Sleep problems surprisingly common in adults with ADHD, study finds

A large study of adults with ADHD found that 60% of these individuals reported some type of sleep disorder. Specifically, 36% reported having problems falling asleep (delayed sleep onset), 31% reported insomnia, and 29% reported restless legs syndrome/periodic limb movement disorder. The paper was published in the Journal of Attention Disorders.

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by persistent patterns of inattention, hyperactivity, and impulsivity that interfere with daily functioning or development. Symptoms of inattention typically include difficulty sustaining focus, forgetfulness, and disorganization, while hyperactivity and impulsivity manifest as restlessness, excessive talking, or interrupting others. ADHD is most often diagnosed during childhood, as symptoms tend to conflict with school rules and expectations. However, the disorder can persist into adulthood, adversely affecting academic, social, and occupational success.

Both children and adults with ADHD often experience sleep problems and disorders. Most research on this topic has focused on children, typically showing that both subjective and objective sleep disturbances are common in these individuals. These disturbances include difficulties falling asleep, nighttime awakenings, and sleep-disordered breathing.

Study author Mirte van der Ham and her colleagues aimed to explore how prevalent sleep problems are in adults with ADHD in the Netherlands. They also sought to determine whether these issues are associated with other psychiatric conditions. Their hypothesis was that sleep problems are more frequent among adults with ADHD compared to the general population, particularly in those with additional psychiatric disorders.

For their analysis, the researchers extracted data from the electronic patient files of individuals attending 46 outpatient clinics of the mental health institute Parnassia Groep in the Netherlands between October 2018 and March 2020. Parnassia Groep is the largest mental health care institute in the Netherlands. All patients were referred by a general practitioner or mental health professional for the diagnosis and treatment of ADHD and any psychiatric comorbidities, in accordance with standard procedures in the country.

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In total, the analysis included data from 3,691 patients, 49% of whom were female, with an average age of 35 years. The researchers used data from assessments of sleep problems (via the Holland Sleep Disorder Questionnaire) along with various demographic and medical information. The assessment screened for the most common sleep disorders, including insomnia, circadian rhythm sleep-wake disorder, hypersomnia, parasomnia, restless legs syndrome/periodic limb movement disorder, and sleep-related breathing disorders.

Insomnia is characterized by difficulty falling asleep, staying asleep, or achieving restorative sleep despite adequate opportunities. Circadian rhythm sleep-wake disorder involves disruptions in the timing of sleep due to misalignment between an individual’s internal clock and the external environment. Hypersomnia refers to excessive daytime sleepiness or prolonged nighttime sleep that interferes with daily functioning.

Parasomnias are abnormal behaviors or experiences, such as sleepwalking or night terrors, that occur during sleep or transitions between sleep stages. Restless legs syndrome and periodic limb movement disorder involve uncomfortable sensations in the legs or repetitive limb movements during rest or sleep, disrupting sleep quality. Sleep-related breathing disorders, such as obstructive sleep apnea, are characterized by pauses in breathing or shallow breathing during sleep, leading to poor sleep and health complications.

The results showed that 60% of patients experienced at least one sleep disorder, while 36% reported having two or more. Almost half of the participants had other psychiatric diagnoses in addition to ADHD. Among the participants, 36% reported difficulty falling asleep, 31% reported insomnia, and 29% reported restless legs syndrome/periodic limb movement disorder.

Women reported sleep disorders slightly more often than men (62% vs. 58%). Insomnia, hypersomnia, and parasomnia were somewhat more frequent in women, while sleep-related breathing disorders were more common in men.

“Adults with ADHD often report sleep problems, which are associated with specific psychiatric comorbidities. Systematic screening for sleep disorders in adult patients with ADHD can contribute to a better understanding of their complaints and may aid improved and integrated treatment for the sleep and psychiatric problems,” the study authors concluded.

This study contributes to the scientific understanding of ADHD and its consequences. However, it should be noted that the research was conducted solely on registered patients with ADHD in the Netherlands. Studies on different populations might yield varying results.

The paper, “Sleep Problems in Adults With ADHD: Prevalences and Their Relationship With Psychiatric Comorbidity,” was authored by Mirte van der Ham, Denise Bijlenga, Mylène Böhmer, Aartjan T. F. Beekman, and Sandra Kooij.