Key Takeaways (TL;DR):
- Sleep loss and ADHD share nearly identical symptoms in children, and many ADHD diagnoses may actually be undetected sleep issues.
- ADHD is a lifelong neurological condition, while sleep problems are often triggered by changes in a person’s lifestyle or environment.
- Not all ADHD is hyperactive; “inattentive” ADHD (hypoactive) is common and presents as daydreaming or difficulty following instructions, which mimics the behavior of a tired child.
- Modern children average 1–2 hours less sleep per night than previous generations, often due to excessive screen time and poor sleep hygiene.
- Because medications for sleep and ADHD differ significantly, a clinical assessment by a primary care provider is essential to differentiate between the two and create an appropriate treatment plan.
Although sleep deprivation and ADHD each have a wide variety of symptoms, it’s surprising how much these two conditions can look like one another. In his book, Why We Sleep, neuroscientist Matthew Walker estimates that 70% of ADHD diagnoses are actually sleep problems.
Nowadays, it’s common for young kids to be screened for ADHD at school, or when they get their annual health checkup. But people often don’t recognize when children actually have sleep issues.
Fortunately, it is possible to tell the difference between ADHD and sleep deprivation after assessment by a health professional. And positive steps and treatment can be initiated to improve both conditions in children as well as adults.
ADHD definition and symptoms
ADHD, which stands for attention deficit hyperactivity disorder, is a neurological condition that affects executive functioning, which is the planning, organizing, and management skills that allow us to complete complex processes and achieve our goals.
ADHD symptoms can include:
- lack of attention
- difficulty focusing or completing tasks
- disorganization
- hyperactivity
- restlessness
- impulsiveness, and
- insomnia.
More than 6 million children in America are estimated to have ADHD. There is no known cause for the condition, but genetics are known to play a role.
Causes of sleep deprivation in adults and kids
There are many different causes of sleep deprivation in children and adults, including diet, stress, medical conditions, excessive screen time, or environmental factors. Mental health issues such as anxiety and depression can also contribute to sleep problems.
Symptoms of sleep deprivation include:
- chronic tiredness
- trouble concentrating
- anxiety
- depression
- moodiness
- headaches
- trouble falling or staying asleep.
Families with busy schedules often don’t prioritize getting enough sleep, despite research that shows a child’s sleep issues can have serious negative impacts on the whole family. But there can be crossover between sleep problems and ADHD.
Types of ADHD and their symptoms
While sleep issues can emerge at any time, ADHD is a chronic condition. Bridget Noorishad, a Nurse Practitioner at WWMG’s Lake Serene Clinic, explains, “We don’t see new onset of ADHD symptoms in adults. The biggest thing to understand is that they’ve likely had symptoms since childhood, and they’ve gone undiagnosed.”
One reason ADHD often goes undiagnosed is because people misunderstand the symptoms. Despite having ‘hyperactivity’ in the name, many individuals with ADHD are not hyperactive.
“Common symptoms are going to correlate with whether they are presenting with hyper or hypo active ADHD – [hypoactive individuals present with] inattention, spacing out, not listening, having to be told things multiple times.
“Or whether they’re more hyperactive, having an uncontrolled amount of energy, are impulsive, unable to sit still, feeling like there’s thoughts racing through their mind constantly that they can’t turn off. Those two kinds [of ADHD] present in different ways depending on the patient,” said Noorishad.
Most adults with ADHD will show some combination of hypoactive and hyperactive traits, while children are more likely to present one way vs the other, with boys somewhat more likely to have hyperactivity than girls.
When sleep deprivation can be mistaken for ADHD
The symptoms of inattentive (hypoactive) ADHD are almost identical to those of sleep deprivation in most children.
“Things like spacing out, falling asleep in class, feeling like they’re losing track of conversations,” said Noorishad, are typical for sleepy children. However, some overtired kids can get wound up and act like a child with hyperactivity.
To differentiate among ADHD, lack of sleep, and potential other contributing factors like mental health issues, it’s important to take a holistic view that looks broadly at the family’s lifestyle and the child’s behaviors.
