Neurodivergence and Sleep

By Amanda Richardson, DNP, PMHNP-BC

Neurodivergent people have more issues with sleep than their neurotypical counterparts, with many sleep issues starting in childhood and worsening with age. This makes sense when you remember that sleep is controlled by the brain and neurodivergent brains handle just about everything differently than a neurotypical brain.  Therefore, most of their challenges related to sleeping aren’t behavioral in origin but instead stem from neurological differences. There are many reasons your child maybe struggling to sleep. It could be biological, a sleep disorder, sensory issues, difficulty with transitions, other mental health issues, or a combination of any of these. Unfortunately, disruptions to sleep can lead to behavioral changes and impaired cognitive function.

Neurodivergent people can have genetic differences that affect how the body produces, releases, and regulates melatonin - the hormone responsible for controlling the sleep-wake cycle, also known as the circadian rhythm. People with autism tend to have about 10% less REM sleep  sleep (the phase that is responsible for dreaming) compared to neurotypical individuals which means they may need more sleep to receive the full benefits of REM sleep, or may follow an unusual sleep pattern. Because REM sleep plays an important role in learning, memory, emotional regulation, and physical rejuvination, interrupted or reduced REM sleep may contribute to feeling less rested and may increase the overall amount of sleep needed.. Some neurodivergent people struggle to read their body’s internal cues which can cause them to miss the signals that it is time to sleep.

People with ADHD often experience a different set of challenges. The brain chemicals that promote alertness have been found to stay active or increase in activity late at night, which creates a sudden “second wind” or increased ability to focus and concentrate late at night. There is also the theory that ADHD brains don’t have an accurate circadian clock which can make it harder for the body to know when to sleep.

It has been well documented that neurodivergent people have higher rates of sleep disorders. The most common ones are circadian rhythm sleep disorders, insomnia, narcolepsy, obstructive sleep apnea, sleep-disordered breathing, and restless leg syndrome.

The most common circadian rhythm sleep disorder is delayed sleep phase syndrome (DSPS). DSPS is when someone routinely falls asleep and awakens more than 2 hours later than what is considered normal.

Insomnia is when someone struggles to fall asleep, stay asleep (waking up during the night but falling back asleep), or wakes early with the inability to fall back asleep.  

Narcolepsy is when there is a sustained problem with wakefulness and sleep. It is a disorder that causes extreme daytime sleepiness, sudden sleep attacks, and a sudden loss of muscle control because the brain is unable to control sleep and wake cycles.

Obstructive sleep apnea (OSA) and snoring is when the upper airway is partially or totally obstructed. Sleep-disordered breathing is when there is an unpredictable breathing rhythm during sleep. Both lead issues hypoxia (lack of oxygen to the brain), inflammation in the brain, and/or recurrent arousal-based sleep disturbances (waking to break the breathing issues to get oxygen to the brain).

Restless leg syndrome is when the body has an intense need to move the legs and is frequently very uncomfortable or painful if ignored. This results in movements that disrupt falling asleep or walking around trying to get stiffness in the legs out.  

Many neurodivergent people also struggle with sensory issues. These sensory issues don’t go away just because it is time to go to sleep. Instead, they keep the body agitated and prevent relaxation and sleep. Light, noise, temperature, fabric of the sheets, and other environmental distractions can all interfere with sleep.

Neurodivergent people also struggle with transitions. They often get stuck in actives that delay bedtime because they struggle to disengage with the activity and go to bed. The time blindness that most also struggle with only adds to this as most only have ‘now’ and ‘not now’ for their sense of time. Other mental health disorders, such as depression or anxiety, also negatively impact sleep. They can cause difficulties falling asleep, sleep not being restful, or increased daytime tiredness.

As most of us know, when someone doesn’t sleep well, the next day will be harder. This is because a lack of sleep leads to several short-term (next day or next few days) issues. The main one we see is the inability to regulate their emotions, being more emotional in general, and an increase in impulsivity. These usually lead to more outward behavioral issues such as crying, increase in anger, meltdowns, and doing things without thinking them through. A lack of sleep makes it harder to think, take in information, process the information, keep your attention focused on what you need to, and then impacts schoolwork as it is harder to build on information that wasn’t learned or understood when they were tired. A lack of sleep can also increase pain or somatic symptoms (physical pain caused by mood or mental disorders). The most common symptoms that we see in children are stomach aches, headaches, and generalized muscle pain.

In summary, we know that there is a lot of overlap between neurodivergence and sleep issues. What we don’t fully understand is why - because we don’t fully understand why we need to sleep and fully what sleep does for us. However, we do know that not getting enough sleep leads to an increase in unwanted behaviors. It also leads to more problems getting sleep, the less sleep we get or if we nap. This leads to bad habits and patterns that are difficult to break. The important thing to remember is that your child is not doing this on purpose. They also don’t understand why they are struggling to sleep and usually don’t know how to put their struggle into words. Especially if their bodies or minds struggle to feel sleepy, it is hard to get them to understand that they are tired. The best thing we can do as parents is to try to understand where the issue with sleep is coming from.

References

Neurodivergent Insights. (n.d.). Autism, ADHD, and sleep. https://neurodivergentinsights.com/autism-adhd-and-sleep/ 

Gregory, A. M., et al. (2023). Sleep problems in autism and attention-deficit/hyperactivity disorder: A narrative review. Neuroscience & Biobehavioral Reviews. https://pmc.ncbi.nlm.nih.gov/articles/PMC9995546/ 

All Aboard ADHD. (n.d.). The misunderstood world of sleep and neurodiversity. https://www.allaboardadhd.com/blog/the-misunderstood-world-of-sleep-and-neurodiversity 

Sleep Matters Perth. (n.d.). Sleep and neurodivergence: Unique features, challenges and strategies. https://www.sleepmattersperth.com.au/sleep-and-neurodivergence-unique-features-challenges-and-strategies/ 

Evolve Psychology. (n.d.). Sleep and neurodivergency: When bedtime is anything but relaxing. https://evolvepsychology.com/resources/sleep-and-neurodivergency-when-bedtime-is-anything-but-relaxing 

Hoedlmoser, K., et al. (2025). [Article title]. Sleep Medicine: X. https://doi.org/10.1016/j.sleepx.2025.100211 

Dodson, W. (2023, August 29). ADHD sleep disturbances: Why you're always tired. ADDitude. https://www.additudemag.com/adhd-sleep-disturbances-symptoms/ 

ADDitude Editors. (2025, January 30). Can't sleep? The cycle of ADHD exhaustion. ADDitude. https://www.additudemag.com/slideshows/cant-sleep-cycle-of-exhaustion/ 

Quinn, P. O. (2025, February 11). Sleeping problems in teens with ADHD: Causes and solutions. ADDitude. https://www.additudemag.com/sleeping-problems-teens-adhd-causes-solutions/ 

Dodson, W. (2025, February 10). Wired and tired: Why people with ADHD struggle with sleep deprivation. ADDitude. https://www.additudemag.com/wired-tired-sleep-deprived/