ADHD and sleep

Why it is difficult – and 8 strategies for better sleep 

Sleep problems are extremely common, and the topic is quite well researched. It also seems that alongside ADHD, practically every type of sleep problem occurs more frequently. 

Several studies suggest that, in adults with ADHD, the onset of melatonin production and the circadian rhythm are delayed in a large majority – around 78% – often by 1–2 hours compared to neurotypical people. 

Before we look at the mechanisms linking ADHD and sleep, it is worth clarifying what counts as a sleep disorder – and how a sleep specialist would see it. 

ADHD and sleep: General sleep problems 

The sleep physician is the doctor who specialises in sleep disorders, such as insomnia, hypersomnia, circadian rhythm disorders and so on. 

We speak of insomnia when a person cannot fall asleep for 30 minutes or longer, at least three nights a week, and this is accompanied by daytime symptoms: sleepiness, fatigue, irritability, cognitive decline, and so on. 

In hypersomnia, people chronically sleep too much, yet are constantly tired and sleepy, as if they ‘never really caught up on their sleep’. 

In people with ADHD, the most frequent circadian problem is delayed sleep phase, the classic ‘night-owl mode’ – they become sleepy later, their daytime activity starts later, while school or work often expects an early ‘lark rhythm’ from them. 

Genetically, people differ. Some are lucky and need less sleep – for example 5–6 hours is enough for them, and in a certain sense they have won the ‘lottery’. But these people are very rare (only a few per cent). Long-term sleep of less than 6 hours is, on average, associated with higher physical and mental risk. 

Others may need 9–10 hours of sleep, while for most adults, roughly 7 hours of sleep is sufficient in the long term. 

Coming back to sleep quality: the main measure is how you feel during the day, not how many minutes of ‘deep’ or ‘REM’ sleep you had. Deep sleep is the most restorative, ‘switching-off’ phase; REM sleep is the dreaming phase with rapid eye movements. 

It is not worth obsessively chasing the ‘perfect 8 hours’ – this is exactly where the sleep physician’s job is to reassure the person. 

And one more thing: if someone goes to bed at dawn and wakes up around noon – and this works perfectly well for them – a sleep specialist will not automatically consider this a problem. 

We also know that sleep duration decreases with age: in older age we generally sleep less. 

It is important to distinguish between two situations. 

One is when someone is truly sleep-deprived: sleepy all day, would constantly lie down, nods off, and can barely function. 

The other is when someone wakes up feeling ‘as if I hadn’t slept at all’, but after half an hour, a coffee and a bit of movement, they come round and feel completely fine during the day. 

The latter is considered normal: this is called sleep inertia – that ‘groggy period’ in the morning while the brain is waking up. Some people simply have a longer warm-up time in the morning. 

ADHD and sleep: Typical ADHD sleep problems 

It is a different story when a person with ADHD comes to a consultation with sleep complaints. They often report that falling asleep has been difficult for them throughout their entire life. 

Sometimes hours go by: they toss and turn in bed, think through everything there is to think about, and only then fall asleep. 

Some people with ADHD can only fall asleep towards dawn as a general pattern. 

If an important event is coming up, they may spend the whole night tossing and turning, mentally rehearsing that event – practically without sleeping at all. 

Under stress, this can be combined with early morning awakenings.  

ADHD and sleep: Early signs 

Many parents feel, in hindsight, that ‘this child was different even in the womb’: kicking and turning all day long, then as an infant barely sleeping, crying a lot, constantly wriggling. 

There is much stronger evidence that, if there are early regulatory difficulties in the first year of life – excessive crying, difficulty being soothed, restless sleep, feeding problems – these infants have a statistically higher risk of later ADHD. 

Parents often notice from a very young age that the child’s sleep is very light and superficial, and they seem to react to practically every noise. 

ADHD and sleep: ‘I can’t sleep’ 

People with ADHD also frequently tell stories of simply not being able to sleep as children – for example, during nap time when they were put to bed after lunch, or at night – they would get up and quietly do something while their parents were asleep. They resisted sleep tooth and nail. 

You hear such stories not only from clearly hyperactive people, but also from those where inattentive symptoms dominate – in other words, across the different subtypes of ADHD. The point is that sleep was disturbed even then. 

It is obvious that if someone has more than one mental or neurological difficulty, their sleep is almost certainly not going to be great either. Alongside ADHD, it is especially important to keep this in mind, because the symptoms can partly overlap. 

Today we also know that ADHD can be associated with other sleep disorders: hypersomnia – when people sleep more than they actually need; narcolepsy – those strange, sudden daytime sleep attacks, even during a conversation or while eating; night sweats; and teeth grinding. 

Nightmares occur three times more often in people with ADHD. Nightmares on their own are not a sign of a psychiatric illness, but they can be deeply disturbing subjectively. 

Overall, ADHD-related sleep problems are very heterogeneous: some people mainly have insomnia, others hypersomnia, some complain more about early morning awakenings. 

ADHD and sleep: Neurobiology 

What happens in a neurotypical person? 

In a dark room, information about light and darkness reaches the brain through the cells of the retina, the eye’s light-sensitive layer, and this regulates melatonin secretion – the sleep hormone produced when it gets dark. 

