Why people with ADHD can’t sleep (and what actually helps)

If you have ADHD, you’re probably exhausted — and there’s a real neurological reason for it. Sleep expert Marlee Boyle, co-founder of Sleep Works, joins us to explain why ADHD brains are wired against a good night’s rest. Plus how perimenopause can make it worse. She walks us through CBT-I techniques, the truth about melatonin, and some surprisingly low-tech tools that can fix your circadian rhythm. If you have trouble falling asleep or staying asleep, this one is for you.

• Watch: ADHD and sleep: 5 strategies to finally beat insomnia

• Listen: PMDD: Why women with ADHD are 4x more likely to struggle

Rae Jacobson: I can't tell you how happy I am to have you here because Marlee, I am so tired.

Marlee Boyle: So you're certainly not alone, Rae. This is a problem. I think the research shows that it's about 80 percent of people with ADHD will struggle with their sleep, which is a huge percentage. But then I still don't know where this 20 percent is that's sleeping great.

Rae: I'd love to meet them.

Marlee: Me too. They must be so well rested.

Rae: Hello. Do you have ADHD? And if you do, are you really tired right now? Me too. This is because I, like apparently you and like many of us with ADHD, am what one would call really bad at sleeping. I've always struggled with sleep on any schedule that would be considered even remotely normal. And as I creep into my 40s and perimenopause sneaks in, things have gotten worse.

And it just seems like, I don't know, unfair. Like, can I just please sleep? Could I sleep, please? Research shows us that people with ADHD are way more likely to have a whole host of sleep issues. And in that kind of horrible Ouroboros, snake-eating-its-tail kind of way, disrupted sleep also makes ADHD symptoms worse. I feel like I have tried everything that I can to fix my sleep and yet here I am, tired again.

So, today I'm bringing in Marlee Boyle. She is the co-founder of Sleepworks, a clinic that helps people like me get better sleep. Marlee has a special focus on ADHD and today she's here to help us all get some rest. I have a very hard time staying asleep. I get in bed, I can fall asleep, but I can't stay there. And I was kind of hoping we could do like a little bit of a pretend I'm your patient thing.

Marlee: Sure, I'd love that.

Rae: Is that okay? So I'm curious, how would someone like you help someone like me?

Marlee: Great question, Rae. I love this. So first I would ask you, have you always been waking up throughout the night?

Rae: Oh, yeah, always, forever.

Marlee: Always. Do you remember being a night owl as a little kid?

Rae: Very well. Yes.

Marlee: A lot of us have the story of our parents having a really hard time getting us to go to bed and then trying to basically dress us for school because we have one eye open.

Rae: Yes. My mother has ADHD. I think my grandmother also did. And I would get up in the middle of the night and she liked watching Spanish soap operas. So I have these vivid, happy memories of sitting up at midnight watching "Corazon Salvaje" with my grandmother and her being like, "I think that's his brother's father's sister. Maybe they're dead. I don't know."

Marlee: Well, at least it's a positive memory. That's wonderful. So what I would suggest for you, Rae, is because you are naturally a night owl, what time would you say that you're waking up in the morning generally?

Rae: I have an 8-year-old, so I'm on a school schedule, so like 6:30.

Marlee: Okay, so that's really early for a night owl. Your biology wants you to be asleep later and sleep later. So we do get a bit of a synergistic improvement in our sleep quality when we line up our circadian rhythm with our sleep time.

Rae: Okay, let's pause here for a little sci-fi explanation. Your circadian rhythm is basically like your internal clock. It runs on a 24-hour cycle and it's regulated by light. Bluish daylight tells your brain, "Hey, it's time to be awake," and the orangey glow of sunset tells us to start releasing hormones like melatonin, which prepares us for sleep.

Marlee: As neurodivergent people, we are also usually sensitive to light. I always say part of the ADHD assessment should be like, "Do you ever turn on overhead lights?" And if you don't, it should be part of the diagnosis because all of us hate it.

Rae: No! Yes! That is so true. I'm a lamp girl for sure.

Marlee: We are lamp people, 100 percent. And we lamp people also tend to have issues with our circadian rhythms. For about 75 percent of people with ADHD, they actually have a delay in their circadian rhythms by roughly 90 minutes compared to a neurotypical person.

(06:05) How biological delays in circadian rhythms clash with societal schedules.

