Perimenopause insomnia and ADHD: When insomnia is the “look-alike”
- Kiesa Kelly
- 4 days ago
- 7 min read
If you are in midlife and thinking, “I can’t focus like I used to,” you are not alone. Perimenopause insomnia and ADHD can feel almost indistinguishable in day-to-day life: brain fog, distractibility, irritability, and a short fuse. Before you label yourself as “lazy” or “broken,” it is worth asking a simpler question: How has your sleep been?
In this article, you’ll learn:
Why poor sleep can mimic ADHD symptoms so convincingly
The most common perimenopause sleep disruptions that drive cognitive symptoms
How ADHD and sleep problems can intensify each other
What a high-quality adult ADHD assessment looks at (and why it matters)
A simple 2-week log you can start today to bring clarity
🧠 Key takeaway: When attention and mood shift during perimenopause, sleep is often the missing variable worth measuring first.
Perimenopause insomnia and ADHD: Why sleep can mimic ADHD so convincingly
Poor sleep hits attention, memory, and emotion regulation
Sleep is not just “rest.” It is fuel for sustained attention, working memory, and the executive functions that help you plan, prioritize, and switch tasks. Even short-term sleep loss can reduce sustained and selective attention, and can make inhibition and mental flexibility harder. That combination looks like classic “ADHD day” for many people. [1]
“I can’t focus” may be a sleep signal, not a character flaw
When you are under-slept, your brain becomes more reactive. Small stressors feel bigger. You may forget what you walked into the room for, reread the same paragraph three times, or lose track mid-sentence. That is not a moral failure. It is often a nervous system doing its best with limited recovery time.
💡 Key takeaway: “I can’t focus” is sometimes your brain’s way of saying “I can’t recover.”
Midlife sleep disruption is common and deserves real attention
Sleep complaints rise during the menopausal transition, and awakenings are a particularly common pattern. Vasomotor symptoms (hot flashes and night sweats), mood changes, and life stress can all contribute to sleep fragmentation. [2,3]
Perimenopause sleep issues that commonly drive cognitive symptoms
Night sweats, awakenings, early morning waking
Night sweats and hot flashes can jolt you awake repeatedly. Some people fall back asleep quickly but never reach deeper, restorative stages consistently. Others lie awake for long stretches, then wake early and cannot return to sleep. Over time, that can create a steady state of sleep debt, even if you spend “enough” hours in bed. [2,3]
Anxiety spikes at night and “brain won’t turn off”
Many people describe a nighttime loop: you wake up, notice you are awake, start thinking about tomorrow, and then the mind accelerates. Perimenopause can increase vulnerability to anxiety and mood symptoms, and those can amplify cognitive complaints the next day. [2,3]
Fragmented sleep → daytime brain fog and irritability
Fragmented sleep does not just make you tired. It can also blunt processing speed, increase emotional reactivity, and reduce frustration tolerance. People may interpret this as “I’m becoming an anxious person” or “I’m losing my edge,” when the driver is often chronic, disrupted sleep. [1,4]
⚡ Key takeaway: Brain fog from insomnia is real, and it often improves when sleep becomes more consolidated.
How ADHD and sleep problems interact
ADHD can make wind-down and consistency harder
If you have ADHD traits, you may be more likely to “second wind” at night, lose track of time, or struggle with consistent routines. Some people do not feel sleepy until very late. This is not simply poor discipline; there can be meaningful differences in arousal and circadian timing in ADHD. [7]
Sleep loss increases distractibility and overwhelm
Sleep deprivation can increase distractibility and overwhelm even in people without ADHD. In people with ADHD, it can magnify baseline challenges. Research in adults with ADHD also finds high rates of insomnia symptoms and insomnia disorder, which can add impairment on top of ADHD itself. [7,8]
The cycle: stress → insomnia → worse executive function
Once the cycle starts, it tends to self-reinforce:
You sleep poorly.
Your executive function drops.