In darkness, the signal of reduced light reaches the brain via the retina and triggers melatonin synthesis – ‘it’s night-time now’, it is time to become sleepy. 

What happens in people with ADHD? 

In people with ADHD, this does not work in the same way – their internal biological clock is shifted. 

On top of that, there is a general neurotransmitter deficit, meaning that there are fewer chemical messenger substances available between nerve cells. 

When we speak about a neurotransmitter deficit, we are usually talking about dysregulation in dopamine and noradrenaline systems; serotonin – a transmitter that also influences both mood and sleep – can be involved as well. 

Melatonin, that well-known sleep hormone which helps us switch into ‘sleep mode’ when it gets dark, is synthesised from serotonin, so disturbances in that system can affect melatonin production. 

Although this has not been proven one-to-one specifically for ADHD, the neurobiological link is very plausible. 

Less serotonin – less melatonin. Reduced melatonin can significantly disrupt sleep. 

And that is still not the whole story. 

In neurotypical people, dopamine ‘wakes them up’ in the morning: as if it were saying: ‘Get up, come on, let’s go.’ 

But in ADHD the dopamine system is different as well, with altered dopamine signalling. Receptor density is different, neurotransmission is different, and the large-scale network connections differ too. 

This makes waking up in the morning very difficult. Clinically, we see these ‘morning stuck states’, where getting out of bed is a huge struggle. The ‘switching on’ can drag on until midday, or even 3 p.m. – this is extremely common in clinical practice. 

Daylight then breaks down melatonin, helping to keep us awake during the day. We feel this particularly strongly in the autumn–winter months: it is dark in the morning, dark outside as well, and we feel sleepy all day long. This is the residual melatonin still acting, because less light is reaching our eyes. 

As a result, in the evening a person with ADHD finds it hard to put themselves to bed – they are over-revved at night, struggle to fall asleep – and in the morning they find it hard to wake up. 

Here we can use a simple analogy: the effects of melatonin and dopamine are opposite, like the sun and the moon, which never meet in the sky. 

Dopamine is the sun; melatonin is the moon. 

ADHD and sleep: Poorer sleep, stronger symptoms 

What do we end up with? 

A person with ADHD sleeps significantly worse than their neurotypical peers. And this in turn amplifies the manifestations of ADHD. 

Imagine someone who has not caught up on their sleep. On the one hand they are sleepy; on the other hand, they are in a slightly over-revved state. 

The feeling can be similar to going to bed very late or staying up all night because of a flight or trip. In the morning, we are in a strange state: we have not slept enough, yet the nervous system feels overstimulated. 

In people with ADHD, sleep problems can worsen attention symptoms and executive functions: planning, organising, task-switching, self-control and mood regulation. 

And the reverse is also true: untreated ADHD further worsens sleep quality – creating a ‘snowball effect’. 

What else might a person with ADHD feel when their sleep is disturbed? 

First of all: daytime sleepiness. 

A person with predominantly inattentive symptoms, who is already easily distracted and often bored in a situation – imagine them in a conversation. Their conversation partner may already feel they are not really paying attention. 

And then the inattentive person starts yawning as well… 

ADHD and sleep: Sleep apnoea and emotional swings 

Sometimes these sleep difficulties also occur together with sleep apnoea – the sleep-related breathing disorder where breathing periodically stops or slows right down during the night. 

Because of sleep apnoea the brain gets ‘less air’. The person already wakes up drowsy and tired.

This is particularly typical in people with excess weight, notably if they eat a large evening meal or drink alcohol at night. 

It is well known that sleep apnoea – and in particular obstructive sleep apnoea, where the upper airways partially or completely close during sleep – markedly worsens attention, executive functions and mood. 

Alongside ADHD, it is especially important to consider this, because symptoms can partly overlap. 

A chronically sleep-deprived person is completely different from a rested one. 

Naturally, such a person can easily nod off during the day as well. Attention and concentration worsen even further, and any task becomes harder. 

Someone who has not slept enough can be irritable, inactive, unmotivated, and hyper-reactive. On top of this, emotional dysregulation can worsen – something that is already common in adults with ADHD. 

ADHD and sleep: Restless legs syndrome 

There is one more problem that many people know very little about: restless legs syndrome. You may well have it and never known its name. 

Several studies suggest that, in children with ADHD, the rate may be up to 40%; parents often describe that the child ‘kicks off the covers in their sleep’, constantly moves and fidgets, as if they cannot find a comfortable position even while asleep. 

In adults, nearly 30% have symptoms of restless legs or periodic limb movements – significantly more common than in the general population. 

This is not the same as hyperactivity – ‘I just feel like moving’ – but a distinctly unpleasant sensation in the legs that prevents sleep, or appears precisely when you have to stay still, such as in the cinema, on a plane, or in the evening before falling asleep. 

It does not exactly hurt, but it is intolerable and makes you want to move your legs, rub them, bang them on the bed just to get rid of the feeling. 

Some people say their legs feel ‘pulled’, others ‘tense’, ‘tingling’, or as if electricity were running through them. 

