ADHD and Sleep: Why We Never Get to Bed

Midnight. I am tired, I will get up early tomorrow, and I am not going to bed. I am not even doing anything; I am just not going.

This is the longest-running and the hardest-to-accept pattern of mine. For many years I called it lack of discipline. What I learned after the diagnosis was that at that midnight desk two separate problems are actually working at the same time, and their solutions differ from each other.

Sleep problems are so common in ADHD that they are among the most frequent complaints around the diagnosis (Faraone et al., 2021).

Two separate problems, intertwined

The first is biological. The body clock, that is, the circadian rhythm, often shifts later in ADHD. Melatonin release starts late, the time for sleep moves forward, getting up in the morning gets harder. This is called delayed sleep phase, and it has nothing to do with choice.

The review by Bijlenga and colleagues (2019) reports that delayed sleep phase disorder is seen in 73 to 78 percent of children and adults with ADHD. This figure surprised me when I first read it; because for years I had thought it was a personal flaw of mine.

The study by Van Veen and colleagues (2010) shows the mechanism more concretely. Of forty adults with ADHD, thirty-one had chronic difficulty falling asleep, and melatonin release in this group was delayed compared with both people with ADHD without sleep problems and the control group. So it is not "I don't want to sleep"; the body has not yet given the signal for night.

The second is behavioral. A person who cannot find any time that belongs to them during the day does not want to let go of the night. Knowing they are tired, knowing they will sacrifice the next day, they keep sitting up. This is called bedtime procrastination; in English it goes by "revenge bedtime procrastination," and the name describes exactly this: taking back from the night what you could not command in the day.

With me this second part weighs more. When the day has not passed with my own choices, at night I try to take that choice back. The problem is that what I take back is not time but the quality of the next day.

These two feed each other. Someone who goes to bed late gets up tired, a day that passes tired leaves less time for themselves, and at night they want more compensation.

Why it matters so much

Sleep debt mimics almost all ADHD symptoms. Distractibility, impulsivity, forgetfulness, emotional overflow: all of them are seen in sleep loss too.

This has two consequences. The first is that a sleep-deprived person with ADHD does not know how many times over they are living their own symptoms. When I wanted to measure this in myself, I did something surprisingly simple: I looked at how many jobs I finished on days when I slept well. The difference was bigger than I had guessed.

The second is that, in the diagnostic process, a sleep disorder has to be evaluated separately; sleep apnea and restless legs syndrome are among the headings always looked at in differential diagnosis.

Trying methods without fixing sleep is like carrying water without closing the hole.

Three things that work

Morning light. The strongest drug-free way of pulling the body clock earlier. Going outside within the first hour after waking is more effective than sitting by a window for fifteen minutes. Dimming the light in the evening works in the same direction but is not as decisive as morning light.

A fixed wake-up time. Fixing the bedtime is hard, because if sleep does not come, it does not come. The wake-up time, on the other hand, can be controlled, and it is what really sets the body clock. Getting up at the same time, weekends included, pulls the bedtime earlier too within a few weeks.

Of these three, this is the one I resisted most, and it was the one that worked most. I thought sleeping in at the weekend was making up for lost sleep; in fact I was spoiling Monday from the start.

Removing the load of decisions before bed. Going to bed is not a single decision: brush your teeth, put the phone down, turn off the light, stop thinking about tomorrow. Each one is a separate starting threshold. Fixing the order and putting the night routine on a list reduces this load markedly. I covered the morning side of the same logic in the article on the morning routine in ADHD.

A few small but effective things

• Charging the phone in another room. Distance instead of willpower: friction design.
• A go-to-bed alarm. There is a wake-up alarm, there is no bedtime alarm. Yet that is the side that is hard.
• Cutting caffeine after noon. Its half-life is five to six hours; an afternoon coffee can keep its effect until midnight. I wrote about caffeine's special place in ADHD in the article on caffeine and self-medication.
• Writing down what comes to mind. The racing thoughts that start in bed are often the worry of "let me not forget." Once it is on paper, the mind can let go; the article on brain dumping explains how it is done.
• Closing the day. When there is no signal that the day is over, the night never ends. End-of-day closure is the smallest ritual that does this job for me.

Is the screen really to blame

Most sleep advice comes down to a single sentence: do not look at a screen before bed. This advice is not entirely wrong, but in ADHD it misses where the problem is.

The reason I cannot put the phone down at midnight is not the light of the screen. The phone is not put down because it is the only thing giving stimulation to a mind that is still awake at that hour. When I turn the screen off and sit in the dark, sleep does not come; I just get bored, and boredom in ADHD is harder to carry than sleep.

So instead of banning the screen, thinking about what to put in its place works better. Listening to something audio, a simple job done by hand with the light dimmed, even a boring book. Not zeroing the stimulus but lowering it.

A common mistake

The most common mistake is trying to apply the sleep hygiene list all at once. A twelve-item list asks twelve new decisions from a tired person at midnight. It lasts three days, then everything is dropped at once.

The second mistake is aiming for an early bedtime. For someone whose body clock is delayed, going to bed early means lying awake in bed, and this makes it even harder by associating the bed with wakefulness. Moving the target to the wake-up time is less intuitive but works better.

The third is catch-up sleep. Trying to close the debt built up during the week at the weekend pushes the body clock back again every Sunday.

If you use medication and your sleep got worse after starting it, I wrote about its relationship with the time of the dose in the article on whether ADHD medication disrupts sleep.

When to see a doctor

If there is snoring, breathing stopping at night, morning headaches or an urge to move the legs, the matter may not be only habit. Sleep apnea and restless legs syndrome need separate treatment, and when they are not treated no sleep hygiene advice works.

Decisions on medication or supplements for the sleep routine are also the doctor's job. Melatonin included, the suggestions circulating on the internet reduce a subject that varies from person to person to a single answer.

What is left with me is this: I have not entirely stopped sitting at that midnight desk. But when I sit there now, I do not call myself undisciplined. I know two separate things are working at the same time, and I can choose which one to touch. Morning light shrinks the biological side, and the half hour I set aside for myself during the day shrinks the behavioral side. When I do not have both, the night gets long again.