Have you ever spent hours trying to fall asleep while your thoughts seemed impossible to quiet? Perhaps you finally managed to sleep, only to wake up exhausted, distracted, and emotionally drained the following morning.
For some people with attention-deficit/hyperactivity disorder (ADHD), these experiences can be familiar.
ADHD is a neurodevelopmental condition affecting attention, impulsivity, and sometimes hyperactivity. Although commonly associated with childhood, ADHD can continue into adulthood and influence relationships, work, mental health, and everyday functioning.
Sleep problems and depression can add further challenges.
But how closely are these conditions connected? And could improving sleep help people with ADHD experience a better quality of life?
A study published in BMJ Mental Health on July 14, 2025, investigated these questions by analysing information from 1,364 adults participating in the Netherlands Sleep Registry.
Researchers found that higher ADHD traits were associated with more severe insomnia, poorer sleep quality, greater depressive symptoms, and lower reported quality of life.
One finding was particularly important: insomnia severity statistically accounted for part of the relationship between ADHD traits and lower quality of life.
However, sleep disturbances did not significantly explain the association between ADHD traits and depression after accounting for demographic factors.
These results show the importance of assessing sleep difficulties in people experiencing ADHD symptoms while also demonstrating that the relationship between ADHD and depression is more complex than poor sleep alone.
Here is what the research reveals and how it may inform clinical care.
- A 2025 study in BMJ Mental Health analysed 1,364 adults from the Netherlands Sleep Registry.
- Higher ADHD traits were associated with more severe insomnia, lower sleep quality, greater depression symptom severity, and lower quality of life.
- Insomnia severity statistically mediated part of the association between ADHD traits and reduced quality of life.
- Sleep quality, chronotype, and social jetlag did not show the same significant mediation effect for quality of life after adjustment.
- No measured sleep or circadian factor significantly mediated the relationship between ADHD traits and depression after demographic adjustment.
- The research was cross-sectional and cannot establish cause and effect.
- Treating insomnia, ADHD, and depression appropriately may improve daily functioning, but the study did not test any treatment.
- Cognitive behavioural therapy for insomnia (CBT-I) is still a recommended first-line treatment for chronic insomnia in adults.
What Is ADHD?
Attention-deficit/hyperactivity disorder is a neurodevelopmental condition characterised by persistent patterns of inattention and/or hyperactivity-impulsivity that interfere with functioning or development.
ADHD symptoms can appear variably among individuals.
Some people mainly struggle with attention, organisation, or remembering tasks.
Others experience restlessness, rash choices, or difficulty waiting.
Many experience a combination of symptoms.
Common difficulties in adults may include:
- Problems sustaining attention during lengthy tasks.
- Difficulty organising activities and managing time.
- Frequently misplacing important items.
- Forgetting appointments or responsibilities.
- Restlessness or difficulty remaining still.
- Interrupting others or acting impulsively.
- Difficulty completing tasks despite intending to finish them.
However, these experiences are not unique to ADHD.
Sleep deprivation, depression, anxiety, medical conditions, and other factors could also contribute to poor concentration and restlessness.
An ADHD diagnosis therefore requires a comprehensive clinical assessment, including developmental history and the effects of symptoms in different settings.
Clinical guidance: NICE – Attention Deficit Hyperactivity Disorder: Diagnosis and Management
Why Do People With ADHD Frequently Experience Sleep Problems?
ADHD and sleep difficulties frequently occur together, but the reasons can differ substantially between individuals.
Several mechanisms may contribute.
1. Difficulty Managing Bedtime Routines
People who struggle with organisation, time awareness, or transitions between activities may find it hard to establish regular bedtime routines.
For example, someone might continue working, gaming, or using a smartphone long after intending to sleep.
This does not mean every person with ADHD has poor sleep habits. Rather, executive-function difficulties may create additional barriers to keeping predictable routines.
2. Mental and Physiological Arousal
Some individuals describe feeling mentally active or restless when trying to sleep.
Persistent thoughts, emotional concerns, or difficulty disengaging from stimulating activities can interfere with sleep onset.
However, a racing mind is not specific to ADHD and can also occur with anxiety, stress, and other conditions.
3. Circadian Rhythm Differences
The circadian system regulates daily patterns of sleepiness, alertness, and many physiological processes.
Some people with ADHD report later sleep habits or delayed sleep timing.
This may create difficulties when work, school, or family commitments require early morning waking.
The mismatch between biological preferences and external schedules can contribute to insufficient sleep.