Everyone describes it differently, but they share one thing: if they move their legs, the sensation eases temporarily. Hence the name restless legs syndrome. 

And it does not only ruin the sleep of the person affected, but also of the partner sleeping beside them. It is worth asking your partner or family member who shares your room whether they notice anything like this. 

It is often linked to iron deficiency, particularly in young women due to the menstrual cycle. 

Interestingly, restless legs syndrome is related to dopamine, which also affects movement and feelings of wellbeing. 

Since dopamine functioning is already disrupted in ADHD, it is not surprising that restless legs syndrome is more common in people with ADHD. 

ADHD and sleep: Sensory sensitivity 

Logically, we might expect hypersensitivity to be common in people with ADHD. 

Many people with ADHD complain that, when they sleep, they are extremely sensitive to everything. 

The fabric of the bedding is bothersome – too warm, scratchy, irritating. They may be disturbed by light, noise, room temperature, humidity, smells. Because of all this sensory fuss – finding the ‘right’ position, what feels comfortable, what feels unpleasant – sleep can become very disrupted. 

Many people also have dry eye syndrome because of dry air and may confuse this with the feeling of being ‘sleepy’. 

And when you ask: ‘How does the daytime sleepiness you mentioned actually show up?’ – they say: ‘It feels like there is sand in my eyes, they itch, they burn…’ – and it turns out that this is not a sleep problem at all, but dry eye, which needs eye drops rather than more sleep. 

There is another intriguing aspect: people with ADHD are often extremely sensitive to sunlight. That is why people with ADHD tend to wear sunglasses more often than others. 

Because of this, sunlight does not reach the retina properly. The body receives fewer ‘wake-up’ light signals, which can further disrupt the sleep–wake cycle. 

ADHD and sleep: Pay attention to yourself 

It is worth not just reading a list of ‘perfect sleep hygiene rules’ and then applying them rigidly but actually paying attention to your own wellbeing. 

What is it that truly disturbs you (light, noise, duvet, temperature, a pet), and what makes your sleeping place feel a bit more comfortable and safe? 

Because if you 

– give up meeting friends in the evening, even though that would ease your tension, 
– give up evening exercise, even though physical activity triggers neurochemical processes that help you relax, 

then you are practically giving up exactly the things that might actually improve your sleep – simply because you read somewhere that ‘this is forbidden in the evening’, and your sleep becomes worse as a result. 

It is therefore worth looking through: 

– What is disturbing me? 
– What is really happening in practice? 
– And what can I do about all this? 

ADHD and sleep: Sleep hygiene 

1st recommendation: 
The first step is, of course, sleep hygiene. 

Here, the task is to consciously filter out stimuli that disturb sleep. 

We use behavioural methods: 

– limiting the time spent in bed, 
– ‘cleaning up’ the function of the bed (only for sleeping and intimacy – not for scrolling on the phone, not for suffering in it), 
– establishing a regular sleep–wake rhythm. 

The bedroom should be dark during sleep, again because of melatonin production. 

If you switch on the light or look at a bright screen, melatonin has to ‘build up’ again before you feel sleepy. 

Short videos and games are highly absorbing, triggering a dopamine loop, and as a result you do not notice your sleepiness – you can easily ‘slide past’ your natural window for falling asleep. 

This is why, if it helps you – including if you have ADHD – to listen to something while falling asleep, such as a podcast or audio, it is better to listen with the device out of sight. You can set a sleep timer – many devices have this function – and try to avoid looking at any screens just before sleep. 

There are guided meditations and ASMR (Autonomous Sensory Meridian Response) audios specifically designed for sleep on YouTube – some people love putting on train noises to fall asleep. Find what works best for you. 

If light bothers you, you can use: 

– blackout curtains, or 
– a sleep mask – although this can also be uncomfortable and make it harder to wake up in the morning. 

Then check for disturbing noise – if there is, earplugs may help. 

Room temperature is important (air conditioning in hot weather), as is humidity (a humidifier can help if the air is very dry). 

A warm eye mask can also be useful – it can improve lubrication on the surface of the eyes. 

Everyone should experiment with which duvet and pillow feel more comfortable – lighter or heavier. 

Many people find a weighted blanket helpful (a kind of ‘hugging’ blanket) which stimulates sensory receptors in the skin, muscles and joints that send inhibitory signals to the central nervous system. This reduces movement and the number of times they wake themselves up. 

If you travel, many hotels offer a ‘pillow menu’: you can try different pillows and discover what best fits your needs. 

In this way you can build yourself a real ‘nest’ for the night. 

A note on alcohol: in the short term, alcohol may have a sedative effect. In the longer term, however, it worsens overall health, increases irritability and also disrupts restorative sleep. 

Physical exercise is best finished at least 2–3 hours before bedtime. 

Another practical tip: do not drink large amounts of fluids late in the evening, which means you are less likely to get up to go to the toilet at night. 

If you do have to get up, very dim light is enough during night-time trips – just enough so you do not ‘kill’ melatonin production. 

ADHD and sleep: Psychoeducation 

2nd recommendation: 
The second major aspect in sleep problems is psychoeducation. 

Every person with sleep difficulties should receive some psychoeducation – and this includes people with ADHD.  

