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A recent study published in the Journal of Affective Disorders suggests that adults with Attention-Deficit/Hyperactivity Disorder who struggle to manage their emotions are more likely to experience insomnia symptoms. The findings provide evidence that trouble accessing effective emotional coping strategies plays a major role in these sleep disturbances, especially among young adults. This highlights the importance of addressing emotional health when treating sleep problems in people with ADHD.
Attention-Deficit/Hyperactivity Disorder, commonly known as ADHD, is a condition characterized by differences in attention, focus, and behavior. Adults with this condition often experience difficulties with emotion regulation in their daily lives. This means they might find it hard to adapt and manage their emotional reactions to fit the demands of a given situation. These emotional challenges tend to have a negative impact on their overall quality of life.
“One of the main research focuses in our group is the role of emotion regulation in mental health, including among adults with ADHD,” said study author Lin Sørensen, a licensed clinical psychologist and professor in the Department of Clinical and Biological Psychology at the University of Bergen in Norway. “Building on this work, we became interested in whether difficulties regulating distressing thoughts and emotions might contribute to sleep problems in adults with ADHD.”
Sleep disturbances are a frequent challenge for people with ADHD. Insomnia involves trouble falling asleep, staying asleep, or waking up too early, which causes fatigue and daytime impairment. Up to 67 percent of adults with ADHD have insomnia, compared to a maximum of 24 percent in the general public. Because sleep issues are so common, scientists increasingly view ADHD as a condition that affects functioning both day and night.
Scientists suspect that a biological and psychological mechanism called hyperarousal links these two issues. Hyperarousal is a state of increased mental and physical alertness, often accompanied by racing thoughts and bodily tension. When people have a hard time managing negative emotions, they tend to experience heightened hyperarousal at bedtime. Emotional distress can trigger the body’s stress response, making it incredibly difficult for the brain to transition into a restful state.
This state of alertness leads to pre-sleep rumination, where a person repeatedly worries about the events of the day. Previous research suggests a link between poor emotional regulation and insomnia in people without ADHD. The authors of the new study wanted to see if this same pattern exists within the adult ADHD population. They hypothesized that emotional regulation problems would serve as a specific vulnerability factor for insomnia in this group.
To investigate these ideas, the research team designed an online survey in collaboration with the Norwegian ADHD Association. The final sample included 1,414 adults who self-reported having an ADHD diagnosis or experiencing strong ADHD symptoms. The participants ranged in age from 16 to 74 years old, with an average age of about 40. The group was mostly female, making up approximately 81 percent of the respondents.
Participants filled out several detailed questionnaires, including the Difficulties in Emotion Regulation Scale. This specific tool measures how well individuals accept negative emotions, control impulses, and maintain awareness of their feelings. It also measures whether people have limited access to effective coping strategies when they feel upset. High scores on this scale indicate that a person struggles significantly to manage their emotional responses.
To track sleep, the participants completed the Bergen Insomnia Scale, which measures how often they experienced various sleep issues over the past month. The researchers also used the Horne-Östberg Morningness-Eveningness Questionnaire to determine each participant’s chronotype. Chronotype refers to a person’s natural biological preference for being awake and active during the morning or the evening. Based on their answers, the participants were categorized as morning types, evening types, or an intermediate type.
The scientists also gathered data on several clinical and demographic characteristics. They asked participants to complete the Adult ADHD Self-Report Scale to measure their current ADHD symptom severity. Additionally, they used standardized questionnaires to measure symptoms of depression and generalized anxiety. The researchers collected information on education levels, occupational status, substance use, and whether the participants were currently taking stimulant medications.
The researchers estimated that 76 percent of the participants experienced insomnia, a number that dropped to 60 percent when using the strictest diagnostic criteria. They found that greater overall difficulties in regulating emotions were associated with more severe insomnia symptoms. This provides evidence that struggling to manage intense emotions is linked to poorer sleep quality. Emotional distress appears to be a major contributing factor to the high rates of insomnia seen in ADHD.
