Research Brief: ADHD and Sleep – Why people with ADHD can’t sleep (and what actually helps)

Marlee Boyle, co-founder of the Sleep Works sleep clinic and a registered respiratory therapist, explains why ADHD brains are wired against a good night’s rest. Her core thesis: most ADHD sleep problems are a circadian-rhythm problem, not a willpower problem – roughly three-quarters of adults with ADHD have a phase-delayed internal clock of about 90 minutes, and the world runs on a morning-lark timetable their biology can’t follow. The fixes she recommends are deliberately low-tech and ADHD-adapted: cheap amber lens glasses worn 2-3 hours before bedtime, blackout-grade bedrooms with contoured eye masks, bright-light therapy in the morning, and CBT-I (cognitive behavioral therapy for insomnia) rather than pills. She is sharply critical of the popular quick fixes: melatonin is a chronobiotic, not a sleeping pill, and is widely mis-timed; OTC sedating antihistamines (Benadryl, Unisom, Gravol) produce sedation, not sleep, and disrupt REM; and consumer wearables have no reliable sleep-stage accuracy and can create orthosomnia. Perimenopause compounds all of it via estrogen and progesterone shifts, with sleep deprivation feeding back into worse ADHD symptoms. The through-line: there is no shortcut, but small consistent changes – even 15 minutes more sleep per night, or 20 minutes of amber glasses instead of zero – compound into real gains.

Claims and Notes

Claim 1: About 80% of people with ADHD struggle with their sleep

• [0:01] “I think the research shows that it’s about 80% of people with ADHD will struggle with their sleep.”
• Stats: 80% figure. Note the host hedges (“I think the research shows”), and the top-line number sits at the top of the published range.
• Verdict: Partially supported. A 2025 systematic review in Frontiers in Psychiatry reports insomnia in up to 80% of adults with ADHD; ADDitude (Nov 2024) cites an estimated 40-80% of adults with ADHD experiencing disordered sleep. “About 80%” is the ceiling of the evidence, not the midpoint.

Claim 2: About 75% of people with ADHD have a circadian rhythm delay of roughly 90 minutes

• [3:40] “For about 75% of people with ADHD, they actually have a delay in their circadian rhythms by roughly 90 minutes.”
• [3:50] “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.”
• Stats: 75% prevalence; 90-minute phase delay.
• Verdict: Supported. The same Frontiers in Psychiatry 2025 systematic review states approximately three-quarters of adults who developed ADHD in childhood show objective evidence of phase-delayed circadian rhythms, with dim-light melatonin onset (DLMO) delayed by roughly 45 minutes in children and 90 minutes in adults (up to 78% timing involvement). The “75% / 90 minutes” figures match the primary literature closely.

Claim 3: Neurodivergent people are usually sensitive to light (“lamp people”)

• [3:18] “As neurodivergent people, we are also usually sensitive to light. I always say like 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…”
• Tags: named concept (“lamp people”).
• Verdict: Supported as expert clinical observation. Light sensitivity in ADHD/autism is widely reported in the sensory-processing literature, though it is not a diagnostic criterion.

Claim 4: Amber lens glasses worn 2-3 hours before bedtime advance the circadian rhythm

• [5:41] “A very practical way to for people with ADHD to entrain their circadian rhythm is, and this is my favorite sleep tool, is to get a pair of amber lens glasses. Just cheap amber orange lens glasses.”
• [6:40] “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.”
• [6:14] First-time user reaction: “it just feels like my eyeballs just took a break.”
• Tags: product category (amber/orange lens glasses, Wayfarer-style), numbered protocol (put on 2-3 hours before goal bedtime).
• Verdict: Supported as a standard chronotherapy practice. Short-wavelength (blue) light suppression in the evening is the accepted mechanism for phase-advancing circadian rhythms; amber glasses are a low-cost implementation. Controlled studies on glasses specifically are limited, but the light-exposure logic is well established.

Claim 5: Bedroom darkness test – hold your hand at arm’s length

• [7:02] “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.”
• Tags: at-home test, numbered step.
• Verdict: Supported as practical guidance. Light exposure during the sleep period suppresses melatonin secretion; the hand-test is a common, crude proxy recommended by sleep clinicians.

Claim 6: Contoured eye masks are the low-cost fix for light leaks

• [7:17] “A very inexpensive easy tool is just an eye mask. … a contoured eye mask. They’re a couple of bucks, inexpensive, contoured so they don’t rub our eyelashes.”
• [7:39] “The contoured ones are minimal contact because they just sit on the outside of your orbital.”
• Tags: product category (contoured eye mask).
• Verdict: Supported as expert recommendation. No independent efficacy studies for masks specifically, but light-blocking is the mechanism; contoured design is a sensory-accommodation detail for ADHD/autistic users.