If you attend psychoeducation or psychotherapy, make sure that sleep is explicitly addressed as a topic. 

This is also a good place to mention sleep-tracking devices and apps. 

When researchers compared the results from polysomnography in a sleep lab – EEG, breathing, heart rate, limb movements – with the data from wrist-worn fitness bands for the same people, they found huge discrepancies. 

When it comes to measuring sleep stages, these wearables are very inaccurate. 

If the person feels fine in general and their main concern is ‘my band app says my sleep is bad’, it is usually better not to use these devices, because they can be highly misleading. 

If they do feel unwell, the data still do not provide very useful information – but they can certainly scare people. 

We absolutely have to mention cats: many people’s sleep is disturbed by their pets. 

Unfortunately, this is one area where you have to be quite firm and keep the animal out of the bedroom – you can put the cat in the hallway, kitchen, wherever, because you cannot really ‘train’ a cat not to disturb you at night. This is where it helps to look at the advice of pet behaviour specialists or zoo psychologists. 

On the other hand, if you always forget to take your medication, you can link your pills to feeding your pet. If your medication is kept where the treats are, then when the cat demands its snack, you are unlikely to forget your tablets either – a cat is hard to ignore. 

Bedtime is individual – because of the circadian rhythm. 

The easiest way to find your own phase is empirically: observe how you sleep when you are on holiday and there is no external pressure – when you naturally go to bed, when you naturally wake up. 

Keeping a diary can then help you work out what is disturbing your sleep. 

A sleep diary is simply a table where you record what you did during the day, when you drank caffeinated drinks, when you exercised, whether you drank alcohol, when you went to bed, when you feel you fell asleep, and how many times you woke up at night. 

If you always exercise at 10 p.m. and sleep badly afterwards, you can move your workout earlier; if you drink caffeine after 4 p.m. and sleep badly every time, you can experiment with stopping caffeine after 4 p.m. 

Ideally, sleep ‘runs by itself’: you get sleepy in the evening – you go to bed – you wake up in the morning when you need to, do what you have to do, feel well during the day, then get sleepy again at night, go to bed… and so on, in cycles. 

If someone feels well – we leave their sleep alone. 

ADHD and sleep: Using melatonin 

3rd recommendation: 
The next tool is melatonin – either as tablets or, nowadays, for example, as a melatonin spray. 

If you are in a phase of life where you have to be somewhere in the early morning (school, work), you can try to shift your rhythm earlier. 

In this case, melatonin is taken about 30 minutes before the desired bedtime. 

It is worth choosing a reliable, well-regulated preparation and following medical dosing recommendations. 

For regulating a delayed circadian rhythm – especially late-onset sleepiness – melatonin works particularly well. 

As we said at the start: in ADHD melatonin tends to be produced later, so externally supplied melatonin makes obvious sense. 

We also see that in jet lag – when travelling across time zones – melatonin can facilitate adjustment. The same applies in social jet lag, when your genetic chronotype is an owl but you have to live as a lark. 

There are also behavioural strategies that support sleep: 

– going to bed at roughly the same time each night, 
– getting up at the same time every day – even at weekends. 

At first, bedtime is not forced – you go to bed when you are sleepy – but getting up is fixed, for example at 7 a.m. every day, including weekends. 

The advantage of melatonin is that – unlike many other sleeping pills – it is our own natural hormone. 

In appropriate doses it does not cause dependence and does not lead to a ‘morning hangover’, but it is still important to discuss it with a doctor. 

ADHD and sleep: Light therapy 

4th recommendation: 
In winter, when there is little natural light, many people develop a state similar to seasonal affective disorder: sleepiness, increased appetite, reduced productivity. 

Natural daylight – especially in the morning – is by far the best ‘wake-up’ signal. 

If you live in a climate with strong morning light, the simplest thing is to go outside or sit on the balcony after breakfast – this can help reset your rhythm very effectively. 

If there is no opportunity to be out in the morning sun, you can use a bright light-therapy lamp as soon as you wake up to ‘illuminate’ your face, reducing melatonin production in the brain. 

There are special high-intensity SAD lamps (named after Seasonal Affective Disorder). 

It turns out that they also work well for circadian rhythm disorders. 

These lamps can emit up to 10,000 lux. You sit for half an hour or prepare your breakfast in front of the lamp, and you feel better afterwards. 

Another useful tool is a dawn-simulation alarm clock: a small light that gradually brightens over 15–30 minutes, simulating sunrise. 

This can provide a very pleasant way to wake up, especially if you use blackout curtains and no natural light enters the room. 

At the same time, in ADHD light therapy is more of an adjunct, not a first-line standard treatment. Its timing and ‘dose’ need to be tailored to the individual, and caution is needed in people with pronounced light sensitivity or eye conditions. 

ADHD and sleep: 8 practical strategies 

If you have read this far, you have probably recognised yourself in at least one of these descriptions. 

The 8 practical sleep strategies that most often help – including alongside ADHD – are supported by research and the experience of sleep specialists. 

With many small, everyday steps you can support your sleep. 

1. If you always go to bed and get up at different times: 
Set a more stable rhythm – go to bed at roughly the same time each night and, especially, get up at the same time every morning, weekends included. 