4. Coexisting Sleep Disorders
People with ADHD symptoms may also experience conditions such as insomnia, restless legs syndrome, or sleep-disordered breathing.
These conditions require their own assessment.
It is important not to assume that every sleep problem in someone with ADHD is directly caused by ADHD.
5. Medication and Other Factors
Some ADHD medications can alter sleep onset, especially depending on dose, formulation, and timing.
However, effective ADHD treatment may also improve daily routines and reduce some difficulties that interfere with sleep.
The overall effect varies.
A prescribing clinician should evaluate potential medication-related sleep problems rather than recommending that patients independently stop or modify treatment.
The 2025 BMJ Mental Health Study Explained
The study was titled:
Associations of ADHD traits, sleep/circadian factors, depression and quality of life.
It was conducted by Siddhi Nair and colleagues from institutions including the University of Southampton and the Netherlands Institute for Neuroscience.
The paper was published in BMJ Mental Health on July 14, 2025.
Original study: Nair et al., BMJ Mental Health (2025)
What Was the Objective?
The researchers wanted to understand whether sleep disturbances and circadian rhythm characteristics could statistically explain relationships between ADHD traits and two important outcomes:
- Depression symptom severity.
- Quality of life.
In particular, they examined insomnia severity, global sleep quality, chronotype, and social jetlag.
These factors are related to sleep but describe different aspects of sleep health.
Who Participated?
The analysis included 1,364 participants from the Netherlands Sleep Registry, a large-scale research resource collecting information about sleep and related characteristics.
Participants averaged about 52 years old, and 75% were women.
This population makeup is important because the results may not generalise equally to younger adults, children, or populations with different demographic characteristics.
Furthermore, the researchers measured ADHD traits, not simply outcomes in a group of participants all clinically diagnosed with ADHD.
That distinction matters when interpreting the findings.
How Researchers Measured ADHD, Sleep, Depression, and Quality of Life
Participants completed several standardised questionnaires.
| Measurement | Assessment tool | What it measured |
| ADHD characteristics | Adult ADHD Rating Scale | Self-reported ADHD traits |
| Insomnia | Insomnia Severity Index | Severity and impact of insomnia symptoms |
| Sleep quality | Pittsburgh Sleep Quality Index | Subjective sleep quality and sleep difficulties |
| Depression symptoms | Hospital Anxiety and Depression Scale | Depression-related symptoms |
| Chronotype | Munich Chronotype Questionnaire | Individual sleep-timing preferences |
| Quality of life | Satisfaction With Life Scale | Overall life satisfaction |
| Quality of life | Cantril Ladder | Self-rated position on a life-quality scale |
These tools are useful for studying patterns in large populations.
However, questionnaires do not provide the same information as comprehensive clinical diagnostic evaluations.
The study therefore investigated associations among self-reported characteristics rather than establishing new clinical diagnoses.
Finding 1: Higher ADHD Traits Were Associated With More Severe Insomnia
One of the clearest findings was an association between ADHD traits and insomnia severity.
Participants reporting more pronounced ADHD characteristics also tended to report more severe insomnia symptoms.
The association was statistically significant, with a reported p-value below 0.001.
The study also identified a significant association between ADHD traits and poorer subjective sleep quality.
The results support the importance of asking about sleep when evaluating adults who experience ADHD-related difficulties.
Does ADHD Cause Insomnia?
Not necessarily.
The study measured variables at one point in time.
Therefore, it could not determine whether ADHD traits contributed to insomnia, whether sleep difficulties intensified ADHD-like symptoms, or whether other factors affected both.
These relationships may operate in multiple directions.
For example, insufficient sleep may worsen concentration and emotional management.
Meanwhile, difficulties with routine, arousal, or sleep timing may make sleep more challenging.
The study supports an association, not a specific causal explanation.
Finding 2: ADHD Traits Were Associated With Greater Depression Symptoms
Researchers also found that higher ADHD traits were associated with more severe depression symptoms.
The association remained statistically significant in their analysis.
This finding is consistent with the wider clinical recognition that ADHD and depression can occur together.
Depressive symptoms may include:
- Ongoing sadness or low mood.
- Reduced interest or enjoyment in activities.
- Changes in energy and motivation.
- Difficulty concentrating.
- Changes in sleep or appetite.
- Feelings of hopelessness or worthlessness.
However, experiencing some of these symptoms does not automatically establish a depressive disorder.
A qualified healthcare professional must consider symptom duration, severity, context, and possible alternative explanations.
