ADHD Experts Podcast: Episode 541

"How Sleep Disorders Impact Every Aspect of Life with ADHD"

Release Date: February 4, 2025
Host: Annie Rogers, ADDitude Magazine
Guest: Dr. Sandra Kuey, Professor of Adult ADHD Studies, VU University Medical Center, Netherlands

Episode Overview

This insightful episode explores the intricate and often underappreciated relationship between ADHD and sleep disorders. Dr. Sandra Kuey, a leading expert in adult ADHD and comorbidities, shares the latest research, clinical experience, and practical strategies on how sleep problems (like delayed sleep phase syndrome, insomnia, restless legs, and more) are deeply intertwined with ADHD symptoms. Listeners gain clear, actionable advice on diagnosis, treatment options, and the lifelong implications of untreated sleep issues in ADHD populations.

Key Topics & Insights

1. Epidemiology: ADHD and Sleep Disorders

[03:29–07:55]

• Strong Association: Swedish nationwide study (6 million people) shows those with ADHD are 8x more likely to be diagnosed with sleep disorders.
  • Adolescents: 16x more likely
  • Young adults: 12x
  • Children/older adults: 6–8x
  • Quote: “People with ADHD indeed are eight times more likely to be diagnosed with any sleep disorder relative to control peers.” (Dr. Kuey, 04:06)
• Range of Sleep Disorders: Nearly all types—delayed sleep phase, insomnia, nightmares, sleepwalking, restless legs, parasomnias, hypersomnia.
• Medication Use: ADHD patients are 14x more likely to be prescribed sleep meds, 37x more likely for melatonin.
• These findings are mirrored in Dutch data and suggested to be globally relevant.

2. How Sleep & Circadian Rhythms Work—and Go Awry in ADHD

[07:56–15:50]

• Chronotype Explained: Most people with ADHD (70–80%) have a genetically determined late chronotype (“night owl”).
  • Quote: “ADHD people have in 70 to 80% a late sleep rhythm. Even 78% cannot sleep at an earlier time even if they wish to, except when they’re really, really tired.” (Dr. Kuey, 10:07)
• "Social Jet Lag": Forced early wake times (for school, work) create a persistent sleep deficit.
  • On average, ADHD individuals get 5–6 hours of sleep vs. the 7–8 needed.
  • Consequences: Sleepiness, impaired cognitive function, poor memory, irritability, low mood, binge eating, and higher obesity risk.
  • These symptoms overlap heavily with core ADHD struggles.

3. Common Sleep Disorders in ADHD: Prevalence and Mechanisms

[15:51–21:15]

• Delayed Sleep Phase / Evening Chronotype: 78% (Dr. Kuey’s 2010 study)
• Insomnia: 43%
  • Tied to “racing thoughts,” rumination, often stress-driven.
• Restless Legs: 30–40%; related to low iron stores (ferritin).
• Sleep Apnea & Other Conditions: Higher rates, often obesity-related.
• Gender Differences: Insomnia more common in women; sleep apnea more in men.
• Comorbidities: Sleep problems more severe with depression, anxiety, PTSD, substance use.

4. How Sleep and ADHD Symptoms Interact

[21:16–24:30]

• Multi-directional Relationship: ADHD can cause sleep trouble (due to restlessness/rumination) and sleep loss can mimic or worsen ADHD symptoms.
  • Quote: “Sleep problems cause ADHD symptoms such as less focus, memory problems, mood issues, irritability…but maybe both interact and increase each other.” (Dr. Kuey, 19:00)
• Emerging View: There may be shared genetic/neurological underpinnings—e.g., “clock genes”—that predispose to both conditions.

5. The Role of Light, Melatonin, and Biological Clocks

[24:31–36:59]

• Light Exposure Key: Morning sunlight is crucial for syncing internal clocks; low exposure delays sleep further.
  • Wearing sunglasses excessively or working indoors deepens the problem.
  • Quote: “If you wear sunglasses during daytime, your brain will perceive your environment as dark and will think that it’s nighttime, so you don’t synchronize your biological clock.” (Dr. Kuey, 30:35)
• Eye Receptors: Recent discoveries show specialized receptors signal light intensity to the brain, influencing both melatonin (“night hormone”) and dopamine (“day hormone”).

6. Environmental and Geographic Factors

[37:00–39:15]

• Light Intensity & ADHD Rates: Areas with more daylight (e.g., Mexico) have lower ADHD prevalence; darker areas (Eastern US, North Europe) see more.
• Winter Depression (Seasonal Affective Disorder): 27% prevalence among Dutch ADHD adults; more common in women.