Work, parenting, and life feel harder.
Stress rises.
Sleep gets even worse.
🔁 Key takeaway: Breaking the sleep-stress loop often restores more clarity than trying to “power through” with willpower.
How a good assessment separates sleep effects from ADHD
A high-quality adult ADHD assessment is not a 5-minute quiz. It is a careful process designed to answer: Is this lifelong ADHD, sleep-driven cognitive strain, another condition, or a combination? Quality standards emphasize a thorough interview, real-life examples of symptoms and impairment, and attention to differential diagnosis. [9]
Timeline: lifelong attention issues vs new or worsening with sleep changes
One of the most helpful questions is, “When did this start?”
More consistent with ADHD: attention, organization, and follow-through challenges that go back to childhood or adolescence, across multiple settings (school, work, home).
More consistent with sleep-related changes: a relatively new onset of “ADHD-like” symptoms that track closely with worsening insomnia, night sweats, or early morning waking.
Patterns: are symptoms dramatically better after good sleep?
If you occasionally get a solid night and feel noticeably more focused, calm, and capable the next day, that is meaningful data. It does not rule out ADHD, but it strongly suggests sleep is a major contributor.
Screening for sleep disorders and other contributors
A good evaluation also considers other factors that can masquerade as ADHD symptoms, such as:
Sleep disorders (insomnia disorder, sleep apnea, restless legs, circadian rhythm issues)
Anxiety, depression, trauma-related hyperarousal
Medication effects and substance use (including alcohol as a sleep disruptor)
Medical contributors (for example, thyroid concerns) in coordination with your medical team
If you are looking for an online ADHD assessment in Tennessee, it is especially important to choose a provider who evaluates sleep and other contributors rather than diagnosing from a short screener alone.
✅ Key takeaway: The goal is not to “prove ADHD.” The goal is to explain your symptoms accurately so your plan actually works.
What to track before your evaluation
A simple 2-week sleep + symptom log
For 14 days, jot down:
Bedtime and wake time (including awakenings)
Estimated time to fall asleep
Night sweats or hot flashes (yes/no, severity 0–3)
Morning energy (0–10)
Focus and brain fog (0–10)
Irritability or emotional volatility (0–10)
You do not need a perfect tracker. You need a pattern.
Triggers: caffeine, alcohol, stress, hot flashes, schedule shifts
Track potential “sleep thieves,” such as:
Caffeine after lunch
Alcohol (even if it helps you fall asleep, it often disrupts the second half of the night)
Late-night scrolling or work
High-stress days
Temperature changes and hot flashes
Functional impact: safety, work errors, emotional volatility
Write down real-life outcomes:
Driving drowsy or near-misses
Work mistakes, missed deadlines, forgotten appointments
Increased conflict, tearfulness, or feeling “not like yourself”
📓 Key takeaway: Symptom logs turn vague worry into usable information for you and your clinician.
What “next steps” can look like after clarity
Coordinating sleep support with your medical team
Because perimenopause symptoms and sleep often overlap, coordinated care matters. Many people benefit from discussing vasomotor symptoms, mood, and sleep options with their prescribing clinician or OB-GYN, while also working on evidence-based insomnia strategies.
When insomnia is present, cognitive behavioral therapy for insomnia (CBT-I) is strongly recommended as a first-line treatment for chronic insomnia, and it has been shown to improve insomnia in peri- and postmenopausal women, including those with hot flashes. [5,6]
If you want to learn more about clinical sleep care, explore our page on insomnia treatment and CBT-I.
When ADHD assessment is still warranted (and helpful)
Sometimes the answer is “both.” You might have lifelong ADHD that becomes more visible when sleep is disrupted. Or you may have sleep-driven cognitive strain that still benefits from executive function supports.
If ADHD assessment is appropriate, you can review what an adult evaluation may include on our Adult ADHD assessment and psychological assessments pages.