Why Might ADHD and Depression Be Connected?
Several explanations have been proposed.
ADHD-related difficulties can sometimes contribute to academic, occupational, financial, or interpersonal stress.
Repeated struggles with organisation, deadlines, or anticipated expectations may affect self-esteem and mental health.
Shared biological, genetic, environmental, and psychological factors may also have a role.
However, the BMJ study did not establish a single biological pathway linking ADHD traits with depressive symptoms.
It would therefore be inaccurate to conclude that ADHD inevitably causes depression.
Finding 3: Insomnia Helped Explain the Relationship Between ADHD Traits and Quality of Life
This was one of the study’s most important results.
The researchers examined whether sleep-related characteristics statistically mediated the association between ADHD traits and quality of life.
What Does Statistical Mediation Mean?
A mediation analysis studies whether a third variable helps account for the relationship between two other variables.
In this case, the researchers examined the relationship between:
ADHD traits → Insomnia severity → Quality of life
The analysis suggested that insomnia severity accounted for part of the association between higher ADHD traits and poorer quality of life.
The researchers found significant indirect associations using both quality-of-life measures.
For the Satisfaction With Life Scale, the standardised mediation estimate was approximately −0.10.
The researchers also found a significant mediation effect using the Cantril Ladder measure.
Why Is This Finding Important?
It suggests that insomnia symptoms may represent a meaningful component of the quality-of-life difficulties associated with ADHD traits.
A person who experiences attention difficulties and persistent insomnia may face overlapping challenges.
Poor sleep may cause fatigue, reduced concentration, mood changes, and difficulty managing daily responsibilities.
These difficulties can affect overall life satisfaction.
However, because the data were cross-sectional, the mediation analysis does not prove that ADHD causes insomnia or that insomnia subsequently causes lower quality of life.
The result identifies a statistical pattern that future longitudinal and treatment studies should investigate.
Finding 4: Sleep Did Not Significantly Explain the ADHD–Depression Relationship
Another important result is easy to overlook.
The researchers tested whether insomnia severity, sleep quality, or circadian characteristics statistically mediated the association between ADHD traits and depression symptoms.
After adjusting for demographic factors, none of the measured sleep or circadian variables showed a statistically significant mediation effect for the ADHD–depression relationship.
This is an important distinction.
It means the study did not support a simple model in which sleep disturbances explain why people with higher ADHD traits also report more depressive symptoms.
Does This Mean Sleep Is Unimportant for Depression?
No.
Sleep disturbance is clinically relevant to depression, and treating insomnia can be important for mental health.
However, this specific analysis did not demonstrate that the measured sleep variables statistically explained the association between ADHD traits and depression.
The finding shows that other factors may contribute to the relationship.
Those mechanisms call for further research.
Key distinction: The study found significant insomnia-related mediation for quality of life, but not for depression after adjusting for demographics.
Finding 5: People With Higher ADHD Traits Tended to Have a Later Chronotype
Researchers also found an association between ADHD traits and later chronotype.
Chronotype describes an individual’s natural preference for when they sleep and wake.
Some people naturally feel alert earlier in the morning, while others tend to feel more awake later in the evening.
People with a later chronotype may struggle when daily obligations require early waking.
However, the study did not find that chronotype significantly mediated the relationship between ADHD traits and quality of life after adjustment.
This suggests that later sleep habits may help explain ADHD-related experiences without necessarily clarifying the observed quality-of-life association.
What Is Social Jetlag?
Social jetlag describes the mismatch between biological sleep timing and socially imposed schedules.
For example, someone who naturally sleeps late may need to wake early during the workweek but sleep much later on weekends.
The resulting schedule inconsistency may contribute to sleep disruption.
In this study, social jetlag did not emerge as an important mediator of the investigated associations.
Summary of the Study’s Main Findings
| Relationship investigated | Main result |
| ADHD traits and insomnia severity | Significant association |
| ADHD traits and poorer sleep quality | Significant association |
| ADHD traits and depression symptoms | Significant association |
| ADHD traits and lower quality of life | Significant association |
| ADHD traits and later chronotype | Significant association |
| Insomnia mediating ADHD–quality-of-life relationship | Significant statistical mediation |
| Sleep factors mediating ADHD–depression relationship | Not significant after demographic adjustment |
| Chronotype or social jetlag explaining lower quality of life | No significant mediation |
The results observe patterns in a particular research sample. They do not establish that every person with ADHD experiences the same sleep, mood, or quality-of-life difficulties.