Claim 7: CBT-I is the gold-standard first-line treatment for chronic insomnia

• [8:15] “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.”
• Tags: named therapy (CBT-I).
• Verdict: Supported. CBT-I is the guideline-recommended first-line treatment for chronic insomnia in adults (AASM/clinical consensus), superior to hypnotics for durable outcomes.

Claim 8: The belief that “you are a bad sleeper” perpetuates being a bad sleeper

• [8:39] “The idea that you’re a bad sleeper perpetuates the actuality of you being a bad sleeper.”
• [8:45] “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.’”
• [9:07] “There’s no guarantee that if we have a bad night’s sleep, we’re going to have a terrible next day.”
• Tags: cognitive restructuring; named CBT-I component.
• Verdict: Supported as a core CBT-I concept. Catastrophizing and sleep-related anxiety are established perpetuating factors in insomnia; cognitive restructuring is a standard intervention.

Claim 9: No consumer wearable has reliable sleep-stage accuracy; Apple Watch example

• [9:29] “We’ll have people book appointments and they’ll be like, ‘My Apple Watch says I’m getting 0% REM.’ And we’re like, ‘But you’re getting REM cuz you’re here.’”
• [9:43] “The wearables across the board, as of like today, there are not any wearables that have any accuracy or any reliable accuracy for sleep stages.”
• Tags: product (Apple Watch); category claim about all wearables.
• Verdict: Partially supported. Consumer wearables are not validated against polysomnography (PSG) for sleep staging and studies show they misclassify wake and overestimate sleep (e.g., 2023 review of 11 devices in PMC10654909). However, the blanket “no reliable accuracy at all” is too strong: a 2024 study (PMC11511193) found Apple Watch agreed with PSG on 93% of sleep-wake epochs and 75% of four-stage epochs. The direction (don’t trust stage numbers) is right; the absolutism overstates.

Claim 10: The term “orthosomnia” was coined during the pandemic

• [9:56] “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 daily sleep data and it dictating how they’ve slept when it doesn’t correlate with their sleep at all.”
• [10:19] “It’s the cognitive restructuring the other way. It’s almost validating I’m a bad sleeper.”
• Tags: named term (orthosomnia).
• Verdict: Partially supported. The phenomenon and definition are accurate, but the term was NOT coined during the pandemic – it was introduced by Baron, Abbott et al. in a February 2017 case study in the Journal of Clinical Sleep Medicine. The concept (an unhealthy preoccupation with imperfect sleep-tracking data) is well documented; the timeline attribution is wrong.

Claim 11: The 20/20 rule for middle-of-the-night waking

• [10:52] “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 got to get out of bed for at least 20 minutes to reset.”
• [11:14] “Our perception of time is influenced too by how miserable it is lying there.”
• [11:27] “Go to a dimly lit room. You don’t want to turn on any lights that you don’t need to. … have a plan to do something that’s boring, not overstimulating.”
• [12:07] Her own plan: “I would have a basket of unfolded laundry, and I would just stand there and fold laundry for 20 minutes. … ‘Even if I can’t get back to sleep, at least this annoying task is done tomorrow.’”
• Tags: numbered protocol (20/20 rule), named technique.
• Verdict: Supported as standard stimulus-control guidance from CBT-I (get out of bed when awake for ~20 minutes; avoid associating bed with wakefulness). The ADHD-specific twist (plan a boring-but-engaging task, cognitive reframe) is expert adaptation.

Claim 12: Perimenopause disrupts sleep via estrogen and progesterone, especially with ADHD

• [13:14] “Perimenopause affects our sleep because of the changes in our hormone levels, particularly our estrogen and progesterone.”
• [13:25] “In the luteal phase … the week before your period” sleep gets worse.
• [13:42] “Sleep deprivation in general exacerbates symptoms of ADHD. So, it becomes debilitating for a lot of women.”
• [14:28] “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.”
• Tags: hormone axis (estrogen, progesterone), named phase (luteal), named condition (perimenopause).
• Verdict: Mostly supported with one contested detail. Estrogen/progesterone changes affecting sleep, worse luteal-phase sleep, and sleep-deprivation-exacerbating-ADHD are all established. The specific claim that hot flashes “don’t tend to happen during deep sleep or REM” is contested: PSG research shows nocturnal hot flashes are strongly associated with awakenings (69.4% of flashes associated with an awakening in one study, PMC4252627), and some studies find hot flashes occurring in REM sleep. The reassurance intent (“you were probably already awake”) is sound; the sleep-stage detail is not reliable.

