Disorders That Never Sleep: How OCD, ADHD, and Tics Affect Your Sleep

People with disorders such as obsessive-compulsive disorder (OCD), ADHD, and chronic tics often also have sleep problems, such as insomnia or restless sleep. These disorders appear to be linked to changes in brain circuits and chemicals such as dopamine. However, we still know little about how these connections work. Understanding this relationship better could help create more effective treatments that improve both mental symptoms and sleep.

Disorders such as obsessive-compulsive disorder (OCD), chronic tic disorders (such as Tourette syndrome), and attention deficit hyperactivity disorder (ADHD) affect brain function and behavior in millions of people around the world.

Each of these conditions can have a major impact on daily life, influencing impulse control, attention, and involuntary movements.

In addition, many people with these disorders also report sleep problems, such as insomnia, difficulty getting restful sleep, or restless sleep. Despite this, the relationship between these conditions and sleep disorders is still not well understood.

Studies have shown that these disorders share changes in similar brain circuits. One of these circuits is the so-called cortico-striatal-thalamo-cortical circuit (CSTC), which connects different areas of the brain responsible for functions such as thinking, movement and decision-making.

This circuit works thanks to chemical substances called neurotransmitters, especially dopamine and GABA. When there is an imbalance in these substances or in this circuit, symptoms such as impulsivity, tics, obsessions or attention difficulties may appear, as well as problems sleeping.

Cortico-striatal-thalamo-cortical circuit

A review analyzed and gathered evidence that alterations in these brain circuits may underlie both the symptoms of neuropsychiatric disorders and the sleep disturbances that often accompany them.

In adults with OCD, tics or ADHD, complaints of insomnia or poor quality sleep are common. In some cases, sleep-related movement disorders have also been observed. In children and adolescents, however, research is still more limited, but there are signs that these patterns are also repeated.

An important point raised by the authors is that many studies to date have relied solely on subjective reports from patients, that is, on how they say they sleep, rather than on objective assessments such as polysomnography, which monitors sleep during the night. This limits the detailed understanding of what actually happens in the brain during sleep in these people.

Finally, the authors emphasize that better understanding how these conditions relate to sleep disorders can help find more effective treatments.

One of the key issues is knowing what to treat first: the underlying condition (such as OCD or ADHD), the sleep problems, or both at the same time. This type of knowledge can help doctors offer more personalized approaches, improving patients' quality of life more broadly and effectively.

READ MORE:

Disrupted Cortico-Striato-Thalamo-Cortical Circuitry and Sleep Disturbances in Obsessive-Compulsive Spectrum, Chronic Tic, and Attention-Deficit/Hyperactivity Disorders

Hall, Margaret D; Gipson, Kevin S; Gipson, Shih Yee-Marie Tan; Colvin, Mary K; Nguyen, Stephanie T.T; Greenberg, Erica

Harvard Review of Psychiatry 33(3):p 114-126, 5/6 2025. 

DOI: 10.1097/HRP.0000000000000429

Abstract:

The bidirectional relationship between sleep and obsessive-compulsive spectrum disorders (OCSDs), chronic tic disorders (CTDs), and attention-deficit/hyperactivity disorder (ADHD) is not well understood. To better treat individuals with these co-occurring sleep and developmental neuropsychiatric conditions, it is necessary to determine the common neural underpinnings to then target with treatment. Research has implicated dysregulated cortico-striatal-thalamo-cortical (CSTC) neurocircuitry in the development of CTDs, OCSDs, and ADHD. We review current literature to assess the state of knowledge about the neurocircuitry of OCSDs, CTDs, and ADHD, and their related sleep disturbances. Our review consistently implicates CSTC-pathway disruptions in OCSDs, CTDs, and ADHD, as well as dopamine and GABA dysregulation, primary neurotransmitters in CSTC circuitry, in sleep disorders. In addition, we highlight reports of subjective poor sleep and insomnia in adults with OCSDs, CTDs, and ADHD, and sleep movement disorders in adults with CTDs. The limited sleep research on youth with these conditions has demonstrated some similar findings. Unfortunately, much of the current research to date has not employed polysomnographic methods for objective sleep-related assessments. Future research should further clarify the neural association between these neuropsychiatric conditions and sleep disturbances to better guide potential therapeutic targets. Determining the most effective treatments for subjective sleep-related complaints in patients with these conditions will be crucial, particularly for determining treatment course—whether to prioritize treatment of the underlying condition, the specific sleep symptoms, or both simultaneously.