Such as, “If there were changes going on in the household when the pattern started, if they notice anything making it better or making it worse. And then when it comes to sleep, whether [the amount of sleep the patient needs] seems excessive or if they can’t ever get to sleep.
“If they’re having a hard time getting more than six or seven hours a night, for little kids that’s unusual. Are they snoring? Those types of things.”
Children today get 1-2 hours less sleep every night than children a century ago, which means that many, if not most, young children are not getting enough. On the other hand, adults know when they are tired, but may never have been screened for ADHD themselves, so this could affect their ability to get or stay asleep.
“Taking note of all the symptoms and communicating that to your primary care provider helps them form a broad, differential diagnosis to then start a workup on,” says Noorishad. “A diagnosis depends on clinical judgment, and we can go only off of what patients are telling us.”
What things contribute to disrupted sleep
“Sometimes kids with the more hyperactive form of ADHD feel like they can’t turn their mind off. Their thoughts are constantly racing through their head and then that makes it hard for them to fall asleep,” said Noorishad.
Because it’s a neurological condition, there is no way to prevent ADHD by itself. However, many things that interfere with an individual’s ability to get a good night’s sleep can be addressed.
“Sleep is one of the most multifaceted areas that is affected by a lot of different things. So it’s very hard to exclusively say [a sleep problem is] related to the person’s mental health, let alone looking at just ADHD,” said Noorishad.
Sometimes, ADHD and sleep issues go hand in hand. The Journal of Clinical Sleep Medicine reports that sleep issues may affect 50% to 80% of people with ADHD.
Sleep can be affected by mental health issues including anxiety and depression and is also influenced by numerous lifestyle choices, including sleep hygiene.
What is sleep hygiene?
Sleep hygiene is important and involves:
- Maintaining a consistent sleep schedule – going to bed and waking up at the same time every day, including on weekends.
- Nutrition – eating a low-sugar, nutrient-dense diet, and limiting heavy meals and sugary snacks before bedtime.
- Minimizing screentime, especially in the evening – power down electronic devices at least 60 minutes before you go to bed.
- Getting enough exercise – at least 60 minutes of moderate intensity exercise per day for kids; and at least 150 minutes per week for adults.
- Optimizing your sleep environment – keep the bedroom cool, quiet, and dark to support a good night’s sleep.
The effect of screen time on sleep
Both sleep and mental health are affected by screen time. Dr. Lisa Adriance, a Psychologist at WWMG, says that sleep problems in children and adults alike are related to excessive screen time.
“Screens and tech in general offer us some great tools but they are also designed to be addictive and problematic. People often get sucked into tech without realizing the impact on their physical and mental health until problems are significant,” she said.
Treatment for sleep problems and ADHD
Cognitive behavioral therapy is a first line of treatment for ADHD, and can be useful for sleep issues as well, especially where anxiety is a contributing factor.
“Behavioral therapies are a really foundational aspect of treatment, especially for kids,” says Noorishad. For ADHD, medications are also commonly used, but for sleep, “It’s far more complicated.
“There are a few medications for when there’s a coexisting diagnosis of ADHD that do work well with sleep. But in general, the medicines that are available for sleep are known to be addictive and quite strong and so we prefer focusing on sleep hygiene interventions first.”
Where to get help for sleep issues or ADHD
If you or your child experiences symptoms related to ADHD or a sleep disorder, talk with your WWMG primary care provider about your concerns.
“Come in and have them do an evaluation and try not to pinhole it to ADHD, but present the symptoms as a whole,” recommends Noorishad.
At your annual checkup, your primary care provider can screen you or your child for ADHD, depression, and anxiety. They will also discuss your sleep habits, and may recommend a sleep study to inform the diagnosis. If needed, they can provide a referral to WWMG’s Sleep Medicine clinic or WWMG Psychology for additional support.
If you or your child struggle with lack of sleep, trouble concentrating, restlessness, or mental health challenges, we can help. Request an appointment with WWMG Family Medicine today.