How ADHD, Sleep, and Depression Can Affect Everyday Life
The combined presence of attention difficulties, sleep problems, and depression symptoms can influence several areas of functioning.
Work and Academic Performance
Sleep difficulties can affect alertness, memory, and concentration.
When someone also experiences ADHD-related challenges with organisation or task management, everyday responsibilities may become more demanding.
Psychological Well-Being
Insomnia may contribute to fatigue and emotional distress.
Depression may also affect motivation, interest, and overall emotional functioning.
These experiences can overlap, making professional assessment particularly important.
Relationships
Poor sleep, low mood, and attention difficulties can affect communication and daily responsibilities.
However, relationship difficulties cannot automatically be attributed to ADHD or insomnia.
Many personal and surroundings factors contribute.
Physical Health
Persistent sleep disturbances may be associated with wider health problems.
Some individuals may also experience conditions such as sleep apnea or restless legs syndrome, which require specific evaluation and management.
Overall Life Satisfaction
Quality of life includes much more than the presence or absence of symptoms.
It can involve relationships, independence, physical health, employment, meaningful activities, and individual well-being.
The BMJ data show that insomnia severity may be one relevant factor in the lower quality of life associated with ADHD traits.
Can Improving Sleep Help People With ADHD?
Improving sleep is a reasonable treatment goal when insomnia is present.
However, the 2025 study did not test whether treating insomnia improves ADHD symptoms, depression, or quality of life.
It cannot establish that sleep treatment would reverse the noted relationships.
Nevertheless, established insomnia treatments may benefit people who have both ADHD and chronic insomnia, with suitable clinical adaptation.
Cognitive Behavioral Therapy for Insomnia
Cognitive behavioural therapy for insomnia (CBT-I) is a structured, evidence-based treatment for chronic insomnia.
It focuses on behaviours and thought patterns that cause persistent difficulty sleeping.
CBT-I may involve:
- Establishing more steady sleep schedules.
- Reducing time spent awake in bed.
- Changing unhelpful beliefs about sleep.
- Learning ways to manage sleep-related arousal.
- Tracking sleep patterns using diaries.
- Adjusting behaviours that maintain insomnia.
The American Academy of Sleep Medicine strongly recommends multicomponent CBT-I for adults with chronic insomnia.
However, CBT-I should be adapted to individual circumstances.
Some techniques, particularly sleep restriction, require professional supervision in people with conditions that could make sleep loss hazardous.
Clinical guideline: American Academy of Sleep Medicine, Behavioural and Psychological Treatments for Chronic Insomnia
Useful Techniques for Controlling Sleep Difficulties
The following approaches may support healthier sleep routines.
These are general suggestions, not treatments proven by the 2025 BMJ study.
1. Set a Consistent Wake-Up Time
A relatively stable wake time can help reinforce daily sleep timing.
For people with ADHD-related difficulties managing routines, external reminders or scheduled morning activities may provide useful structure.
2. Create a Predictable Evening Routine
A simple routine may include reducing stimulating activities, preparing for the next day, and allowing time to wind down.
Keep the routine realistic, not too complicated.
3. Manage Caffeine Intake
Caffeine can remain active in the body for several hours.
People experiencing insomnia may benefit from reviewing how much caffeine they consume and when they consume it.
Individual sensitivity varies.
4. Get Regular Daylight Exposure
Daylight exposure, especially earlier in the day, helps support circadian regulation.
Outdoor walks or other daytime activities may be useful when practical and safe.
5. Include Consistent Physical Exercise
Exercise maintains overall physical and psychological health and may improve sleep.
However, the amount, type, and timing should reflect individual fitness and medical needs.
6. Review Medication Timing With a Clinician
Some medications can alter sleep.
For people receiving ADHD treatment, clinicians may consider medication timing, duration of action, or other factors when sleep problems arise.
Patients should not stop or change prescribed medicines on their own.
7. Seek Assessment for Persistent Insomnia
If sleep difficulties persist or interfere with daytime functioning, clinical assessment can help identify possible causes and suitable treatment options.
Simple sleep hygiene advice alone is generally insufficient as a stand-alone treatment for chronic insomnia.
How Should ADHD and Depression Be Treated Together?
When ADHD and depression coexist, care needs to address both conditions.
The appropriate treatment plan depends on symptom severity, clinical history, functional impairment, and personal choices.
ADHD Treatment
Evidence-based approaches may include medication, structured psychological interventions, environmental adjustments, and practical support with functioning.
