Attention-deficit/hyperactivity disorder (ADHD) is a condition that affects how the brain works. It’s linked to behaviors like being hyperactive, impulsive, and having trouble paying attention. ADHD may seem very different from narcolepsy, a sleep disorder that causes extreme daytime sleepiness, hypersomnia (sleeping too much), and other symptoms. However, the two conditions appear to be related. In fact, studies have found that approximately 1 in 4 people with narcolepsy also have ADHD.

Here, we’ll explore the connection between ADHD and narcolepsy, including similarities and differences in their symptoms and treatments. If you think you might have both ADHD and narcolepsy, talk to your healthcare provider. They’ll be able to help determine the cause of your symptoms and work with you to find the best course of treatment.

What Is ADHD?

ADHD affects an estimated 7.2 percent of children and teens and 3.4 percent of adults worldwide. In the United States, ADHD is thought to affect 6 percent of adults. ADHD may cause a person to have difficulty paying attention and controlling impulsive behaviors. People with ADHD may also be overly active (hyperactive).

Symptoms of ADHD include:

• Not listening when directly spoken to
• Being easily distracted and forgetful
• Fidgeting
• Interrupting or intruding on others
• Losing necessary items like wallets, glasses, or keys
• Talking excessively

ADHD often begins in childhood and lasts into adulthood. However, in some people, it’s not diagnosed until adulthood. It may be challenging to recognize ADHD in adults, as the classic symptoms of the disorder, such as hyperactivity, may be less clear. ADHD symptoms may fade with age, or a person might learn to manage them with medication and coping strategies.

The Relationship Between ADHD and Narcolepsy

Research has shown that certain sleep disorders, like narcolepsy, often happen along with ADHD.

One study found that among 839 people with narcolepsy, 25 percent also had ADHD. Adults with narcolepsy have nearly 10 times the odds of having ADHD compared to the general population. Another study of children with narcolepsy found that about 15 percent of those with type 1 narcolepsy had symptoms of ADHD. Type 1 includes cataplexy, or sudden muscle weakness often triggered by strong emotions. About 30 percent of those with type 2 narcolepsy, which does not include cataplexy, had ADHD symptoms. Because symptoms of ADHD and narcolepsy can overlap, it’s possible to be misdiagnosed.

What Causes ADHD in Narcolepsy?

Researchers have suggested several potential causes of the connection between ADHD and narcolepsy.

Dopamine and Noradrenaline Regulation

One possible reason for the link between narcolepsy and ADHD is that the two share common pathways in the brain. Researchers believe that ADHD is connected to problems with brain chemicals like the neurotransmitter dopamine and the hormone and neurotransmitter norepinephrine, which help control attention and behavior.

Norepinephrine is a chemical in the brain that helps control the fight-or-flight response when we’re stressed. If it isn’t working properly, it can affect rapid eye movement (REM) sleep — the stage of sleep when we dream. People with narcolepsy often have trouble with REM sleep, too. Some ADHD medications work on the same brain chemicals that are involved in REM sleep.

Low Iron Levels

Studies have found that low iron levels in the blood are associated with ADHD. While not directly related to narcolepsy, low iron levels have been found in people with other sleep disorders, such as restless legs syndrome.

Genetics

Researchers have suggested that there may be a genetic link between ADHD and narcolepsy. Studies have found that some people with ADHD and excessive daytime sleepiness have a shorter REM latency (time to reach the first phase of REM sleep). These people often don’t have a specific genetic trait seen in people with type 1 narcolepsy and in some people with type 2 narcolepsy who don’t have ADHD. This finding suggests that people with both ADHD and excessive daytime sleepiness could be considered to have a unique form of type 2 narcolepsy.

How Are ADHD and Narcolepsy Treated?

Although there’s no cure for narcolepsy or ADHD, a combination of medication and lifestyle changes can help manage their symptoms.

Talk to your healthcare team about the best way to manage your symptoms.

Medications for ADHD

Psychostimulants are often the first line of treatment for ADHD. These medications help people with ADHD regulate their symptoms of hyperactivity and attention difficulties.

These drugs, which help balance the levels of different neurotransmitters (brain chemicals), include:

• Amphetamines
• Methylphenidates

Medications for Narcolepsy

Some types of medications are approved to treat narcolepsy but not ADHD, including:

• Antidepressants
• Sodium oxybate and oxybate salts
• Stimulant drugs

Some stimulant medications that help to improve wakefulness in people with narcolepsy and other sleep disorders have been found to significantly improve the symptoms of ADHD.

Talk to your doctor about your options. It may take some time for you and your healthcare team to find the best medication to treat your symptoms.

Good Sleep Hygiene

To treat narcolepsy, many doctors recommend a combination of medications and lifestyle changes that support good sleep hygiene. As ADHD and ADHD medications can also lead to sleep problems, forming positive habits around sleeping may also be beneficial for people with ADHD.

The National Institute of Neurological Disorders and Stroke recommends that people with narcolepsy practice the following habits as much as possible:

• Stick to a regular sleep schedule, even on weekends.
• Take short naps when you feel sleepiest during the day.
• Exercise daily for at least 20 minutes.
• Avoid caffeine, alcohol, or heavy meals before bedtime.
• Don’t smoke, especially in the evening.
• Keep your sleeping space comfortable, and maintain a cool temperature.
• Take time to relax before bed.

Cognitive Behavioral Therapy

In addition to medications, psychotherapy is effective in helping to treat narcolepsy and ADHD. A specific type of psychotherapy known as cognitive behavioral therapy (CBT) has been found to help people with narcolepsy better manage sleep patterns, manage anxiety, and control cataplexy triggers. CBT programs designed specifically for people with ADHD can help them more effectively manage their time, cope with difficulties in executive functioning — the mental skills used to plan, stay organized, and follow through — and regulate their emotions and impulsivity.

People with ADHD and narcolepsy are also at a higher risk of experiencing depression or anxiety. CBT can help these people manage anxiety or depressive disorders and their symptoms. If you’re interested in therapy to improve your quality of life with narcolepsy or ADHD, ask your doctor for a recommended mental health provider.

Find Your Team

MyNarcolepsyTeam is the social network for people living with narcolepsy. Here, more than 11,000 members come together to ask questions, offer support and advice, and share stories with others who understand life with narcolepsy.

Have you been diagnosed with narcolepsy and ADHD? Share your story in the comments below or by posting on your Activities page.