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Episode of the ADHD Experts Podcast from Attitude Today. We are pleased to bring you a feature article from the Fall 2025 issue of Attitude magazine. To listen to the full issue and receive future issues, subscribe now@attitudemag.com subscribe and now for today's story, the Disorder that Never Sleeps by JJ Sandra Kuweech, MD, PhD with ADHD, we think of challenges that appear from dawn to distractibility, impulsivity, emotional dysregulation. A growing body of research, however, has discovered that some of ADHD's most impairing challenges emerge at and after bedtime. Though these challenges relate to sleep, their consequences reverberate around the clock. Whether an early bird, night owl, or something in between, each of us has an internal clock that determines our sleep rhythm. This clock, located in the midbrain, is heritable and it starts ticking in childhood. Because it directs the rhythm of all bodily organs, it has far reaching influence. Most people with ADHD, up to 80%, are night owls with a significantly later sleep rhythm than non ADHD individuals. My colleagues and I quantified this discrepancy through a sleep study in which we measured the timing of melatonin production in the saliva of people with and without adhd. When this naturally occurring hormone is secreted by the brain, it primes the body for sleep about two hours later, three hours later for people with ADHD, our findings reveal that melatonin was released at 9:30pm with an estimated 11:30pm sleep onset for non ADHD people and at 11:00pm with an estimated 2:00am sleep onset for people with ADHD. In a world in which school and work obligations begin first thing in the morning, a late bedtime can lead to significant problems. The optimal sleep duration for adults is seven to eight hours. Because people with ADHD tend to go to sleep late but must still wake early, they sleep just five to six hours on average. This means that day after day, year after year, people with ADHD are chronically sleep deprived. The consequences of short sleep duration include fatigue, decreased focus, suboptimal cognitive functioning, impaired memory, irritability, and binge eating. If these Sound familiar? It's because many are also associated with adhd. So not only does ADHD cause sleep problems, but sleep problems aggravate ADHD symptoms. The ripple effects of delayed sleep Your sleep rhythm sets the schedule for a host of bodily processes. For example, if you sleep from 11pm to 7am, your body enters its deepest phase of sleep at 4:30am when your temperature reaches its lowest point. At 6:15am, your blood pressure rises in preparation for waking. At 7am, when your eyes open and receive sunlight, melatonin secretion stops. Activation of the digestive system begins around 8am the timing of these processes is determined by your bedtime, so when it's pushed back to 2am or 3am, your other rhythms are knocked out of sync. For example, many people with ADHD and delayed sleep phase disorder, falling asleep and waking up several hours later than normal, experience appetite later in the morning. They tend to skip breakfast and then make poor nutrition choices later in the day, leading to weight gain. The solution to a late sleep rhythm is shift your bedtime earlier. When your biological clock works against you, as it does for so many with adhd, you'll need to take deliberate steps and maintain resolve. Here's what research has taught us. 1. Make use of melatonin Many people with delayed sleep phase disorder use melatonin to effectively establish an earlier bedtime. My research team found that for individuals with ADHD, nightly use of 0.5 milligrams of melatonin resulted in dim light melatonin onset when melatonin levels begin to rise in the body 90 minutes earlier than otherwise expected. When combined with sleep hygiene, this leads to an earlier bedtime. A low dose of melatonin 0.5 or 1 mg taken around 10pm is sufficient. Higher doses are not more effective and may cause you to feel sleepy the next day. Melatonin works for about three to four hours so it helps you fall asleep but not stay asleep. For difficulties with night waking, you might try long acting melatonin. Number two Let there be light. To fully adjust your sleep wake rhythms, use morning light therapy to help you wake up at an earlier hour. Choose a wake up time between 7am and 9am, ideally after seven to eight hours of sleep and sit in front of a light box or wear light therapy glasses for 30 minutes upon waking. Repeat for 5 to 21 days, especially in winter. The light box should have an intensity of 10,000 lux and your face should be about 20cm from the box. Number three nix the nap. Exhausted individuals end up napping during the day but long naps Push back bedtime. If you do take a nap, set an alarm so it doesn't exceed 30 minutes. Number four stop sleeping in many night owls make up for short sleep duration during the week by sleeping in on weekends. However, abundant research shows that late wake times on weekends followed by early wake times during the week exacerbate sleep problems and leave you more tired. With the help of melatonin and light therapy, try to maintain a consistent wake time even on weekends. Shape up for sleep do the following to establish healthier sleep wake patterns Soak in sunlight do get outside Walk the dog Take a lunchtime stroll. Don't keep curtains drawn Dim your wine down. Do lower the lights at 9:30pm don't use devices at bedtime they emit blue light Tip your temperature. DO Take a warm shower at bedtime. Don't get cold feet Wear socks. Go dark. Do use close fitting eye masks. Don't use night lights. JJ Sandra Kuich, MD, PhD, is a psychiatrist at SCIQ and head of the Expertise Center Adult ADHD in the Netherlands.