Tennessee telehealth pathway + what documentation typically includes
For Tennessee residents, a telehealth ADHD evaluation may include:
A detailed clinical interview (developmental history, symptom timeline, impairment)
Standardized rating scales and collateral information when available
Screening for sleep problems and common comorbidities
A clear written summary and recommendations, which may support coordination with your medical providers
If you are building practical systems alongside evaluation and treatment, you may also benefit from executive function coaching and our mental health screening resources.
Summary and next steps
Perimenopause can bring real sleep disruption, and sleep disruption can produce attention problems that look like ADHD. The most helpful approach is usually not “guessing” but gathering evidence: track sleep and symptoms, address insomnia with proven supports, and pursue a quality assessment when the picture is still unclear.
If you are ready to talk through next steps, you can start with:
The ASRS ADHD screening tool as a conversation starter (not a diagnosis)
A free consult to discuss telehealth options and fit
🤝 Key takeaway: Clarity comes faster when you treat sleep as a data point, not an afterthought.
About the Author
Dr. Kiesa Kelly is a psychologist and neuropsychologist by training at ScienceWorks Behavioral Healthcare. She brings 20+ years of experience with psychological assessment and has specialized clinical and research training in ADHD.
Dr. Kelly earned her PhD in Clinical Psychology with a concentration in Neuropsychology and completed advanced training experiences across major academic medical centers, including an NIH-funded postdoctoral fellowship focused on ADHD. She is available via telehealth in Tennessee and many other states.
References
García A, Del Angel J, Borrani J, Ramirez C, Valdez P. Sleep deprivation effects on basic cognitive processes: which components of attention, working memory, and executive functions are more susceptible to the lack of sleep? Sleep Sci. 2021;14(2):107-118. https://doi.org/10.5935/1984-0063.20200049
Baker FC, Lampio L, Saaresranta T, Polo-Kantola P. Sleep and sleep disorders in the menopausal transition. Sleep Med Clin. 2018;13(3):443-456. https://doi.org/10.1016/j.jsmc.2018.04.011
Troìa L, Garassino M, Volpicelli AI, Fornara A, Libretti A, Surico D, Remorgida V. Sleep Disturbance and Perimenopause: A Narrative Review. J Clin Med. 2025;14(5):1479. https://doi.org/10.3390/jcm14051479
Ballesio A, Aquino MRJV, Kyle SD, Ferlazzo F, Lombardo C. Executive Functions in Insomnia Disorder: A Systematic Review and Exploratory Meta-Analysis. Front Psychol. 2019;10:101. https://doi.org/10.3389/fpsyg.2019.00101
McCurry SM, Guthrie KA, Morin CM, et al. Telephone Delivered Cognitive-Behavior Therapy for Insomnia in Midlife Women with Vasomotor Symptoms: An MsFLASH Randomized Trial. JAMA Intern Med. 2016;176(7):913-920. https://doi.org/10.1001/jamainternmed.2016.1795
Edinger JD, Arnedt JT, Bertisch SM, et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2021;17(2):255-262. https://doi.org/10.5664/jcsm.8986
Surman CBH, Walsh DM. Managing Sleep in Adults with ADHD: From Science to Pragmatic Approaches. Brain Sci. 2021;11(10):1361. https://doi.org/10.3390/brainsci11101361
Fadeuilhe C, Daigre C, Richarte V, et al. Insomnia Disorder in Adult Attention-Deficit/Hyperactivity Disorder Patients: Clinical, Comorbidity, and Treatment Correlates. Front Psychiatry. 2021;12:663889. https://doi.org/10.3389/fpsyt.2021.663889
Adamou M, Arif M, Asherson P, et al. The adult ADHD assessment quality assurance standard. Front Psychiatry. 2024;15:1380410. https://doi.org/10.3389/fpsyt.2024.1380410
Disclaimer
This article is for informational purposes only and is not a substitute for professional medical or mental health advice, diagnosis, or treatment. If you have urgent safety concerns, seek immediate help or call emergency services.