Marlee: So that means an hour and a half later to be able to fall asleep and an hour and a half later to be able to wake up. And not that a delayed circadian rhythm means you have difficulty with sleep, but it makes us night owls, and typically we're living in a society that operates for morning larks.

Rae: I feel like this is one of these many things where it's just that the ADHD brain does not work within the confines of what is expected in society. Like, you have to have a 9-to-5 job because you have to make money and survive, but your brain is not built for that, so you are just tired all the time?

Marlee: We're just tired all the time. We're perpetually sleep-deprived and working at inoptimal times for our performance and our functioning.

Rae: The world works on a timetable that is anathema to how ADHD brains operate, and unsurprisingly, that has real-world consequences. We're tired, so we slept in, and now we're late and we're rushing. And when we're rushing, we forgot that really important thing, and we don't have our homework, and we don't have that work thing, and we didn't pack our kid's lunch, and we are screwed.

And there's shame in it, too, like a feeling like you're not able to function like you should be — sort of embarrassment and even self-blame. Add to this that a sleep deficit has a big impact on cognitive function, emotional regulation, and even physical health, and you are looking at a recipe for disaster. This is why I need to figure out how to sleep through the night, which Marlee explained is also a circadian rhythm issue.

Marlee: The first part of your sleep when you fall asleep, your body might think that you're having a nap, and then the period of time that you're awake throughout the night, your body might think it's daytime. And then you're falling back to sleep probably right before your alarm clock goes off in the morning before you have to wake up at 6:30 to get your kid ready for school.

Rae: Luckily, there are things we can do to entrain our circadian rhythm, which is like a fancy way to say line up your circadian rhythm with your actual schedule so you don't wake up at 2 a.m. every day.

Marlee: So, a very practical way for people with ADHD to entrain their circadian rhythm is — and this is my favorite sleep tool — is to get a pair of amber-lensed glasses. Just cheap, amber, orange-lens glasses. They change everything to kind of like an orangey glow. There's nothing special about them.

Rae: And they look cool.

Marlee: And they look cool. I think we're going to start like a new fashion trend of people in amber glasses.

Rae: Just for our audio listeners, I'm going to describe: Marlee has put on a pair of kind of hip Wayfarer-style glasses that have orange lenses and now I feel like we're at the beach.

Marlee: They are very cool. A lot of times when people with ADHD put these on for the first time, they're like, "Oh my gosh, it just feels like my eyeballs just took a break," or, "They just took a drink of water. It feels so good." And it's because a lot of our artificial light that we have in our homes is energy-efficient, short wavelengths of light. It's harsh lighting and it's like irritating our brains a little bit.

So when we put on these amber glasses, it's very soothing. But if we put them on two to three hours before our goal bedtime, they're going to help our brain advance our circadian rhythms, so we're falling asleep earlier. So your brain starts to go, "We just watched the sun go down. Start the down-regulation process." And then when we're ready to go to sleep, we need our bedrooms to be completely dark.

And there's a really simple test you can do at home to see if your bedroom is dark enough for sleep. You just hold your hand out at arm's length. If you can see your hand at that distance with your lights off in your room, there's too much light for your brain to continuously secrete melatonin while you're sleeping. And so a very inexpensive easy tool is just an eye mask.

And I really like these — I'm holding up a contoured eye mask. They're a couple of bucks, inexpensive. Contoured so they don't rub our eyelashes. A lot of people don't like sleeping masks or eye masks because it's irritating.

Rae: I'm in that camp, yeah.

Marlee: Yeah, like any sensory issues, which I do as well. The contoured ones are minimal contact because they just sit on the outside of your orbital, so it doesn't really feel like you have something over your eyes.

(12:12) Cognitive behavioral therapy and addressing maladaptive sleep beliefs.

Rae: Got it. So can I ask you, there are these kind of external tools like the eye mask, like the glasses. I have to admit, maybe it's vanity and maybe it's just practicality, it is unlikely that I'm going to wear sunglasses for three hours before bed every night in my apartment and when I'm out at dinner with friends. But is there anything I can be doing sort of more internally that can help me kind of learn to regulate my sleep a little bit better?

Marlee: Yeah, absolutely. So cognitive behavioral therapy for insomnia is considered the gold standard preferred first-line treatment for chronic insomnia. And it works really well for people with ADHD as well. And so one of the pieces that you can do that's kind of internal or behavioral work is undoing some of those maladaptive beliefs we have about our sleep.

