This may be keeping people with ADHD up at night

Did you know chronic sleep loss can cause impulsivity, distraction and other symptoms commonly associated with attention-deficit/hyperactivity disorder (ADHD)? Additionally, 78% of people who already have ADHD experience a condition called delayed sleep-wake phase disorder (DSWPD). 

What is delayed sleep-wake phase disorder? 

“DSWPD is a condition where affected individuals have an extreme and persistent tendency towards later bedtimes and later wake times,” explains Dr. Christopher Fahey, a sleep medicine physician at Advocate Health Care. “Unlike ‘night owls,’ individuals with DSWPD suffer personal, work or school-related consequences because of their inability to adapt to a ‘normal’ sleep schedule. Affected individuals typically will have extreme difficulty initiating sleep, leaving them tired during the day.” 

People with ADHD are certainly no strangers to sleep struggles in general. In fact, they are more likely to experience obstructive sleep apnea, peripheral limb movement disorder, restless legs syndrome and circadian-rhythm sleep disorders.  

Is delayed sleep-wake phase disorder different than insomnia?

“Chronic insomnia involves difficulty initiating sleep, difficulty maintaining sleep, or a combination of the two lasting at least three months,” says Dr. Fahey. “Patients with DSWPD will improve as their sleep times match up with their circadian rhythms. Patients with chronic insomnia have difficulties getting to sleep regardless of what time they try to go to sleep.” 

Why is it common for people with ADHD to experience delayed sleep-wake phase disorder? 

Multiple factors may explain the high comorbidity between ADHD and DSWPD: 

• Chronic sleep loss can lead to poor attention, increased impulsivity and distractibility – which are hallmarks of ADHD.   
• Being out of alignment with light-dark cycles may result in sleep deprivation, increasing stressors on the nervous system, and altering how the nerve cells mature and connect.  
• Genetic factors may predict the development of both DSWPD and ADHD. 

“ADHD may lead to behaviors that promote DSWPD traits,” Dr. Fahey says. “For example, individuals with ADHD may need to stay up later to complete their work, consume more caffeine to stay attentive or overuse nighttime technology, leading to later sleep and wake times.” 

How to manage delayed sleep-wake phase disorder 

People who have DSWPD – with and without ADHD – may benefit from pharmacological and non-pharmacological therapies. However, Dr. Fahey says any therapy should be pursued in conjunction with a sleep medicine specialist to ensure the safety and effectiveness of these strategies for each individual. 

Additional tips: 

• Practice good sleep habits. Set a regular sleep-wake time and try not to exceed those times by more than 30 minutes. Avoid stimulating activity at least two hours before bedtime and refrain from caffeine, alcohol and nicotine starting then, too. 
• Take low dose melatonin. Melatonin can help reset your circadian rhythm if it’s taken at appropriate times. 
• Get intentional light exposure. Use bright light therapy in the morning to align yourself with natural light and dark cycles. In the evening, avoid bright light, particularly blue light.   

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