7. Consequences of Chronic Sleep Disturbance

[39:16–43:30]

• Short sleep leads to hormonal changes (leptin, ghrelin) driving appetite & weight gain.
• Risks: Obesity, diabetes, cardiovascular disease, and even cancer.
  • Quote: “Obesity is basically a low grade inflammation for your whole system…the only way to prevent that, is by treating your sleep problems.” (Dr. Kuey, 41:20)

8. Treatment Approaches for Sleep Disorders in ADHD

[43:31–56:16]

• Chronotherapy: Resetting the sleep cycle with melatonin, light therapy, and consistent habits.
  • Lifestyle & Sleep Hygiene: Dark rooms, no screens after 9:30 p.m., morning light exposure, avoid daytime naps, and fixed wake times—even weekends.
  • Melatonin: Effective for delayed sleep phase—but use very low doses (0.5 mg) at the right time to avoid morning “hangover.”
    • Quote: “The advice is to use really low dosages...with these low doses, the result is pretty good…if you use higher dosages, you will have hangover the next day.” (Dr. Kuey, 55:21)
  • Light Therapy: Uses high-lux light boxes (10,000 lux) or “light glasses” in the morning, especially in winter, to advance body clocks and ease depression.
• Other therapies:
  • CBT for Insomnia (CBTi): Especially when anxiety/depression is comorbid.
  • Restless Leg Treatment: Check and correct low ferritin; avoid certain SSRIs.
  • Sleep Apnea: Weight loss, mandibular devices, or CPAP machines as indicated.

9. Clinical Trials and Evidence

[56:17–58:58]

• Chronotherapy trials found that:
  • Melatonin (0.5 mg) alone advances sleep onset 1.5 hours
  • Melatonin + light therapy: 2 hours
  • ADHD symptoms improve up to 14% with therapy—even without major increases in sleep duration (pointing to rhythm regularity as key)
• Light Therapy Alone: Objective and subjective ADHD symptom reduction, also improves depression.

Notable Audience Q&A

Melatonin: Safety and Use in Children

[60:53]

• Melatonin is safe as a chronic treatment for genetically-based delayed sleep phase; stopping it reverses progress in 2 weeks.
  • Quote: “If you stop melatonin, the rhythm will be late in two weeks again…So if you stop, what’s the use?” (Dr. Kuey, 61:06)
• Quality Assurance: US supplements aren’t regulated—best to get melatonin prescribed for precise dosing.

Stimulant Medication and Sleep

[63:21]

• Stimulants can push back sleep onset, but preexisting delayed sleep phase is a bigger issue. Always treat sleep first, then add stimulants.

Sunglasses & Light Sensitivity Questions

[65:32]

• For those with sensory issues/migraines: Limit sunglass use; use only when truly necessary for comfort and safety, but try to increase light exposure for circadian health.
  • Quote: “...don’t use it all the time. It’s meant to be able to synchronize your system with daylight.” (Dr. Kuey, 66:52)
• Research ongoing into the mechanism of light oversensitivity in ADHD.

Night Lights for Children

[67:01]

• Best to avoid, as any light at night reduces melatonin production.

Middle-of-the-Night Wakings (2–3 a.m.) and Racing Thoughts

[67:52]

• Address underlying anxiety or depression; use techniques like mindfulness, breathing, CBT for insomnia. If ineffective, seek professional CBTi.

Teenagers: Unique Challenges

[70:05]

• All adolescents have later sleep phases (biological), but in ADHD it tends to be persistent for life.
• Weekend sleep-ins help recover lost sleep but worsen “Monday morning jet lag.”
  • Quote: “If they haven’t slept during the week, they have to…otherwise they will be intoxicated with sleep loss, which is really toxic. But they will also be jet lagged the next Monday.” (Dr. Kuey, 71:04)

Notable Quotes

• On Chronotype:
  • “Timing is everything…your sleep rhythm is genetically driven. You’ll be an early bird or night owl or somebody in between.” (Dr. Kuey, 09:40)
• On Sunglasses and Light:
  • “If you wear sunglasses during the day, your brain thinks it’s nighttime.” (Dr. Kuey, 30:35)
• On Treatment Sequence:
  • “Treat the sleep disorder first…then you have control of sleep even when you use stimulant medication.” (Dr. Kuey, 64:33)
• On Adolescents and Sleep:
  • “Adolescents are a special breed. All adolescents are later sleepers than adults or children…biologists tend to say it’s for a good reason.” (Dr. Kuey, 70:16)

Practical Tips & Takeaways

[43:31–56:16]

• Maximize morning light, minimize evening/night light (especially screens)
• Keep a stable wake time seven days a week
• Use low-dose melatonin for delayed sleep phase (not high retail doses)
• Cognitive-behavioral therapy for insomnia and comorbid anxiety/depression is critical in many cases
• Address iron deficiency for restless legs
• Prioritize treatment of sleep rhythm before adding ADHD medications

Resources & Further Reading

• ADHD Powerbank (adhdpowerbank.com): Short videos on ADHD and comorbidities.
• DIVACenter.eu: Diagnostic interviews in multiple languages.
• Head Heart Hormones Network: For women with ADHD & hormonal mood changes.
• Society of Light Therapy & Biological Research (for treatment tips).
• National Sleep Foundation (for general sleep health info).

Final Thoughts

Dr. Kuey emphasizes that better sleep must be a central part of comprehensive ADHD management. The interplay is deep, and treating sleep disorders can yield improvements even for challenging ADHD symptoms. Light, routine, and tailored medical interventions make a measurable difference to daily life, executive function, mood, and long-term health in ADHD.

[End of episode summary]