Rae: So the idea that you're a bad sleeper perpetuates the actuality of you being a bad sleeper?

Marlee: You got it. I know I've had clients who are like, "I can't even walk by my bedroom door in the evening because I look at my room as the torture chamber as soon as the sun goes down," because they're anticipating such a struggle every night. And so the first step to address some of these things is addressing those thoughts. They're not helpful and they're not even that accurate.

There's no guarantee that if we have a bad night's sleep, we're going to have a terrible next day. Most of us with sleep problems have had poor night's sleep and our next day was perfectly fine. We got through those days just fine. So even just being more realistic about those things like, "I might have a great day. There's a possibility I could have a good day." And that's cognitive restructuring.

Rae: This is one of the reasons Marlee is not a fan of smartwatches or other wearables for sleep.

Marlee: We'll have people book appointments and they'll be like, "My Apple Watch says I'm getting zero percent REM." And we're like, "But you're getting REM because you're here." So the wearables across the board as of today, there are not any wearables that have any accuracy or any reliable accuracy for sleep stages.

There actually during the pandemic when everyone started tracking their sleep, there was a term coined in that time; it's called orthosomnia. And essentially it is the effect of people looking at their sleep data and it dictating how they've slept when it doesn't correspond with their sleep at all. So people will look at their sleep data in the morning, it says they slept poorly, then they go through their whole day being like, "Oh, I slept so poorly last night."

Rae: It's almost like the opposite of the CBT-I practice.

Marlee: It's the opposite. It's the cognitive restructuring the other way. It's almost validating "I'm a bad sleeper."

(18:14) The 20/20 rule and practical strategies for dealing with middle-of-the-night wakefulness.

Rae: So I have a question about that then. If I wake up in the middle of the night, I'm always in this position where I'm like: Should I just get up and give up and wait to get tired again — which traditionally has not worked that well for me — or should I kind of white-knuckle it and turn in circles for 20 minutes until I eventually fall back to sleep somehow?

Marlee: Great question. I feel like this is something that a lot of people struggle with. And I'd actually recommend to get out of bed when you can't sleep. But with some guidelines around that, especially for people with ADHD. I call it the 20/20 rule. If you're in bed for longer than 20 minutes awake, you've got to get out of bed for at least 20 minutes to reset.

Rae: Yeah, I admit I'm not sure how I'd know how long I'd been there. It always feels like an eternity.

Marlee: It feels like a long time. Well, our perception of time is influenced too by how miserable it is lying there. So if you feel like, "Oh, it's been a long time," it's already time to get out. Don't wait it out, which is what I always thought you should do. You don't want to wait it out, you want to get out of bed, go to a dimly lit room — you don't want to turn on any lights that you don't need to.

If you have a pair of amber glasses, you can put those on to help navigate with some low lighting. And you want to have a plan to do something that's boring, not over-stimulating. That is engaging enough that you're not going to doze off, but not so engaging that you're going to have trouble task-switching back to bed.

So, for example, some things I like to do: I hate laundry. I think there's way too many steps to laundry. I don't understand why this hasn't been a streamlined process. It's too many steps. So what I would do is my plan would be if I have to get up in the middle of the night, I would have a basket of unfolded laundry and I would just stand there and fold laundry for 20 minutes.

And then I would do some cognitive restructuring in that moment, telling myself, "Even if I can't get back to sleep, at least this annoying task is done tomorrow." And that was super helpful because it took the pressure off of falling back to sleep, but it also was boring enough and I think my body also was like, "Enough with this waking up throughout the night. You do not want to be doing laundry. You hate it."

Rae: Personally, I find folding laundry very Zen. That said, it never occurred to me to get out of bed instead of flipping like an angry pancake for an hour. And the idea that Marlee had new advice to offer was a huge relief because like I said, I've never been good at sleeping, but these days, things are on a whole new level.

This is likely because I'm in my 40s and there's a lot of evidence that perimenopause can have a big effect on sleep, especially for women with ADHD. It sucks. So I asked Marlee, my dreamy Canadian sleep oracle, why this happens to so many of us and whether there's anything specifically I can do about it.

Marlee: So perimenopause affects our sleep because of the changes in our hormone levels, particularly our estrogen and progesterone.

Rae: Is that also why I can't sleep before my period?