Claim 13: Melatonin is a chronobiotic, not a sleeping aid

• [15:58] “Melatonin in the sleep medicine world is almost never used as a sleeping aid. … It is a chronobiotic. … 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.”
• Tags: named substance (melatonin), named class (chronobiotic).
• Verdict: Supported. Melatonin’s established role in sleep medicine is circadian phase shifting (e.g., delayed sleep-wake phase disorder), not sleep onset; its direct hypnotic effect is minimal.

Claim 14: Melatonin should be taken 10-12 hours before wake time, not at bedtime

• [16:40] “It can be helpful to take melatonin for a short period of time to help advance your circadian rhythm.”
• [16:51] “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 7:00 a.m., you’re taking it roughly 7:00 p.m.”
• [17:05] Taking it at bedtime “is actually … solidifying their delay in the circadian rhythms.”
• Tags: numbered protocol (timing rule), named substance.
• Verdict: Partially supported. Timed low-dose melatonin for phase advance is standard (typical guidance: 0.5-1 mg several hours before bedtime, roughly consistent with her “10-12 hours before wake” rule for a 7am rise). The claim that inappropriately timed melatonin can worsen phase delay is consistent with chronobiology. Note that “10-12 hours before wake” is a simplification; clinicians time doses relative to DLMO, and optimal timing varies by individual.

Claim 15: She doesn’t recommend supplement melatonin because quality can’t be guaranteed

• [17:15] “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.”
• [17:28] “I do believe that we can produce the perfect amount of melatonin ourselves if we’re just given ourselves more exposure to complete darkness.”
• Tags: named substance, product-grade distinction (pharmaceutical vs supplement).
• Verdict: Supported. OTC melatonin supplements are unregulated in the US and show wide dosage-label inaccuracy; pharmaceutical-grade is the clinical preference. Endogenous melatonin production via darkness is basic physiology.

Claim 16: OTC sedating antihistamines (Benadryl, Unisom, Gravol) are not for long-term use and produce sedation, not sleep

• [17:44] Host history: “I would turn to Benadryl or Unisom or diphenhydramine. Like a thing that I knew would knock me out. … I would wake up in a really bad mood.”
• [18:03] “Taking anything like that, whether it’s the Unisom or Benadryl or Gravol or any of those sedating antihistamines, long-term is not advised.”
• [18:43] “It’s sedation, not sleep, which are different processes.”
• [19:23] “The biggest stage that would affect our mood and executive functions is our REM sleep … Most sleeping aids disrupt that stage of sleep and make us spend more time in the lighter stages.”
• [19:41] “You wake up grouchy or … the hungover feeling … it’s because you didn’t sleep, you were sedated.”
• Tags: named products (Benadryl, Unisom, Gravol), named drug (diphenhydramine), drug class (sedating antihistamines), named sleep stage (REM).
• Verdict: Supported. Sedating first-generation antihistamines (diphenhydramine, doxylamine) are not recommended for chronic insomnia; they carry anticholinergic burden, tolerance develops, and they suppress REM/alter sleep architecture. Prescribed hypnotics are likewise intended for short-term use (typically 7-10 days), matching her guidance at [18:21].

Claim 17: Sleeping aids are intended for short-term use only (7-10 days)

• [18:21] “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 intended to use.”
• Tags: numbered duration (7-10 days).
• Verdict: Supported. Prescription hypnotic labeling and clinical guidelines advise short-term/intermittent use.

Claim 18: Small changes compound – 15 minutes more sleep per night is 91+ hours per year

• [21:15] “If we can get 15 minutes more of sleep every night, that’s over 91 hours of extra sleep in a year.”
• Tags: statistics (15 min/night, 91+ hrs/year).
• Verdict: Supported arithmetically (15 min x 365 = 5,475 min = 91.25 hrs). The behavioral claim (small consistent gains beat perfectionism) is the video’s closing theme: “We don’t have to be perfect. These don’t have to be perfectly followed. You can fluctuate and still get back on track” [21:28].

Claim 19: Sleep deprivation tanks executive function even in neurotypical people

• [22:28] “There was such a huge overlap that existed between how people are functioning, cuz even neurotypical people, if they’re sleep deprived, their executive functions tank, and then all of a sudden it’s very hard to make a plan and execute a plan.”
• Tags: named mechanism (executive function).
• Verdict: Supported. Sleep deprivation reliably impairs executive functions (working memory, cognitive flexibility, planning) across populations.

