When most people think about someone who has an ADHD diagnosis they envision a child unable to sit still in school. Typical indicators of ADHD include struggling to pay attention, hyperactivity, and impulsivity. But often people—both children and adults—who have ADHD experience fatigue.
“People with ADHD often struggle with maintaining good habits of sleep, diet, and exercise so they are often running on less than a full tank,” says Ari Tuckman, Psy.D., a psychologist in West Chester, Pennsylvania, and author of Understand Your Brain, Get More Done: The ADHD Executive Functions Workbook.
What causes someone who has ADHD to feel tired?
There are many reasons why someone with ADHD may feel tired.
Trouble sleeping
It is common for people with ADHD to have difficulty sleeping. Research finds a high prevalence (25% to 50%) of sleep disturbances across all age groups with the condition—including restless leg syndrome, sleep apnea, insomnia, and narcolepsy. Sleep problems often begin in childhood, or at puberty, and increase with age, from difficulty falling asleep, to higher incidence of nightmares. These sleep difficulties may be because of impaired circadian rhythms and delayed onset of melatonin production. Or, people with ADHD may experience trouble falling asleep because they have trouble shutting down their hyperactive brain. Alternately, some have the opposite experience of falling into such a deep sleep that they have trouble waking up. Either of these sleep issues can lead to daytime sleepiness, and other problems, like difficulty concentrating.
Anxiety
Coexisting disorders (comorbidities) can worsen sleep issues. According to the CDC, 33% of children who have ADHD also have anxiety. That number is as high as 50% for adults with ADHD, according to the Anxiety and Depression Association of America. If a person has anxiety, it may be difficult for them to fall asleep due to their worried thoughts. Also if you are worried all the time you may feel tired from excessive cortisol (the “stress hormone”) that you produce when you are anxious.
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Stress
The stress of having ADHD can be tiring. People with ADHD use a lot of energy to focus and pay attention. If they have trouble with executive functioning skills like forgetting or remembering dates or deadlines this can lead to issues with work, school and relationships which is stressful. “ADHD can be a death by a thousand cuts—the extra work and inefficiencies of poorly managed ADHD drain away the person’s energy,” Tuckman says.
Improper Rx dosage
Many people who have ADHD take stimulant medication such as Adderall or Ritalin. Sometimes these medications may make it difficult to fall asleep when the dosage is incorrect or if the dose is taken too close to bedtime.
Types of ADHD fatigue
Lack of sleep and emotional burden can lead to exhaustion in several ways, specifically chronic fatigue, burnout, and brain fog.
Chronic fatigue and ADHD
It is possible that there is a link between chronic fatigue syndrome and ADHD although this is still being researched. “Individuals with ADHD struggle with attention, behavior and mood regulation,” says Sam Goldstein, Ph.D., neuropsychologist and clinical director at Neurology Learning and Behavior Center. “If they develop a syndrome such as fibromyalgia then they are more likely to experience more severe symptoms.”
One study found that by treating patients diagnosed with chronic fatigue syndrome who met the criteria for ADHD with psychostimulant medication that their symptoms of fatigue improved. When medication is given in the right dosage, it can help calm the mind and allow for better, more restorative sleep.
ADHD burnout
According to the American Psychological Association, burnout is a state of total emotional and physical exhaustion. So how is that different for someone who has ADHD?
“Over time, they will feel like they are running on empty, which causes them to be even less efficient, so it can go from bad to worse,” Tuckman says. “They may use coping methods to feel better but then feel even worse like eating junk food or staying up late rather than getting a good night of sleep.”
People with ADHD sometimes need to work twice as hard as someone without a diagnosis to pay attention or stay on task. They may also have to prove themselves to others who they may have disappointed in the past due to being late or forgetting an event. This constant state of stress and overworking will eventually lead to ADHD burnout.
Brain fog
Brain fog is when thinking feels sluggish, fuzzy, and not sharp. Brain fog can occur in everyone when they are jet-lagged, sick or after taking certain medications.
A disorder called concentration deficit disorder (CDD), which was previously referred to as sluggish cognitive tempo (SCT) is when people daydream, seem to be in a fog or are easily fatigued. This can be confused with inattentive ADHD. A research study found that both disorders are impairing, but ADHD is more severe.
How to cope with ADHD fatigue
The best ways to fight ADHD fatigue involve treating the symptoms of the condition that lead to exhaustion.
1. Medication
One of the most effective ways to treat ADHD symptoms is with either stimulant or non-stimulant medications. By treating the symptoms related to ADHD, you will most likely feel less tired and may be able to sleep better at night.
2. Therapy
Counseling for ADHD is helpful. Therapy helps people with ADHD (and their families) to manage better with their symptoms. Cognitive behavioral therapy offers solutions by suggesting different ways of thinking or behaving.
3. Accommodations or 504 Plan
The Individuals with Disabilities Education Act (IDEA) and Section 504 of the Rehabilitation Act of 1973 are two laws that govern special services or accommodations for people who have ADHD. These accommodations may allow children with ADHD to have more time on a test or a distraction-free setting.
Accommodations may also be granted for adults in workplace settings, including flexible working hours, a quiet area to work, or adjusted training materials. The goal is for those with ADHD to experience more success, at work or school. These accommodations may create less stress and help them to feel less tired.
4. Sleep routine
Create a sleep routine. A regular sleep schedule helps you to fall asleep easier since it signals your brain to go into sleep mode. Some ways to create a sleep routine are to:
- Set a regular bedtime and wake up time.
- Create a pre-bedtime ritual such as reading a paper book (no blue light).
- Turn off all devices an hour before your bedtime.
5. Meditation
Research studies show meditation can improve sleep quality. Meditation helps decrease anxiety and racing thoughts that everyone, including people with ADHD, may experience. This can lead to an easier time falling asleep or staying asleep.
“There are many good resources on ADHD, including the CHADD website and local chapters,” says Tuckman. “If you feel yourself dragging too much, then create a stronger foundation by working on your sleep, diet, and exercise.”