Marlee: Yes. So in the luteal phase, yes, like the week before your period. Oh my god, the worst. A lot of people struggle so much. It certainly does impact us hormonally and that does make an impact to our sleep. But the reason it affects people with ADHD so profoundly is because sleep deprivation in general exacerbates symptoms of ADHD. So it becomes debilitating for a lot of women.

Rae: So that's really interesting to me because I think I was understanding this backwards. I was thinking that perimenopause is sort of worse for people with ADHD in some way that I had yet to understand — not what you're saying, which is perimenopause has such a profound effect on sleep that it really exacerbates things for people with ADHD. That makes a lot of sense.

Marlee says those CBT-I techniques for reframing how we think about sleep can be really helpful for perimenopause and menopause as well. A lot of the symptoms that keep us up at night, like hot flashes and night sweats, those don't tend to happen during deep sleep or REM sleep. So how we think about them is really important.

Marlee: So one of the things that can kind of lighten that worry for people as they're going through these disruptions of their sleep throughout the night in perimenopause is remembering, "Okay, I wasn't in my deep sleep, I was already awake," and not to worry. Because when we get ourselves into — start to worry like, "Oh no, tomorrow's going to be awful, I'm awake again, what if I can't get back to sleep?" — those things will actually keep us awake.

So being able to be like, "Okay, I probably was already awake before this happened. Give myself a few minutes, I'll get back to sleep." That's way less disruptive and it just puts you on a better trajectory to not develop chronic insomnia.

Rae: So a lot of this is really about managing how you think about your sleep and managing the anxiety piece. Not so much the actual sleep of it all as the things that get in the way of the sleep.

Marlee: You got it.

Rae: I do wonder, because all of this is very rational. I also know as a person with ADHD who's gotten a lot of really rational great advice in my life, but I don't always follow it that well. And when that happens, I do have a habit of turning to things that I think are maybe in my mind like a quick fix. "Maybe I could just take this pill and I'll be better." So Marlee, why is melatonin not the wonder drug that I want it to be?

Marlee: I know, wouldn't that be great if it was? If we could just get this over-the-counter natural supplement?

Rae: Eat this candy and now I'm a great sleeper? Why?

Marlee: Oh, it would be so wonderful! But it's not. And the thing about melatonin, which I always like to tell people, is melatonin in the sleep medicine world is almost never used as a sleeping aid. It is used, it's a chronobiotic.

Rae: Really? What?

(24:32) The limitations of melatonin and the risks of long-term reliance on sedating sleep aids.

Marlee: So melatonin's profile has a very limited amount of efficacy to make us sleepy. So very minimal sedation. What melatonin actually is, is it resets our circadian rhythm. It changes our clock.

Rae: But if people with ADHD have a delayed circadian rhythm and melatonin can change your circadian rhythm, is it not then helpful to take it?

Marlee: Yeah, it can be helpful taken to take melatonin for a short period of time to help advance your circadian rhythm. So that's where it can be very helpful for people with ADHD. Now the thing is we want to take it about 10 to 12 hours before we want to be awake to set our clock. So if you want to be awake at 7 a.m., you're taking it roughly 7 p.m., but you're not going to bed at 7 p.m.

So a lot of people are taking melatonin at bedtime and then it's actually causing more of that — it's solidifying their delay in the circadian rhythms. So I don't generally recommend supplementary melatonin because I can't guarantee the quality of it. I think that if you can get pharmaceutical-grade melatonin in small dosage, it can be really helpful.

However, I do believe that we can produce the perfect amount of melatonin ourselves if we just give ourselves more exposure to complete darkness as well.

Rae: Okay. Now I want to turn maybe to some of the things that are a little less safe. When I would be having sleep disturbance, I would turn to Benadryl or Unisom or diphenhydramine — like a thing that I knew would knock me out. And it did. It was great. Except I started noticing that I would wake up in a really bad mood.

Marlee: So taking anything like that, whether it's the Unisom or Benadryl or Gravol or any of those sedating antihistamines long-term is not advised. But taking any — so any of the sleeping aids that are even prescribed are not intended for long-term use. That is the problem.

For short-term use, so if it's just the luteal phase, if it's a situation maybe you're going through a stressful period of your life and it's going to be a short-term 7-to-10-day period, that is how sleeping aids are actually being intended to be used.

Rae: Yeah, but that's not how people take them.

Marlee: That's not how people are using them, 100 percent. So the problem and even why you would have experienced with Unisom or Gravol why you'd wake up in a bad mood — and this is true across the board with any of these medications or over-the-counter drugs — is it's sedation, not sleep, which are different processes.