The UK’s National Institute for Health and Care Excellence (NICE) recommends comprehensive assessment and individualised treatment planning.
Depression Treatment
Depression may require psychological therapy, medication, or a combination, depending on severity and clinical circumstances.
Treatment should consider the person’s overall mental health, including ADHD and sleep problems.
Coordinated Care
Healthcare professionals may need to consider how treatments affect one another.
For example, certain drug protocols may influence sleep, while continual insomnia may complicate mood symptoms and daytime functioning.
Coordinated assessment can help avoid overlooking conditions that require separate treatment.
Clinical guidance:
NICE, ADHD Diagnosis and Management
NICE, Depression in Adults: Treatment and Management
What Are the Limitations of the 2025 Research?
The study delivers useful insights, but several limitations affect how the findings should be interpreted.
1. Cross-Sectional Study Design
All variables were assessed within a cross-sectional survey.
This means researchers could identify statistical associations but could not prove causality.
2. Self-Reported Measurements
Participants completed questionnaires about ADHD traits, sleep, depression, and quality of life.
Self-reported data can be influenced by recall, interpretation, and other factors.
The study did not rely on clinical diagnoses or objective sleep measurements for every variable.
3. Participant Demographics
The sample consisted mainly of middle-aged adults, with women making up about 75% of participants.
The results may not generalise equally to all age groups or demographic populations.
4. ADHD Traits Rather Than Confirmed Diagnoses
The study evaluated ADHD characteristics on a rating scale.
Its results should not be interpreted as describing only people with confirmed ADHD diagnoses.
5. Statistical Mediation Does Not Prove Causality
Although insomnia severity significantly mediated the ADHD–quality-of-life relationship, this does not establish a causal pathway.
Longitudinal research and randomised treatment trials would provide stronger evidence.
6. No Treatment Was Tested
The study did not evaluate CBT-I, ADHD medication, antidepressants, or other interventions.
Therefore, it cannot demonstrate whether a particular treatment improves quality of life in this population.
What Does the Research Mean for Future ADHD Care?
The study suggests that sleep-related symptoms deserve attention when assessing adults with ADHD characteristics.
Historically, clinical discussions about ADHD have often focused on attention, hyperactivity, impulsivity, and functional difficulties.
The BMJ findings add support to the idea that insomnia severity may be relevant to understanding broader quality-of-life challenges.
Subsequent research could investigate whether treating insomnia improves quality of life among adults with ADHD traits or formally diagnosed ADHD.
Longitudinal studies could also help determine how changes in ADHD symptoms, sleep, and mood influence one another over time.
Further work involving more varied populations may clarify whether these relationships differ by age, sex, medication status, and coexisting health conditions.
For now, the most practical implication is to recognise sleep, ADHD symptoms, and depression as potentially overlapping areas that deserve appropriate assessment rather than assuming one condition explains the others.
Conclusion: Why Sleep Deserves Attention in ADHD Care
The relationship between ADHD, sleep, depression, and quality of life is complex.
Research published in BMJ Mental Health in July 2025 found that adults reporting higher ADHD traits also tended to experience more severe insomnia, poorer sleep quality, greater depressive symptoms, and lower quality of life.
The most notable finding was that insomnia severity statistically explained part of the association between ADHD traits and reduced quality of life.
However, sleep and circadian factors did not significantly mediate the association between ADHD traits and depression after demographic adjustment.
These results suggest that sleep difficulties are an important area to assess, but they do not establish a simple causal chain connecting ADHD, insomnia, depression, and quality of life.
The central message is that recognising and appropriately treating sleep problems may be an important part of comprehensive ADHD care, even though more research is required to establish exactly how sleep treatment influences long-term quality of life.
For individuals experiencing persistent sleep problems, difficulties with attention, or depressive symptoms, appropriate clinical assessment can help identify effective treatment options.
References
1. Nair, S., Deshpande, N., Hill, C., Cortese, S., Van Someren, E. J. W., and Chellappa, S. L. (2025). Associations of ADHD traits, sleep/circadian factors, depression and quality of life. BMJ Mental Health, 28(1), e301625.
Published July 14, 2025.
Read the free full-text article.
2. National Institute for Health and Care Excellence. Attention deficit hyperactivity disorder: diagnosis and management (NG87).
3. Edinger, J. D., et al. (2021). Behavioural and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 17(2), 255–262.
4. National Institute for Health and Care Excellence. Depression in adults: treatment and management (NG222).
5. University of Southampton. Associations of ADHD traits, sleep/circadian factors, depression and quality of life.