2. If you ‘live, work and scroll’ in your bed: 
Teach your brain that the bed is for sleep and intimacy – do not work there, do not scroll your phone there, and only get into bed when you really intend to sleep. 

3. If you cannot switch off from screens, caffeine or food in the evening: 
Try to hold back and, 1–2 hours before bed, reduce screen time and blue light to your face, avoid caffeine, and do not use alcohol as a ‘sleeping aid’. 

4. If your bedroom is bright, noisy or uncomfortable: 
Create a personal ‘sleep nest’ – a dark room (blackout curtains, sleep mask), cool, relatively quiet; use what you like for sleeping: earplugs, humidifier, comfortable pillows, maybe a weighted blanket. 

5. If your mind is buzzing and you cannot wind down at night: 
Introduce a soothing, repetitive winding-down routine – a pleasant shower or bath, dimmed lights, and fall asleep with a calm voice or audio story. Try not to focus on ‘forcing sleep’, but on sensing your body: from your toes upwards, moving slowly through the body and consciously relaxing each body part. 

6. If you ‘don’t start up’ in the morning and feel slowed for hours: 
Switch on the morning light – get out into natural light as soon as possible after waking or use a light-therapy lamp or dawn-simulation alarm clock so your internal clock knows it is daytime. 

7. If you do not understand what is happening with your sleep: 
Then it is time for education and a sleep diary – learn what is normal for you personally, and keep a sleep diary for a few weeks (when you go to bed, when you get up, caffeine, exercise, awakenings) so that both you and your clinician can see the patterns in your life. 

8. If home tricks are not enough:  

When should you seek help? 
Most sleep problems – especially insomnia – often resolve on their own. 

If there is a genuine circadian rhythm disorder, however, it will not simply disappear. This is particularly true in ADHD. 

And if you are trying to live by a lark rhythm, while your chronotype is an owl, you will always need certain extra efforts. 

Restless legs syndrome definitely requires a doctor. 

It is better to discuss with a specialist whether medication timing can be adjusted, whether melatonin makes sense, whether it is worth checking iron levels, or whether you should attend a sleep lab to rule out sleep apnoea. 

Many people are afraid because of the prejudice: ‘If I go to the doctor, they will give me some terrible tablet.’ But ADHD and sleep problems interact with each other. Sleep problems need to be assessed before prescribing ADHD medication. 

If there is something in your life that you do not like, that is chronically present and significantly reduces your quality of life, you do not have to endure it. 

Here you can find a short, free online self-screening test (this is not a diagnosis, just a quick self-check): Free ADHD Simple → https://adhdsimple.co.nz/quiz-landing 

Find out more about yourself. 

In reality, there is a stepwise, graded scheme for treating sleep disorders. 

There is a range of medications that do not cause dependence, including some relatively mild preparations. 

If this is a chronic difficulty – for example, you suffer from not being able to sleep before important events or occasions – such medicines can be used on an as-needed basis. 

Only at the very end does a classic hypnotic come into play – always with an individual risk–benefit assessment. 

Most likely, sleep problems will come and go throughout your life. Sleep is a natural process and does not need to be forced into a rigid artificial frame. Ask for help in learning to make peace with your own sleep. 

Last updated February 2026 
Written by Olga Karolyi for ADHD Test 

Important: This article is for information only. Diagnosis and treatment are determined and overseen by a qualified clinician. If you feel affected, contact your GP. 

References: 

Key UK guidance 

• National Institute for Health and Care Excellence. (2018, last reviewed 2025). Attention deficit hyperactivity disorder: Diagnosis and management (NG87). https://www.nice.org.uk/guidance/ng87 

• National Health Service. (2025). ADHD in adults. https://www.nhs.uk/conditions/adhd-adults/ 

• Royal College of Psychiatrists in Scotland. (2022). ADHD in adults: Good practice guidance (CR235). https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-reports/cr235-adhd-in-adults---good-practice-guidance.pdf 

Further reading  

• American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.; DSM-5-TR). American Psychiatric Association 

• Asherson, P., Giaroli, G., Gringras, P., Phillips, H., Selsick, H., Smith, M., & Hank, D. (2025). The optimal system of care for the management of delayed sleep onset in adult ADHD in the UK: A modified Delphi consensus. Frontiers in Psychiatry, 16, 1566390. https://doi.org/10.3389/fpsyt.2025.1566390 
  (Expert consensus focusing on adults with ADHD, outlining a system-level approach to managing delayed sleep onset (DSPS), including sleep hygiene, melatonin, light therapy, medication timing and long-term follow-up. It provides useful background for understanding the “night-owl” chronotype, 1–2-hour melatonin delay and the need for structured care pathways.) 

• Barkley, R. A. (2014). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (4th ed.). Guilford Press. 
  (A widely regarded “core text” on ADHD, covering diagnostic issues, comorbidities and functional impact in depth. It provides a solid backbone for understanding how sleep problems fit into the wider ADHD picture, both clinically and over the lifespan.) 

