing to poor sleep?
Albert Hernandez
July 20, 2022
Medically Reviewed by Tanya Hernandez, PMHNP-BC
Updated on: October 20, 2022
6 min read
Tossing and turning. Being unable to convince your brain to fall asleep when your body is exhausted. Chronic insomnia feels so frustrating.
Many of my patients tell me about their sleep difficulties. Studies indicate that between 25% to 50% of people with Attention Deficit Hyperactivity Disorder (ADHD) report sleep problems of some kind. Adults with ADHD often experience insomnia due to their racing thoughts. Insomnia can mean “difficulty falling asleep, difficulty staying asleep, or waking too early." Any of these presentations of insomnia can disrupt daytime hours with general sleepiness or lack of attention due to drowsiness.
When you can’t turn off your active mind at night, that can lead to sleeplessness. Some patients who have difficulty focusing on a project during the day might find themselves actually ruminating on a thought or task at night when they wish they could be sleeping restfully. Although ADHD medications can slow down racing thoughts, they aren’t designed to work 24 hours a day.
"The challenges of feeling fatigue due to sleepless nights can make patients’ symptoms of anxiety, depression, and irritability worse. So, how can adults with ADHD get restful sleep?"
Recommendations For Fighting Insomnia
Sleep isn’t only important for your physical health; sleep helps to regulate your mood, as well. Sleep problems and the fatigue that accompanies poor sleep can cause you to feel increased anger, irritability, or depression. How much sleep is needed to feel your best? For adults ages 18-to-60 years old, the recommended amount of sleep per night is seven hours or more.
However, if you’ve been fighting the racing thoughts and restlessness of adult ADHD at bedtime, seven or eight hours of sleep every night probably seems like a fantasy. While ADHD medication can help improve the symptoms that might keep you from getting all the rest you need, ADHD meds usually don’t last until bedtime. Generally, patients with adult ADHD take their medication on such a schedule that their symptoms are managed during work or school, not at the end of the day. Also, taking a stimulant too close to bedtime can interfere with sleep. 
If you notice problems settling down for bed at night, you might be looking for rest tips. Here are some ideas from the Mayo Clinic and the American Academy of Sleep Medicine on how to get more restful sleep:
- Get regular exercise. Exercising on a regular basis has been shown to improve sleep quality. It can be a daily walk, an intense bike ride, or a dance class. Don’t feel that working out only “counts” if you’re dripping sweat or breathing so hard you can barely speak. The important thing is moving your body most days of the week, in a way that you enjoy.
- Watch your intake. Before bed, make sure that you’re not filling up with rich foods. Having to digest a heavy meal can cause sleep problems. Also, don’t consume alcohol or caffeine too close to bedtime. Caffeine can contribute to sleeplessness, especially if you’re sensitive to its effects. Alcohol can make you feel tired, but as your night goes on, the alcohol in your system can interfere with the quality of your sleep.
- Have a routine in place. Keeping a routine around your sleep/wake time can help your body automatically get ready for sleep. It helps to keep the same bedtime every night, whether it’s during the week or on the weekends. Try to get up around the same time on your days off, too, rather than sleeping in.
- Turn off those devices! That’s right--at least a half-hour before you head to bed for the night, you need to disengage from all electronics. Some experts even recommend an hour with no electronics prior to bedtime. No scrolling through Instagram, binge-watching Netflix, or reading the news on your phone. Does staying away from your phone or TV for 30 minutes before bedtime seem more impossible than a Baltimore Orioles World Series win? You can do this. If you’re getting close to bedtime, try replacing your phone time with reading a book, gentle yoga or stretching, or prepping tomorrow’s lunch or dinner.
Good Sleep Habits Aren’t Helping--Now What?
If you’re practicing good sleep hygiene, and your ADHD is well-controlled with treatment, but you’re still experiencing insomnia, it may be time for prescription help for your sleeplessness. Two commonly-prescribed sleep aids are hydroxyzine (brand names: Vistaril, Atarax) and trazodone (brand names: Desyrel, Desyrel Dividose, Oleptro). Neither hydroxyzine nor trazodone is a controlled substance; they are not considered to be habit-forming. They have some known side effects that my patients usually find to be manageable. Hydroxyzine’s side effects can include dry mouth, dizziness, or headache. Trazodone’s side effects can include daytime drowsiness and lowering blood pressure when you stand up, known as orthostatic hypotension.
Trazodone and hydroxyzine both have antihistamine effects, kind of like Benadryl, which aid with falling asleep at bedtime. Trazodone also has some impacts on serotonin, a brain chemical that impacts mood and sleep. Both medications are a good option for my patients with adult ADHD who are struggling with sleeplessness.
It’s not uncommon for my patients with adult ADHD to let me know they’re experiencing insomnia. The symptoms of ADHD that can cause increased activity and trouble focusing during the day may also disturb sleep at night. Changing some of your daily habits may improve your ability to fall asleep and stay asleep. For some patients, improving sleep hygiene alone may not rid them of their insomnia. In those cases, I will often recommend hydroxyzine or trazodone as a prescription sleep medication.
If you are experiencing insomnia or other symptoms of ADHD and you live in or near El Paso or one of the other locations we serve, consider getting treatment at Upper Valley Behavioral Health. Our expert behavioral health providers can help you identify the best medications to treat your ADHD, whether you are experiencing insomnia or not. Click here to complete our application for treatment.
Disclaimer: This post is for informational purposes only. It does not replace instructions from your licensed prescriber. Please consult your healthcare provider for guidance on your specific medication regimen.
Woman that is up all night due to racing thoughts caused by Adult ADHD.
