Emotion regulation difficulties in adults with ADHD and associations with insomnia symptoms

Adults with attention-deficit/hyperactivity disorder (ADHD) frequently experience both emotion regulation difficulties and sleep disturbances. Although theories of insomnia and studies in non-ADHD samples suggest a link between poor emotion regulation and insomnia, this relationship is understudied in ADHD. We examined whether difficulties regulating emotions were associated with insomnia symptoms in adults with ADHD, and whether this association was moderated by gender, age (<30 or ≥30 years), or eveningness preference.

A cross-sectional online survey was distributed in collaboration with the Norwegian ADHD Association. Of 1541 respondents, 1414 adults with self-reported ADHD diagnosis (81% female; ages 16-74; years, M age = 40 years) met inclusion criteria. Participants completed measures of emotion regulation, insomnia symptoms, chronotype, and sociodemographic and clinical characteristics, including education level, occupational status, ADHD symptoms, depression, anxiety, substance use, medication use, and comorbid conditions.

Multiple linear regression analyses showed that greater emotion regulation difficulties, especially limited access to effective regulation strategies, were associated with more insomnia symptoms. Associations remained significant after controlling for sociodemographic and clinical characteristics. The association between emotion regulation difficulties and more insomnia symptoms was stronger (medium effects) among emerging adults (<30 years) than older adults (small effects). No moderation effects were found for gender, age as a continuous moderator, or eveningness preference.

Difficulties in adaptively regulating emotional states, a common challenge in ADHD, were linked to more insomnia symptoms. These findings underscore the importance of assessing and addressing sleep disturbances in adults with ADHD, particularly among those with emotion regulation difficulties.