• Bjorvatn, B., Brevik, E. J., Lundervold, A. J., Halmøy, A., Posserud, M. B., Instanes, J. T., & Haavik, J. (2017). Adults with attention deficit hyperactivity disorder report high symptom levels of troubled sleep, restless legs, and cataplexy. Frontiers in Psychology, 8, 1621. https://doi.org/10.3389/fpsyg.2017.01621 
  (Large cross-sectional study showing that more than 80% of adults with ADHD report significant sleep problems across their lifetime, including short sleep, restless legs symptoms, snoring and breathing pauses. It supports the view that sleep disorders are genuinely more frequent in ADHD, rather than just “subjective fussiness”.) 

• Cortese, S., Fusetto Veronesi, G., Gabellone, A., Margari, A., Marzulli, L., Matera, E., Petruzelli, M. G., Piarulli, F. M., Tarantino, F., Bellato, A., Parlatini, V., Rietz, E. D., Larsson, H., Hornsey, S., Hill, C., & Margari, L. (2024). The management of sleep disturbances in children with attention-deficit/hyperactivity disorder (ADHD): An update of the literature. Expert Review of Neurotherapeutics, 24(6), 585–596. https://doi.org/10.1080/14737175.2024.2353692 
  (Updated overview of managing sleep disturbances in children and adolescents with ADHD, covering sleep hygiene, behavioural methods, melatonin and medication timing. It strongly supports psychoeducation, consistent bedtime routines, switching off screens and gradual step-by-step changes.) 

• de Oliveira, A. C. G., Lamana, I. V., Nogueira, N. B. A., Bertazzo, L. T., Santos, J., & Stangherlin, L. (2025). Attention-deficit hyperactivity disorder (ADHD) and sleep disorders: What we know now and where we are headed. Brazilian Journal of Clinical Medicine and Review, 3(1), bjcmr25. https://doi.org/10.52600/2965-0968.bjcmr.2025.3.1.bjcmr25 
  (Narrative review of the bidirectional relationship between ADHD and a range of sleep disorders, showing how poor sleep worsens ADHD symptoms while ADHD features and comorbidities further disturb sleep. It also highlights that some drug treatments can themselves provoke or aggravate sleep problems, underlining the need to align medication with non-pharmacological strategies such as sleep hygiene and behavioural therapy.) 

• Dey, A., Do, T. L., Almagor, D., & Khullar, A. (2025). Managing comorbid sleep issues in patients with attention-deficit/hyperactivity disorder. CMAJ: Canadian Medical Association journal = journal de l’Association médicale canadienne, 197(12), E323–E324. https://doi.org/10.1503/cmaj.241262 
  (Short clinical summary emphasising that around half of patients with ADHD report major sleep problems such as insomnia, delayed sleep phase, restless legs and obstructive sleep apnoea. It argues that routine screening and treatment of sleep issues are essential, and that ADHD care is incomplete without systematic sleep assessment.) 

• Díaz-Román, A., Mitchell, R., & Cortese, S. (2018). Sleep in adults with ADHD: Systematic review and meta-analysis of subjective and objective studies. Neuroscience & Biobehavioral Reviews, 89, 61–71. https://doi.org/10.1016/j.neubiorev.2018.02.014 
  (Systematic review and meta-analysis integrating questionnaire, polysomnography and actigraphy data in adults with ADHD. It shows consistently shorter sleep, poorer sleep quality and more daytime sleepiness, confirming that the problem goes beyond subjective complaints.) 

• Ekholm, B., Spulber, S., & Adler, M. (2020). A randomized controlled study of weighted chain blankets for insomnia in psychiatric disorders. Journal of Clinical Sleep Medicine, 16(9), 1567–1577. https://doi.org/10.5664/jcsm.8636 
  (Randomised controlled trial in 120 psychiatric patients comparing weighted chain blankets with light blankets. The weighted blankets reduced insomnia severity and daytime fatigue, offering experimental support for their calming, “prolonged hug”-like effect.) 

• Espie, C. A. (2006). Overcoming insomnia and sleep problems: A self-help guide using cognitive behavioural techniques. Constable & Robinson. 
  (A CBT-I–based self-help book written for the general public, with clear, step-by-step strategies to improve sleep without over-reliance on medication. It is an excellent resource to underpin psychoeducation sections and to recommend to motivated patients who want practical tools they can start using on their own.) 

• Esposito, S., Laino, D., D’Alonzo, R., Mencarelli, A., Di Genova, L., Fattorusso, A., Argentiero, A., & Mencaroni, E. (2019). Pediatric sleep disturbances and treatment with melatonin. Journal of Translational Medicine, 17, 77. https://doi.org/10.1186/s12967-019-1835-1 
  (Review of childhood sleep disturbances—especially difficulties falling asleep, circadian rhythm problems and sleep issues linked to neurodevelopmental conditions such as ASD and ADHD—and the role of melatonin in these contexts. It outlines when melatonin can be used, in what doses and with what precautions in paediatric practice.) 