Albert Hernandez
July 20, 2022
Medically Reviewed by Tanya Hernandez, PMHNP-BC
Updated on: October 20, 2022
6 min read
Albert Hernandez
July 20, 2022
Medically Reviewed by Tanya Hernandez, PMHNP-BC
Updated on: October 20, 2022
6 min read
Tossing and turning. Being unable to convince your brain to fall asleep when your body is exhausted. Chronic insomnia feels so frustrating.
Many of my patients tell me about their sleep difficulties. Studies indicate that between 25% to 50% of people with Attention Deficit Hyperactivity Disorder (ADHD) report sleep problems of some kind. Adults with ADHD often experience insomnia due to their racing thoughts. Insomnia can mean “difficulty falling asleep, difficulty staying asleep, or waking too early." Any of these presentations of insomnia can disrupt daytime hours with general sleepiness or lack of attention due to drowsiness.
When you can’t turn off your active mind at night, that can lead to sleeplessness. Some patients who have difficulty focusing on a project during the day might find themselves actually ruminating on a thought or task at night when they wish they could be sleeping restfully. Although ADHD medications can slow down racing thoughts, they aren’t designed to work 24 hours a day.
"The challenges of feeling fatigue due to sleepless nights can make patients’ symptoms of anxiety, depression, and irritability worse. So, how can adults with ADHD get restful sleep?"
Recommendations For Fighting Insomnia
Sleep isn’t only important for your physical health; sleep helps to regulate your mood, as well. Sleep problems and the fatigue that accompanies poor sleep can cause you to feel increased anger, irritability, or depression. How much sleep is needed to feel your best? For adults ages 18-to-60 years old, the recommended amount of sleep per night is seven hours or more.
However, if you’ve been fighting the racing thoughts and restlessness of adult ADHD at bedtime, seven or eight hours of sleep every night probably seems like a fantasy. While ADHD medication can help improve the symptoms that might keep you from getting all the rest you need, ADHD meds usually don’t last until bedtime. Generally, patients with adult ADHD take their medication on such a schedule that their symptoms are managed during work or school, not at the end of the day. Also, taking a stimulant too close to bedtime can interfere with sleep.
If you notice problems settling down for bed at night, you might be looking for rest tips. Here are some ideas from the Mayo Clinic and the American Academy of Sleep Medicine on how to get more restful sleep:
- Get regular exercise. Exercising on a regular basis has been shown to improve sleep quality. It can be a daily walk, an intense bike ride, or a dance class. Don’t feel that working out only “counts” if you’re dripping sweat or breathing so hard you can barely speak. The important thing is moving your body most days of the week, in a way that you enjoy.
- Watch your intake. Before bed, make sure that you’re not filling up with rich foods. Having to digest a heavy meal can cause sleep problems. Also, don’t consume alcohol or caffeine too close to bedtime. Caffeine can contribute to sleeplessness, especially if you’re sensitive to its effects. Alcohol can make you feel tired, but as your night goes on, the alcohol in your system can interfere with the quality of your sleep.
- Have a routine in place. Keeping a routine around your sleep/wake time can help your body automatically get ready for sleep. It helps to keep the same bedtime every night, whether it’s during the week or on the weekends. Try to get up around the same time on your days off, too, rather than sleeping in.
- Turn off those devices! That’s right--at least a half-hour before you head to bed for the night, you need to disengage from all electronics. Some experts even recommend an hour with no electronics prior to bedtime. No scrolling through Instagram, binge-watching Netflix, or reading the news on your phone. Does staying away from your phone or TV for 30 minutes before bedtime seem more impossible than a Baltimore Orioles World Series win? You can do this. If you’re getting close to bedtime, try replacing your phone time with reading a book, gentle yoga or stretching, or prepping tomorrow’s lunch or dinner.
Good Sleep Habits Aren’t Helping--Now What?
If you’re practicing good sleep hygiene, and your ADHD is well-controlled with treatment, but you’re still experiencing insomnia, it may be time for prescription help for your sleeplessness. Two commonly-prescribed sleep aids are hydroxyzine (brand names: Vistaril, Atarax) and trazodone (brand names: Desyrel, Desyrel Dividose, Oleptro). Neither hydroxyzine nor trazodone is a controlled substance; they are not considered to be habit-forming. They have some known side effects that my patients usually find to be manageable. Hydroxyzine’s side effects can include dry mouth, dizziness, or headache. Trazodone’s side effects can include daytime drowsiness and lowering blood pressure when you stand up, known as orthostatic hypotension.
Trazodone and hydroxyzine both have antihistamine effects, kind of like Benadryl, which aid with falling asleep at bedtime. Trazodone also has some impacts on serotonin, a brain chemical that impacts mood and sleep. Both medications are a good option for my patients with adult ADHD who are struggling with sleeplessness.
It’s not uncommon for my patients with adult ADHD to let me know they’re experiencing insomnia. The symptoms of ADHD that can cause increased activity and trouble focusing during the day may also disturb sleep at night. Changing some of your daily habits may improve your ability to fall asleep and stay asleep. For some patients, improving sleep hygiene alone may not rid them of their insomnia. In those cases, I will often recommend hydroxyzine or trazodone as a prescription sleep medication.
If you are experiencing insomnia or other symptoms of ADHD and you live in or near El Paso or one of the other locations we serve, consider getting treatment at Upper Valley Behavioral Health. Our expert behavioral health providers can help you identify the best medications to treat your ADHD, whether you are experiencing insomnia or not. Click here to complete our application for treatment.
Disclaimer: This post is for informational purposes only. It does not replace instructions from your licensed prescriber. Please consult your healthcare provider for guidance on your specific medication regimen.
Tags: Adhd, adhd awareness, adhd problems, adhd sleep, adhd insomnia, adhd support, adhd brain, adhd life, adhd tips, adhd adult, adhd explained, insomnia
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