Restless Nights & Racing Minds: Sleep and ADHD in Midlife Women

Why it’s not “just stress”—and what you can do about it

At the Autism ADHD Centre, we regularly hear a version of the same story from high-achieving, midlife women:
“I get into bed exhausted... and then my brain kicks into gear.”

There’s work to revisit. A conversation to replay. An entire calendar to reorganise at 2am. Add to that the hormonal shifts of perimenopause or menopause—and suddenly, sleep isn’t just elusive. It feels like a battleground.

It’s a familiar frustration, especially for women navigating (or wondering about) a late ADHD diagnosis. Because while we often associate ADHD with hyperactivity, it’s the invisible symptoms—like racing thoughts, restlessness, or trouble switching off—that quietly disrupt some of the most essential rhythms of life. Sleep included.

Why is sleep so hard for women with ADHD?

ADHD is a neurodevelopmental condition that affects the brain’s ability to regulate attention, behaviour, and—crucially—arousal and alertness. Research suggests that up to 75% of adults with ADHD report difficulty falling or staying asleep [1]. And for many women, especially those undiagnosed until midlife, these issues are compounded by hormonal fluctuations, lifestyle demands, and the ever-present mental load.

The result? A cycle that’s hard to break: poor sleep affects executive functioning, emotional regulation and focus. These are already vulnerable areas for people with ADHD. Without restorative sleep, the challenges compound.

But I’m coping... does it really matter?

It’s a fair question. Many women with ADHD present as outwardly successful. You may have built a thriving career, managed a household, and learned to mask or work around your symptoms for decades. But if sleep is the one thing that continues to feel out of reach—it’s worth listening to that.

Because quality sleep isn’t just about rest. It’s about resilience. It's the foundation for decision-making, energy regulation, and emotional bandwidth. When sleep falters, everything else becomes harder.

The Hormone Factor

For women over 40, there’s often another layer to consider: perimenopause and menopause. Oestrogen and progesterone—which influence everything from serotonin production to body temperature—also play a key role in sleep quality. As these hormones fluctuate, many women experience night sweats, insomnia, and increased anxiety. For those with ADHD (diagnosed or not), these symptoms can intensify existing struggles.

This overlap is still under-researched, but growing awareness is helping shift the conversation. In 2023, ADHD UK and Balance Menopause published a joint statement calling for better support and recognition for women managing ADHD alongside hormonal transitions [2].

3 Practical Ways to Support Sleep (Even When Your Brain Won’t Switch Off)

These are not one-size-fits-all fixes—but they are gentle starting points, rooted in what we’ve seen help many of the women we support:

1. Create a ‘landing routine’ instead of a bedtime routine.
For brains that struggle to transition, it’s not enough to “just go to bed.” Try starting your wind-down 30–45 minutes before sleep, with calming sensory cues: dim lighting, a warm shower, or soft background sound. Think of it as preparing your nervous system to land.

2. Stop trying to “earn” your rest.
This one’s cultural as much as neurological. Many women with ADHD are chronic overfunctioners. But sleep isn’t a reward for productivity—it’s a biological need. Giving yourself permission to rest, even if the dishwasher isn’t loaded, can be surprisingly powerful.

3. Track patterns—not perfection.
Instead of aiming for 8 perfect hours, try noticing what tends to help (or hinder) your sleep. Was your mind racing after a long Zoom day? Did your best night’s sleep follow an evening walk? This kind of pattern-tracking can offer insight—and shift your focus from blame to curiosity.

Wondering if ADHD might explain more than just poor sleep?

It’s a common experience. Many women come to us not because of overt symptoms, but because of subtle, persistent struggles that don’t quite add up—like decades of sleep issues, constant mental noise, and a sense that “everyone else finds this easier.”

We offer comprehensive adult assessments for ADHD, autism, or both. Our approach is neurodivergent-affirming, compassionate, and tailored to adults who may have been missed earlier in life.

Sleep difficulties alone don’t mean you have ADHD. But if they’re part of a broader picture, it may be worth exploring.

You don’t need to wait until burnout to ask the question.

References:
[1] Weiss et al. (2015). Sleep and ADHD: A review of the literature. Journal of Attention Disorders.
[2] Balance & ADHD UK (2023). ADHD, Perimenopause and Menopause: The Overlooked Overlap. www.balance-menopause.com