These 10 tips provide specific treatment considerations for any ADHD symptoms associated with sleep disturbance. If each of these problems is not treated, ADHD symptoms become more severe.

1. Measure TAH: Evaluate the Onset of Sleep and Duration in Total Average Hours -TAH. Sleep, according to circadian rhythm research, is best to start before midnight and should last, according to research, 8.25 TAH. Less than 7 TAH should always be systematically addressed, at any age. Consistent duration of uninterrupted sleep is important and is better than taking a nap to correct the next day.

2. Assess sleep levels: level 1: falling asleep, level 2: staying asleep, level 3: waking up too early in the morning and not being able to go back to sleep. Each level suggests different clinical and treatment considerations. Some may claim that they have no problem with either of these first two points, but may have problems with the next measurement.

3. Assess the general sleep architecture: Sufficiently deep sleep, with a feeling of adequate rest in the morning. Perpetual dream levels and physical sleep activity levels often demonstrate significant problems.

4. Evaluate the lifetime duration of sleep problems: Many live for years with sleep problems and only in middle age do they begin to show significant wear and tear. Just because someone did well on 4 hours of sleep and naps doesn’t help the defragmentation process that takes place in an 8 hour sleep at night. Sleep treatment for these challenges typically results in excessive sleep for days or weeks until the body establishes a new calibration.

5. Assess for sleep apnea – Many snore or have significant airway problems. SPECT brain imaging studies often show specific areas of brain hypofunction secondary to sleep apnea, and sleep apnea, with decreased cerebral oxygen, will always aggravate ADHD. Sleep apnea problems can be corrected with specific interventions and require a sleep laboratory evaluation.

6. Untreated ADHD or other comorbid psychiatric problems: The most common cause of level 1 sleep problems is untreated ADHD and/or depression associated with worry and prefrontal cortical dysregulation. Comorbid major depression, mood disorder, and other psychiatric problems can also interfere with all three levels of sleep.

7. Overly Treated ADHD: If It’s Stimulating [or other psychiatric] medications are set inappropriately high, and the duration of effectiveness of stimulant medications is not set appropriately, the medications will interfere with sleep on many levels. Paradoxically, when stimulant medications are well-adjusted and comorbid depression is corrected, sleep medications are often not necessary. Always dose psychiatric medications according to the Therapeutic Window principles outlined in my other articles here.

8. Assess for hormonal dysregulation: Estrogen dominance will significantly affect sleep patterns and is always associated with other hormone-related difficulties that need specific correction regardless of ADHD workup. Other hormonal dysregulations can also occur, such as increased cortisol with stress or adrenal dysfunction, which will also affect sleep. ADHD medications do not correct hormonal imbalances.

9. Assess for medical/metabolic dysregulation: Many medical conditions will significantly affect sleep patterns. Restless legs syndrome, for example, is often associated with a simple magnesium deficiency. A variety of nutritional problems can significantly disrupt sleep patterns and, again, cannot be successfully treated with ADHD medication.

10. Evaluate sleep hygiene: Watching television and eating in bed, using the bed for stimulating activities will break the association of the bed with sleep. If the bed is to play regularly, where and when can you sleep?

Sleep problems with ADHD seem almost inconsequential at first, with seemingly little relevance to either recovery process. However, upon careful review, co-occurring ADHD and sleep problems can complete an impenetrable, toxic cycle of impairment that requires simultaneous intervention.