ADHD or Sleep Apnea?

An adult who cannot focus, forgets things, makes careless mistakes and feels foggy all day may be describing ADHD. The same adult may also be describing obstructive sleep apnea, a common condition in which breathing stops and restarts many times during sleep. Sleep apnea is easy to miss because its main symptoms happen while you are asleep. This page compares the two, explains what research in adults does and does not show, and covers why a sleep question belongs in any ADHD evaluation.

What sleep apnea is

The National Heart, Lung, and Blood Institute (NHLBI) describes sleep apnea as a common condition that occurs when breathing stops and restarts many times during sleep, which can keep the body from getting enough oxygen. In obstructive sleep apnea (OSA), the most common type, the upper airway becomes blocked during sleep. Factors such as obesity, large tonsils or changes in hormone levels can narrow the airway.

NHLBI also states the part that matters most here: undiagnosed or untreated sleep apnea can lead to problems with concentrating, making decisions, remembering things and controlling behavior. Those are words that could come straight from an ADHD symptom list.

Side by side

The OSA rows come from NHLBI's sleep apnea pages, and the ADHD rows from the National Institute of Mental Health (NIMH). NHLBI notes that fatigue, headache and insomnia from sleep apnea are more common in women, while frequent loud snoring is more common in men, so the classic picture of a loud-snoring man is only part of the story.

What research in adults shows

The link between sleep apnea and ADHD-type symptoms is better established in children than in adults. In children, NHLBI notes that sleep apnea can cause overactivity and trouble paying attention in school. In adults, the evidence is thinner, and it is worth being precise about what exists.

• A sleep-clinic study (2019). Researchers gave the Adult ADHD Self-Report Scale screener to 194 adults referred for sleep testing. OSA was found in 83% of them, and 19% screened positive for ADHD symptoms. The severity of OSA was not related to the presence of ADHD symptoms, but those who screened positive were sleepier during the day. A positive screener is not a diagnosis, and the study could not show which condition came first.
• A review of sleep in adult ADHD (2021). A review in Brain Sciences notes that sleep-disordered breathing may be highly prevalent in adults with ADHD, and that in sleep-disordered breathing the severity of thinking problems tracks the degree of breathing disruption. It suggests treating disordered breathing might remove one source of cognitive impairment, and notes that a formal sleep study can clarify the diagnosis.
• A case report and mini review (2024). Published in the Journal of Clinical Sleep Medicine, it describes a man diagnosed with attention deficit disorder in childhood whose attention problems did not return after he began CPAP treatment for OSA and stopped ADHD medication. The authors write that improvement of ADHD symptoms after OSA treatment is established in children but not in adults, and they support screening for OSA and other sleep problems in people being assessed for ADHD.

Put together: sleep apnea can produce attention and memory problems, the two conditions can exist together, and there is not yet strong evidence on how often treating OSA resolves ADHD-like symptoms in adults. A single case shows it can happen. It does not show how often.

Clues that point one way or the other

• Timeline. ADHD requires several symptoms before age 12. Focus problems that began in adulthood, especially alongside weight gain, new snoring or morning grogginess, make a sleep problem worth checking. Childhood does not rule OSA out, though, since children can have it too.
• Sleepiness versus restlessness. Dozing off in meetings or while reading, or feeling unrefreshed after a full night, points toward a sleep problem. Restlessness and a need for constant activity are more typical of ADHD.
• What a bed partner hears. Loud snoring, pauses in breathing or gasping are the signs NHLBI lists, and you may not know about them until someone tells you.
• Both can be true. A person with lifelong ADHD can develop OSA in midlife. Treating one does not rule out the other.

Why it matters for treatment

If sleep apnea is driving the symptoms, the fix is to treat the sleep apnea, and NHLBI warns that untreated OSA also raises the risk of stroke, heart attack and other serious problems. If ADHD is present too, sleep still matters for medication decisions. The FDA label for Adderall XR lists insomnia among the most common adverse reactions in adults, and a prescriber needs to know about any existing sleep disorder when choosing and adjusting treatment.

NHLBI says diagnosis usually means seeing a sleep specialist or going to a center for a sleep study, and that a provider may also order blood tests, for example of thyroid hormone levels, to look for related conditions. That overlap is one reason this guide also compares ADHD and thyroid problems.

Dr. Shershow's adult ADHD evaluation asks about sleep as part of the health history, along with medical conditions, medications and substances, and considers other explanations for symptoms before reaching a conclusion. For the broader picture of sleep in ADHD, see ADHD and sleep problems and ADHD and insomnia.

What to note before a visit

• Ask a partner or roommate whether you snore loudly, stop breathing or gasp in your sleep.
• Keep a simple sleep diary for a week or two: bedtime, wake time, night wakings and how sleepy you feel during the day. NHLBI offers a sample.
• Note when focus problems began, and whether school reports mention them.
• List medications, including sleep aids, and alcohol and cannabis use.

The guide on preparing for an adult ADHD evaluation has a fuller checklist, and the site's article on sleep problems in adults with ADHD covers sleep habits.

When to talk to a clinician

If you snore loudly, someone has seen you stop breathing in your sleep, or you are sleepy during the day despite enough time in bed, talk to your primary care clinician about sleep apnea. If attention and organization problems go back to childhood and affect work or home, these are signs worth discussing with a clinician who evaluates ADHD. Many people need both conversations.

The adult ADHD self-test can help you organize your symptoms, but it cannot tell ADHD from a sleep disorder. To see how an evaluation works, read about adult ADHD testing in NYC or adult ADHD testing in New Jersey.