ADHD and Sleep Disorders: Watching for Comorbid Sleep Issues

Amit Chopra, MD, shares an overview of his upcoming presentation on sleep disorders in teens and young adults with attention-deficit hyperactivity disorder (ADHD), with emphasis on clinical identification and management.

Chopra framed ADHD as a condition that must be considered "on a 24-hour continuum rather than focusing on daytime symptoms only," arguing that sleep disorders in this population represent the rule rather than the exception. He reported that 50 to 70% of individuals with ADHD have comorbid sleep disturbances, encompassing insomnia, circadian rhythm disorders, restless legs syndrome, obstructive sleep apnea, and hypersomnia.¹

The neurobiological basis Chopra offered centered on dopaminergic dysfunction. He explained that because dopamine regulates the internal circadian clock, patients with ADHD frequently experience delayed sleep onset. He additionally described an impairment of homeostatic sleep drive—the pressure to sleep that accumulates with wakefulness—resulting in a paradox wherein sleep-deprived patients with ADHD may not subjectively feel sleepy. Cortical hyperactivity was also implicated as a contributing mechanism.

Chopra identified delayed sleep phase syndrome (DSPS) as a clinically significant and commonly misidentified sleep disorder in this population, particularly among adolescents.² He cautioned that DSPS is frequently mischaracterized as insomnia, noting that "it has a very different treatment paradigm that includes the use of melatonin and light therapy and behavioral interventions." Environmental factors such as excessive screen use and lack of structured daytime activity may be reinforcing circadian dysregulation, he said.

Chopra emphasized the bidirectional relationship between psychiatric disorders and sleep, noting that sleep disturbance both results from and exacerbates ADHD symptomatology. He advocated for broad, systematic sleep evaluation in ADHD patients, asserting that effective treatment of comorbid sleep disorders produced meaningful improvements in daytime functioning and overall clinical outcomes.

RSVP for Chopra’s upcoming presentation with the American Society for Adolescent Psychiatry here.

Dr Chopra is a psychiatrist and sleep specialist at Massachusetts General Hospital and assistant professor of psychiatry at Harvard Medical School.

References

1. Hvolby A. Associations of sleep disturbance with ADHD: implications for treatment. Atten Defic Hyperact Disord. 2015;7(1):1-18.

2. Wajszilber D, Santiseban JA, Gruber R. Sleep disorders in patients with ADHD: impact and management challenges. Nat Sci Sleep. 2018;10:453-480.