Claim 20: Behavioral sleep medicine is not adapted for neurodivergent people; simplifying steps helps

• [22:54] “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.”
• Tags: named population (neurodivergent).
• Verdict: Supported as expert observation; consistent with the ADHD literature on executive-function burden and task simplification.

Key References

1. Understood (Hyperfocus with Rae Jacobson), “Why people with ADHD can’t sleep (and what actually helps) | Hyperfocus” (YouTube, June 2026). https://www.youtube.com/watch?v=-Lv7jmdqTUU
2. Sleep Works (Marlee Boyle, co-founder). https://www.sleep-works.com/ – verified HTTP 200; Boyle is RRT, Certified in Clinical Sleep Health, Advisory Board Member - ADHD Center for Women, BSc Biology.
3. “ADHD as a circadian rhythm disorder: evidence and implications for chronotherapy,” Frontiers in Psychiatry (2025). https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2025.1697900/full – supports Claims 1, 2 (insomnia up to 80% of adults; ~75% phase-delayed circadian rhythms; DLMO delayed ~90 min in adults).
4. ADDitude, “ADHD Sleep Problems Linked to Gender, Mental Health: Study” (Nov 2024). https://www.additudemag.com/how-does-adhd-affect-sleep-study/ – disordered sleep in 40-80% of adults with ADHD.
5. Baron KG, Abbott S, et al., “Orthosomnia: Are Some Patients Taking the Quantified Self Too Far?” Journal of Clinical Sleep Medicine 13(2) (2017). https://jcsm.aasm.org/doi/10.5664/jcsm.6472 – original orthosomnia paper; corrects Claim 10’s timeline.
6. “Accuracy of Three Commercial Wearable Devices for Sleep…” (2024), PMC11511193. https://pmc.ncbi.nlm.nih.gov/articles/PMC11511193/ – Apple Watch 93% sleep-wake / 75% four-stage epoch agreement with PSG; qualifies Claim 9.
7. “Accuracy of 11 Wearable, Nearable, and Airable Consumer Sleep Tracking Devices” (2023), PMC10654909. https://pmc.ncbi.nlm.nih.gov/articles/PMC10654909/ – wearables overestimate sleep, misclassify wake stages; supports Claim 9’s direction.
8. “Magnitude of the impact of hot flashes on sleep in perimenopausal and menopausal women” (2015), PMC4252627. https://pmc.ncbi.nlm.nih.gov/articles/PMC4252627/ – 69.4% of objective hot flashes associated with awakening; qualifies Claim 12.
9. Hyperfocus related content from the video description (all verified HTTP 200):
   • “ADHD and sleep: 5 strategies to finally beat insomnia” https://youtu.be/xFb-ExrRoKs
   • “PMDD: Why women with ADHD are 4x more likely to struggle” https://www.understood.org/en/podcasts/hyperfocus/adhd-and-pmdd
   • Transcript and resources page: https://www.understood.org/en/podcasts/hyperfocus/adhd-sleep-what-helps
   • Hyperfocus podcast hub: https://www.understood.org/en/podcasts/hyperfocus

Caveats

• Single-source interview: nearly all guidance comes from one clinician (Marlee Boyle) in conversation with host Rae Jacobson; she is credible (RRT, clinical sleep health certification, ADHD Center for Women advisory board) but the video is a podcast-style explainer, not a peer-reviewed review.
• One historical error confirmed: orthosomnia was coined in 2017, not during the pandemic (Claim 10).
• One contested claim: hot flashes/night sweats “don’t tend to happen during deep sleep or REM” (Claim 12) conflicts with PSG studies associating nocturnal hot flashes with awakenings, some finding them in REM. Use the reassurance without the sleep-stage detail.
• The 80% prevalence figure (Claim 1) is the top of a 40-80% range; treat as “up to 80%.”
• Wearables claim (Claim 9) is directionally right but overstated in its absolutism; recent Apple Watch validation is better than “no reliable accuracy.”
• Melatonin timing (Claim 14) is a simplification; clinical dosing is individualized relative to DLMO.
• The video does not cover: prescription options (e.g., orexin antagonists, trazodone, stimulant timing for ADHD), sleep apnea or RLS screening in ADHD, light-therapy intensity/duration specs, or long-term outcomes of CBT-I in ADHD specifically.

Source: Understood (Hyperfocus with Rae Jacobson), “Why people with ADHD can’t sleep (and what actually helps) | Hyperfocus” (YouTube). https://www.youtube.com/watch?v=-Lv7jmdqTUU