How much does ADHD play a part in obstructive sleep apnoea?
For nearly ten years, I worked as a respiratory clinical nurse specialist. In that role, obstructive sleep apnoea (OSA) was something I understood through a certain lens: primarily a condition related to weight, lifestyle, and anatomical factors. That was the medical understanding we were taught, and it made sense—at the time.
But when I began training as an ADHD coach and entered the world of neurodivergence, I started hearing something unexpected.
People, particularly women with ADHD, were talking about also having OSA. At first, I was shocked. I hadn’t come across this link in clinical practice, and I couldn’t get my head around it.
But then I began digging into the research.
And what I found changed my perspective completely.
A surprising connection: ADHD and obstructive sleep apnoea
One study found that 19.1% of adults with OSA screened positive for ADHD—a significantly higher rate than the 4.4% typically seen in the general population (Sedky et al., 2020). That alone is worth paying attention to.
On top of that, ADHD and OSA share several overlapping symptoms—like difficulties with concentration, irritability, mood fluctuations, and poor sleep quality (Sciberras et al., 2017). This overlap can make it hard to distinguish between the two, and many people may not realise they’re dealing with a sleep disorder in addition to ADHD.
Sleep apnoea can exacerbate executive function challenges, worsen emotional dysregulation, and lead to greater daytime fatigue—all of which are common issues in ADHD, especially in midlife.
The perimenopausal twist
Things became even more compelling when I read about the impact of hormonal changes on sleep.
During perimenopause and menopause, levels of oestrogen and progesterone decline. These hormones don’t just influence mood and temperature regulation—they also play a role in maintaining muscle tone in the upper airway and supporting regular breathing during sleep.
So when hormone levels drop, the risk of OSA increases significantly. Research shows that women going through perimenopause experience higher rates of sleep disorders, including OSA (Zhou et al., 2018). Another study reports that OSA is often underdiagnosed in women because symptoms can present differently—often as fatigue, insomnia, or mood issues rather than the classic “snoring and choking” presentation seen in men (De Sousa et al., 2022).
When I started to look at this all together, it was like a lightbulb moment.
The missing piece of the puzzle?
Many women report that their ADHD symptoms worsen significantly during perimenopause. This is often attributed to hormonal shifts—which is absolutely valid—but what if there’s more to it?
What if some of those “worsening” symptoms are being fuelled by untreated or undiagnosed sleep apnoea?
What if poor sleep quality is affecting working memory, motivation, emotional regulation, and energy levels—and we’re attributing it solely to ADHD or menopause, when in fact, it’s a more complex interaction?
For neurodivergent women in midlife, this may be a crucial missing piece of the puzzle.
Where do we go from here?
This is an area I’m deeply interested in exploring further—both in my coaching work and in my research. I’d love to see more awareness, more screening, and more integrated care for women experiencing ADHD, hormonal shifts, and sleep issues.
If you’re a perimenopausal woman who’s been diagnosed with ADHD—or suspect you might have it—and you’re also experiencing poor sleep, excessive fatigue, or waking unrefreshed, it might be worth exploring the possibility of sleep apnoea.
As a coach, I don’t diagnose or treat sleep disorders—but I do help women become curious about what else might be affecting their wellbeing. Because awareness is the first step to change.
References:
Sedky, K., Bennett, D. S., & Carvalho, K. S. (2020). Association between obstructive sleep apnoea and ADHD in adults. Journal of Clinical Sleep Medicine. PMC6874421
Sciberras, E., Song, J. C., Mulraney, M., Schilpzand, E. J., & Hiscock, H. (2017). Sleep problems in children with ADHD: associations with mental health and everyday functioning. Journal of Attention Disorders. PMC3676641
Zhou, E. S., Reid, K. J., Zee, P. C., & Attarian, H. (2018). Women’s sleep in midlife: A review of current findings. Menopause. PMC6092036
De Sousa, J. V., Madani, M., & Badr, M. S. (2022). Gender differences in obstructive sleep apnoea: Clinical implications. Sleep Medicine Clinics.PMC8712658