• Evan D Chinoy, Joseph A Cuellar, Kirbie E Huwa, Jason T Jameson, Catherine H Watson, Sara C Bessman, Dale A Hirsch, Adam D Cooper, Sean P A Drummond, Rachel R Markwald, Performance of seven consumer sleep-tracking devices compared with polysomnography, Sleep, Volume 44, Issue 5, May 2021, zsaa291, https://doi.org/10.1093/sleep/zsaa291 
  (Laboratory comparison of popular consumer sleep-tracking devices with the polysomnography “gold standard”. The devices estimate total sleep time reasonably well but are unreliable for wake after sleep onset and sleep stages, so they are useful for broad trends rather than diagnosis or “perfect” sleep analysis.) 

• Fadeuilhe, C., Daigre, C., Grau-López, L., Richarte, V., Palma-Álvarez, R. F., Corrales, M., Sáez, B., Baz, M., & Ramos-Quiroga, J. A. (2022). The impact of insomnia disorder on adult attention-deficit/hyperactivity disorder severity: A six-month follow-up study. Psychiatry Research, 308, 114349. https://doi.org/10.1016/j.psychres.2021.114349 
  (Six-month follow-up of adults with ADHD and DSM-5 insomnia, showing that improvements in insomnia are accompanied by reductions in ADHD symptoms and psychiatric comorbidities. It neatly illustrates the two-way relationship: when sleep improves, daytime ADHD functioning can improve as well.) 

• Hamel, C., & Horton, J. (2022). Melatonin for the Treatment of Insomnia: A 2022 Update: Rapid Review. Canadian Agency for Drugs and Technologies in Health. https://www.ncbi.nlm.nih.gov/books/NBK605080/ 
  (Health technology rapid review summarising the effectiveness and safety of melatonin for insomnia. Findings suggest mainly modest benefits with generally mild side-effects, supporting a cautious view of melatonin as a targeted tool rather than a miracle cure.) 

• Harvard Health Publishing. (2024, July 24). Blue light has a dark side. Staying Healthy – Harvard Health. https://www.health.harvard.edu/staying-healthy/blue-light-has-a-dark-side 
  (Accessible overview explaining, based on Manchester experiments and related work, that not only blue wavelength but overall light intensity and timing strongly influence the circadian clock. It fits well with a “myth-busting” message: evening “yellow mode” alone is not enough if the screen remains very bright and mentally stimulating.) 

• Hiscock, H., & Sciberras, E. (Eds.). (2019). Sleep and ADHD: An evidence-based guide to assessment and treatment. Academic Press. 
  (This edited volume focuses directly on the overlap between ADHD and sleep. It combines up-to-date neurobiological explanations with very practical guidance on assessment and treatment, mainly in children and adolescents, but the theoretical background is broadly useful beyond paediatrics.) 

• Huang, Y.-S., Guilleminault, C., Li, H.-Y., Yang, C.-M., Wu, Y.-Y., & Chen, N.-H. (2007). Attention-deficit/hyperactivity disorder with obstructive sleep apnea: A treatment outcome study. Sleep Medicine, 8(1), 18–30. https://doi.org/10.1016/j.sleep.2006.05.016 
  (Outcome study in children with ADHD and mild obstructive sleep apnoea, comparing adenotonsillectomy, methylphenidate and no treatment. Surgery improved both sleep and ADHD symptoms more than medication, underlining that underlying OSA should be treated rather than simply “medicating” attention problems.) 

• Konofal, E., Lecendreux, M., Arnulf, I., & Mouren, M.-C. (2004). Iron deficiency in children with attention-deficit/hyperactivity disorder. Archives of Pediatrics & Adolescent Medicine, 158(12), 1113–1115. https://doi.org/10.1001/archpedi.158.12.1113 
  (Study showing that children with ADHD frequently have low ferritin levels, which are associated with more severe symptoms. It supports checking iron stores where there is “restless legs” or fidgety discomfort and considering ferritin testing rather than dismissing it as simple restlessness.) 

• Kooij, J. J. S., & Bijlenga, D. (2014). High prevalence of self-reported photophobia in adult ADHD. Frontiers in Neurology, 5, 256. https://doi.org/10.3389/fneur.2014.00256 
  (Online survey in which many adults with ADHD report sensitivity to light and more frequent use of sunglasses in daytime. The authors link this to dopamine–melatonin mechanisms in the eye and to circadian disruption, giving a biological backdrop for “night-owl” chronotypes and light-based interventions.) 

• Larsson, I., Aili, K., Nygren, J. M., Jarbin, H., & Svedberg, P. (2021). Parents’ experiences of weighted blankets’ impact on children with attention-deficit/hyperactivity disorder (ADHD) and sleep problems—A qualitative study. International Journal of Environmental Research and Public Health, 18(24), 12959. https://doi.org/10.3390/ijerph182412959 
  (Qualitative study of parents of children with ADHD and sleep problems who used weighted blankets. Parents described better sleep quality and fewer night-time awakenings, providing narrative evidence for the calming, “deep pressure” effects often reported in practice.) 

• Menczel Schrire, Z., Phillips, C. L., Chapman, J. L., Duffy, S. L., Wong, G., D’Rozario, A. L., Comas, M., Raisin, I., Saini, B., Gordon, C. J., & Grunstein, R. R. (2022). Safety of higher doses of melatonin in adults: A systematic review and meta-analysis. Journal of Pineal Research, 72(3), e12782. https://doi.org/10.1111/jpi.12782 
  (Systematic review and meta-analysis examining how safe higher-than-usual doses of melatonin are in adults across clinical trials. Short- to medium-term use appears generally well tolerated with mostly mild side-effects, but there is still limited evidence on long-term safety.) 