When the authors looked at specific emotional challenges, one particular issue stood out. Participants who reported having limited access to effective emotion regulation strategies experienced the most significant sleep problems. This means that simply feeling upset was not the main driver of insomnia. Instead, not knowing how to calm down or effectively handle those upset feelings was the primary predictor of sleep disturbances.
The association between emotion regulation difficulties and insomnia was most prominent among younger participants. For emerging adults under the age of 30, the connection between emotion regulation problems and insomnia was much stronger than it was for older adults. “We were surprised to find that the association between emotion regulation difficulties and sleep problems was stronger among younger than older adults with ADHD, as we had expected the opposite pattern,” Sørensen said.
Emerging adulthood comes with increased demands for independence and self-management, which might amplify emotional stress. For older individuals, other life elements might simply overshadow this specific relationship. “One possible explanation is that sleep problems in older adults are more strongly influenced by factors such as family responsibilities, work demands, and menopause, particularly given that most participants were women with ADHD,” Sørensen explained.
Interestingly, the participants’ chronotype did not affect the results. Although an evening preference was very common in the sample, being an evening type did not make the link between emotional struggles and insomnia any stronger or weaker. “One interesting finding was that the link between emotion regulation difficulties and sleep problems was not explained by being a ‘night owl,'” Sørensen said.
Researchers had originally thought that staying up late would compound the problems. “We expected evening preference to play a role because it is common in ADHD and is often associated with poorer self-regulation and more sleep problems, but this was not the case,” Sørensen told PsyPost. Gender also did not modify the relationship, as both men and women with ADHD showed similar patterns linking emotional struggles to sleep issues.
These main findings remained statistically significant even after the researchers accounted for other influences. They adjusted the data for factors like depression, anxiety, ADHD medication use, and overall ADHD symptom severity. Depression was strongly associated with insomnia, which aligns with previous research on mental health and sleep. However, emotional regulation difficulties still predicted insomnia independently of depression, showing that emotional coping is uniquely linked to sleep.
When considering the impact of the study, Sørensen emphasized the daily consequences of these symptoms. “Difficulties regulating strong and intense emotions may make it more challenging to fall asleep and remain asleep throughout the night,” she explained. “However, because our study was correlational, we cannot determine the direction of this relationship.”
It is highly likely that a two-way street exists between the two variables. Poor sleep makes it harder to regulate emotions the next day, which in turn elevates hyperarousal and ruins sleep the next night. “It is equally possible that sleep problems contribute to greater difficulties with emotion regulation,” Sørensen added. “In fact, theoretical models suggest that the relationship is likely bidirectional: difficulties regulating emotions can impair sleep, while poor sleep can, in turn, reduce the capacity to regulate emotions effectively.”
The study relied entirely on self-reported data, which comes with certain inherent limitations. “Our study was cross-sectional, and therefore cannot establish the direction of the observed associations,” Sørensen said. “In addition, participants were recruited through a survey conducted in collaboration with the Norwegian ADHD Association, and ADHD diagnoses were self-reported rather than clinically verified as part of the study.”
The sample was overwhelmingly female, which might not accurately represent the broader adult ADHD population. Females in this study were less likely to be employed and more likely to be on sick leave, which could influence stress and sleep patterns. Additionally, sleep was not measured objectively using medical equipment in a sleep laboratory. Future research should aim to recruit a more balanced sample across all genders and use objective clinical measures.
Looking ahead, the researchers hope to build on these findings to better understand how daily experiences affect nightly rest. “We are particularly interested in understanding ADHD as a 24-hour condition and identifying the mechanisms that link daytime functioning with sleep and nighttime functioning,” Sørensen said.
The study, “Emotion regulation difficulties in adults with ADHD and associations with insomnia symptoms,” was authored by Lin Sørensen, Camille Hjo, Anna Elfrida Vollsund, Elisabeth Flo-Groeneboom, Daniel A. Jensen, Ane M. Tømmeraas, Nina Holmen, Stephen P. Becker, Edmund J.S. Sonuga-Barke, Bjørn Bjorvatn, and Christian K. Tamnes.