Rae: Got it.

Marlee: Yes. And so sedation does provide that subjective experience that we are asleep. So it eliminates that terrible symptom of us lying in our beds tossing and turning and being mad that we're awake, which is excruciating and that can be really helpful to eliminate that for a night or two. But it doesn't provide natural sleep where our brains go through certain stages.

And the biggest stage that would affect our mood and executive functions is our REM sleep, our rapid eye movement sleep, the stage of sleep that we do the bulk of our dreaming. Most sleeping aids disrupt that stage of sleep and make us spend more time in the lighter stages.

Rae: And is that why you wake up grouchy?

Marlee: You wake up grouchy or the hungover feeling of feeling sedated. And it's because you didn't sleep. You were sedated.

Rae: So Marlee, is what you're telling me there is no shortcut? Is that really what we're saying here is that both — you are validating the fact that people with ADHD do have a harder time sleeping and that changes in hormones like before your period or perimenopause or menopause also make that harder, but there is no cheat code and we simply have to be thorough and thoughtful and use sensible — sounds like cheap and not highly technological tools to help us manage this in a way that is sustainable?

Marlee: Absolutely. And I know that's so disappointing! Like, give me the magic pill! But I will give you some good news about all of this. With the circadian rhythms specifically, if we — most people, it doesn't take long to regulate your circadian rhythm.

Some people notice an improvement the very first time that they do a 24-hour of amber glasses on at night, then the blackout eye mask. Even if you can't put these on three hours before bed, 20 minutes is better than zero minutes. And then in the morning using something like a bright light therapy lamp — often used for seasonal affective disorder — to get artificial sunlight.

With sleep even little bits make big changes. I always tell people too: If we can get 15 minutes more of sleep every night, that's over 91 hours of extra sleep in a year. That's a lot of extra recovery time for our executive functions.

Rae: So we don't — I mean, finally some good news, thank you. We don't have to be perfect. These don't have to be perfectly followed. You can fluctuate and still get back on track even if you've gotten off track. That is music to my ADHD ears.

I'll be the first to say that advice from doctors, especially when it comes to ADHD, is easier said than done. But it's good to know that when it comes to sleep, small changes can actually make a really big difference. And Marlee isn't just an expert, she's got firsthand experience. One of us! One of us! She has ADHD and she went through most of her life as a bad sleeper.

Marlee: It was suggested that I go for an assessment for ADHD. I went for an assessment and of course was diagnosed with ADHD, and it was a surprise to me, but it was a surprise to no one else in my life. Even I've recently run into my middle school teacher and she was like, "I thought you had an ADHD diagnosis." She's like, "I've known since you were in grade seven. What are you talking about?"

But what I loved was working with sleep deprivation and working with people that are sleep-deprived. There was such a huge overlap that existed between how people are functioning because even neurotypical people if they're sleep-deprived, their executive functions tank. And all of a sudden it's like very hard to make a plan and execute a plan, which makes it harder to get back on track.

And then started working with people with ADHD and just recognizing, "Oh my gosh, this is a huge problem for a lot of us," and just realizing that a lot of the behavioral sleep medicine strategies are not adapted for people that are neurodivergent. So taking out a lot of the steps makes things more digestible and sets us up for better success because behavioral change is hard for everybody, but then it's so much harder when we have ADHD and sleep deprivation.

That's kind of how I got started and it's just been the best experience and I think I found my people. And it's truly the most rewarding career I could possibly ask for. Helping people sleep is — no pun intended — but it is a dream.

Rae: Thank you so much to Marlee Boyle, who is herself a dream, and to all our sleepy ADHD listeners. We really hope that this helps. Link to Marlee's sleep clinic in the show notes. See you in two weeks.

"Hyperfocus" is made by me, Rae Jacobson, and Cody Nelson. Calvin Knie is our video producer and video is edited by Alyssa Shea. Our research correspondent is Dr. KJ Wynne. Briana Berry is our production director and Neil Drumming is our editorial director.

If you have any questions for us or ideas for future episodes, write me an email or send a voice memo to hyperfocus@understood.org. This show is brought to you by Understood.org. Our executive directors are Laura Key, Scott Cocchiere, and Jordan Davidson.

Understood is a nonprofit dedicated to empowering people with learning and thinking differences like ADHD and dyslexia. If you want to help us continue this work, you can donate at understood.org/give.