• Migueis, D. P., Lopes, M. C., Casella, E., Soares, P. V., Soster, L., & Spruyt, K. (2023). Attention deficit hyperactivity disorder and restless leg syndrome across the lifespan: A systematic review and meta-analysis. Sleep Medicine Reviews, 69, 101770. https://doi.org/10.1016/j.smrv.2023.101770 
  (Systematic review and meta-analysis of the association between ADHD and restless legs syndrome from childhood through adulthood. It finds RLS symptoms in around 10–40% of children and 20–33% of adults with ADHD, reinforcing that RLS is an important comorbid condition that disrupts sleep onset and daytime functioning.) 

• Morin, C. M., & Benca, R. (2012). Chronic insomnia. The Lancet, 379(9821), 1129–1141. https://doi.org/10.1016/S0140-6736(11)60750-2 
  (Major overview of chronic insomnia covering definition, prevalence, risk factors, biology and treatment. It stresses that cognitive-behavioural therapy for insomnia (CBT-I) is first-line, with medication as an adjunct, and provides a clear framework for distinguishing “true” insomnia from simple dissatisfaction with sleep.) 

• Palagini, L., Manni, R., Aguglia, E., Amore, M., Brugnoli, R., Bioulac, S., Lopez, R., Micoulaud-Franchi, J.-A., Plazzi, G., Riemann, D., & Geoffroy, P. A. (2021). International expert opinions and recommendations on the use of melatonin in the treatment of insomnia and circadian sleep disturbances in adult neuropsychiatric disorders. Frontiers in Psychiatry, 12, 688890. https://doi.org/10.3389/fpsyt.2021.688890 
  (International expert consensus on how to use melatonin to treat insomnia and circadian rhythm disorders in adult neuropsychiatric conditions. It distinguishes prolonged-release (2–10 mg) from low-dose immediate-release products and supports a cautious, timing-centred approach rather than blanket prescribing.) 

• Sateia, M. J., Buysse, D. J., Krystal, A. D., Neubauer, D. N., & Heald, J. L. (2017). Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: An American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 13(2), 307–349. https://doi.org/10.5664/jcsm.6470 
  (Evidence-based guideline on pharmacological treatment of chronic insomnia, reviewing hypnotics, “Z-drugs”, melatonin agonists and certain antidepressants. It clarifies what is recommended, what is uncertain and underlines that strong hypnotics are not the first step in long-standing sleep problems.) 

  
  

• Silk, T. J. (2019). New frontiers: Neurobiology of sleep in ADHD. In H. Hiscock & E. Sciberras (Eds.), Sleep and ADHD: An evidence-based guide to assessment and treatment (pp. 331–353). Academic Press. https://neupsykey.com/new-frontiers-neurobiology-of-sleep-in-adhd/ 
  (Chapter reviewing the neurobiology of the sleep–wake system and how the brain networks and neurotransmitter systems involved—noradrenaline, dopamine, serotonin, acetylcholine, histamine and orexin/hypocretin—may relate to ADHD symptoms and sleep disruption.) 

  
  

• Trauer, J. M., Qian, M. Y., Doyle, J. S., Rajaratnam, S. M. W., & Cunnington, D. (2015). Cognitive behavioral therapy for chronic insomnia: A systematic review and meta-analysis. Annals of Internal Medicine, 163(3), 191–204. https://doi.org/10.7326/M14-2841 
  (Systematic review and meta-analysis showing that CBT-I produces clinically meaningful improvements in sleep onset latency, night-time awakenings and sleep quality, with effects that are durable over time. It supports CBT-I as the “gold standard” for chronic insomnia rather than a few basic hygiene tips.) 

  
  

• Van der Heijden, K. B., Smits, M. G., Van Someren, E. J. W., Ridderinkhof, K. R., & Gunning, W. B. (2007). Effect of melatonin on sleep, behavior, and cognition in ADHD and chronic sleep-onset insomnia. Journal of the American Academy of Child & Adolescent Psychiatry, 46(2), 233–241. https://doi.org/10.1097/01.chi.0000246055.76167.0d 
  (Clinical trial of melatonin in children with ADHD and chronic sleep-onset insomnia, showing earlier sleep onset and longer sleep without deterioration in cognitive performance. It supports the idea that melatonin mainly shifts the timing of sleep rather than simply “knocking someone out”.) 

  
  

• Williams, T. (2023). Impact of circadian rhythm on attention-deficit hyperactivity disorder [Poster]. Physician Assistant Scholarly Project Posters, University of North Dakota. https://commons.und.edu/cgi/viewcontent.cgi?article=1291&context=pas-grad-posters 
  (Poster presenting a systematic literature review on whether shifting the circadian rhythm earlier—through melatonin, light therapy, sleep-hygiene interventions and careful stimulant timing—improves sleep and ADHD symptoms. It brings together emerging evidence that circadian-based interventions can be a meaningful part of ADHD management.)