Why Sleep Is Hard for Adults With Autism and/or ADHD (AuDHD) - And What You Can Do About It
Sleep problems are extremely common in autism, ADHD, and AuDHD, often more severe and more complex than in neurotypical people, showing up as insomnia, circadian rhythm shifts, fragmented nights, sensory-related sleep disruption, and daytime sleepiness.
The causes are multifactorial - involving brain chemistry, genetics, sensory sensitivities, co-occurring conditions like anxiety or depression, and lifestyle patterns - and each condition (autism, ADHD, AuDHD) has its own distinct sleep profile.
Support is possible through personalized strategies, such as consistent routines, sensory-friendly sleep environments, reducing stimulation before bed, CBT-I, and carefully guided use of melatonin - though what works varies widely and research in adults is still lacking.
If you live with autism, ADHD, or both (AuDHD), chances are you’ve struggled with sleeplessness, aka insomnia. And this not just once in a while - research shows that for many neurodivergent adults, sleep problems are chronic, more severe, and often more complex than what neurotypical people experience.
But here’s some good news: while sleep disruptions are common, there are things we can do about it to support our sleep. The more we understand what’s behind them, the more we know whether it’s a direct cause from autism/ADHD/AuDHD or a secondary cause stemming from accompanied struggles such as depression and anxiety that often comes with these conditions, the better we can work with our brains and bodies to improve rest.
The many faces of sleep trouble in autism and ADHD
Sleep issues in autism and ADHD show up in different ways, but the patterns are surprisingly similar. The most common struggles include:
Insomnia: difficulty falling asleep or staying asleep
Circadian rhythm shifts: delayed sleep phase, feeling “out of sync” with the inner clock
Fragmented nights: multiple awakenings, light and unrefreshing sleep
Sleep apnea: disordered breathing
Parasomnias: can manifest in terrors or sleepwalking
Restless legs or limb movements
Daytime sleepiness, narcolepsy, or hypersomnia: feeling unusually tired during the day, sudden “sleep attacks”, needing much longer sleep than average and feeling unrefreshed after sleeping a “normal” amount (7-9 hours)
In fact, one large review found that adults with autism and ADHD both show longer time to fall asleep, more waking during the night, and lower sleep efficiency compared to neurotypical people.
How Autism, ADHD, and AuDHD sleep struggles differ
While autism and ADHD share many overlapping sleep problems, research also shows each condition - and especially when both occur together - comes with its own distinct sleep profile.
Autism:
Adults with autism spend less time in REM sleep - the deep sleeping phase linked to dreaming, memory processing, and emotional regulation - averaging about 15% vs. 25% in neurotypicals. This can affect mood, focus, and other aspects of cognition such as problem-solving and decision-making.
Fragmented, non-restorative sleep is especially common.
Genetic differences in melatonin and circadian rhythm regulation, affecting the body’s sleep-wake cycle.
ADHD:
Adults with ADHD are up to 83% more likely to experience sleep disturbances than neurotypicals.
25-50% live with insomnia, circadian rhythm issues, or sleep-disordered breathing.
Periodic limb movements, restless legs, and lower self-rated sleep quality are common.
AuDHD:
When autism and ADHD overlap, sleep difficulties are often additive - and worse.
Adults with AuDHD report more awakenings, more fragmented nights, and poorer overall sleep quality than either group alone.
Why sleep can be so difficult
Science points to a mix of biological, sensory, and behavioral factors that make sleep uniquely challenging in adults with ADHD and/or autism.
Brain chemistry and genetics: changes in melatonin production, circadian genes, and dopamine pathways affecting the body’s sleep-wake cycle.
Sensory sensitivities: lights, sounds, textures, or even temperature can feel overwhelming at night.
Co-occurring conditions: anxiety, depression, or gastrointestinal issues make sleep worse.
Lifestyle factors: reduced sunlight exposure (especially for those sensitive to light), irregular routines, and disrupted sleep hygiene.
Why it’s hard to get answers
One of the biggest challenges is that sleep assessment tools aren’t always designed for neurodivergent adults. Self-report questionnaires can miss the individuality factor, and gold-standard measures like polysomnography or actigraphy aren’t used often enough because they can be uncomfortable or hard to tolerate.
On top of that, it’s not always clear whether sleep issues are a primary disorder directly caused by autism and/or ADHD, or a secondary effect of medications, mental health, or other conditions.
The consequences of sleep disruption
Poor sleep doesn’t just make you tired - it ripples into every area of your daily life. It can impair memory and learning, drain emotional resilience, increase accident risk, and worsen mental health. It also amplifies existing challenges with focus, mood regulation, and energy - it really becomes a self-inforcing vicious cycle.
What helps: strategies that work
Some good news: while there’s no one-size-fits-all solution, there are approaches that can improve sleep in adults with autism and/or ADHD.
Non-medication approaches (first-line):
Stick to consistent sleep/wake times (also on weekends).
Build a calming bedtime routine (reading, stretching, meditation -> and yes, no phone).
Optimize the sensory environment: blackout curtains, weighted blankets, white noise, or earplugs.
Limit stimulants like caffeine and screens before bed.
Try cognitive behavioral therapy for insomnia (CBT-I), adapted for neurodivergent needs.
Medication approaches:
Melatonin can help but responses are mixed, especially in autism. If used, it should be done under professional guidance.
Most important:
Every neurodivergent adult is unique. What soothes one person may overstimulate another. Tailoring sleep strategies to your personal sensory and biological profile is key. Consider journaling about the different strategies you try, and what impact you feel. Don’t overwhelm yourself with implementing too much at a time, and keep in time that you have to try strategies for a few weeks to get a feel for the impact it has on your sleep.
What we still don’t know
Unfortunately, most research still comes from children or from neurotypical populations. Adults with autism and/or ADHD are underrepresented, and comorbidity (such as anxiety or depression) is rarely addressed directly. Many studies rely heavily on self-reports and don’t control for medication effects. Long-term outcomes of interventions - like whether CBT-I or melatonin really work over years and not just weeks - remain unclear.
This means that science is still catching up. But what’s clear already is that sleep is a central issue for neurodivergent adults, and it deserves attention, personalization, and care.
References
https://neurodivergentinsights.com/autism-adhd-and-sleep/?srsltid=AfmBOopkrdRpVeafZqieoC3Gzne8lIQZo35N0YRUl2E8BUNikkiZGICQ - accessed 2.10.25
https://pmc.ncbi.nlm.nih.gov/articles/PMC10755553/ - accessed 2.10.25
https://www.sciencedirect.com/science/article/pii/S0924977X20302157 - accessed 2.10.25
https://www.sciencedirect.com/science/article/abs/pii/S1389945720304718 - accessed 2.10.25
Hi, I’m Alexandra!
I’m a trained molecular biologist (Dr. sc. ETH Zurich) and medical writer passionate about bringing science to the people - because knowledge should be accessible to everyone in a clear, understandable way.
Learn more about me here.