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“[T]here is a consistent association between sleep problems and symptoms of ADHD.”1

  • Dr. Heather Schneider, et al

“[T]here is a consistent association between sleep problems and symptoms of ADHD.”1

  • Dr. Heather Schneider, et al

ADHD is commonly associated with disturbed sleep2

62%

Based on parent reports, children with attention-deficit/hyperactivity disorder (ADHD) are 2 to 3 times more likely to experience sleep disturbances vs their neurotypical peers.3 Data indicate that 62% of pediatric patients with ADHD have moderate to severe sleep problems,2 including:

  • Circadian-based phase delays4
  • Nighttime awakening2
  • Restless leg syndrome and/or periodic limb movement disorder2

AAP clinical guidelines recommend screening children or adolescents with ADHD for symptoms of primary sleep disorders.4

ADHD and sleep disturbances share a common neurobiologic etiology2,5

Overlapping areas of the brain are implicated in both ADHD and sleep dysfunction

  • The dorsolateral and ventral prefrontal cortex, brain regions involved in ADHD, also regulate arousal and are sensitive to sleep deprivation1
  • Delayed response to melatonin and dysfunctional thermoregulation, which cause sleep dysfunction, have been identified in patients with ADHD6

Insomnia in ADHD has been shown to worsen ADHD symptoms

While it can be difficult to know what is causing a lack of sleep for your patients, we do know that insomnia can worsen ADHD symptoms.2 Shorter sleep duration has even been shown to predate the onset of clinical symptoms of ADHD.1

  • Disturbed sleep patterns may lead to daytime sleepiness, which in turn, exacerbates ADHD symptoms, behavioral difficulties, and functional impairment2
  • Research has shown that ADHD severity, especially the severity of hyperactivity, is associated with both the current and persistent presence of sleep problems7
    • In particular, difficulty with sleep initiation and maintenance and shortened sleep duration are associated with more severe hyperactivity in ADHD7
Sleep Disturbances

Factors to consider to improve sleep and bedtime behavior in ADHD patients

Management of sleep disorders should always start with sleep hygiene interventions, such as2:

Routine bed and waking times
Routine bed and waking times
A dark, quiet, and temperature-controlled sleep space
A dark, quiet, and temperature-controlled sleep space
Avoidance of television or “screen time” before bed
Avoidance of television or “screen time” before bed

It is also important to consider the effect of your patients’ current ADHD treatments on sleep:

Both stimulants and nonstimulants may have direct effects on sleep architecture
Both stimulants and nonstimulants may have direct effects on sleep architecture3
Inadequate nighttime control of ADHD symptoms (eg, medication wearing off) also indirectly impacts sleep
Inadequate nighttime control of ADHD symptoms (eg, medication wearing off) also indirectly impacts sleep

Comorbid sleep problems and their associated impairment may warrant consideration as an additional target for treatment.7 Explore more on the management of comorbidities in ADHD here.

Abbreviation: AAP, American Academy of Pediatrics.

More to ADHD

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References:1. Schneider HE, Lam JC, Mahone EM. Sleep disturbance and neuropsychological function in young children with ADHD. Child Neuropsychol. 2016;22(4):493-506. 2. Hvolby A. Associations of sleep disturbances with ADHD: implications for treatment. Atten Defic Hyperact Disord. 2015;7(1):1-18. 3. National Resource Center on ADHD. ADHD, sleep and sleep disorders factsheet. https://chadd.org/about-adhd/adhd-and-sleep-disorders/. Accessed November 12, 2019. 4. Subcommittee on Attention-Deficit/Hyperactivity Disorder, Steering Committee on Quality Improvement Management, Wolraich M, et al. Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents: Supplement. Pediatrics. 2019;144(4):1-43. 5. Munz MT, Prehn-Kristensen A, Thielking F, Mölle M, Göder R, Baving L. Slow oscillating transcranial direct current stimulation during non-rapid eye movement sleep improves behavioral inhibition in attention-deficit/hyperactivity disorder. Front Cell Neurosci. 2015;9:307. 6. Bijlenga D, Van Someran EJW, Gruber R, et al. Body temperature, activity and melatonin profiles in adults with attention-deficit/hyperactivity disorder and delayed sleep: a case-control study. J Sleep Res. 2013;22:607-616. 7. Vogel SWN, Bijlenga D, Benjamins JS, Beekman ATF, Kooij JJS, Van Somerern EJW. Attention deficit hyperactivity disorder symptom severity and sleep problems in adult participants of the Netherlands sleep registry. Sleep Med. 2017;40:94-102.