ADHD Wiki
English

Sleep problems

Full page: about 4 min Draft — not yet reviewed by a human

Summary

  • Sleep timing, habits, other sleep problems, or medication may contribute; self-control is not the whole explanation.
  • Sleep monitoring may differ from reported difficulties. Time to fall asleep and daytime effects both matter.
  • Record sleep changes during medication for review.

Trouble falling asleep can have several causes

Research-backed

A review of sleep in children and adolescents with attention deficit hyperactivity disorder (ADHD) discusses several contributors separately: sleep timing, bedtime habits, breathing or limb movement problems during sleep, coexisting mental health problems, and medication effects(Cortese et al., 2013). Adult insomnia guidelines also call for considering accompanying breathing or limb movement problems(Riemann et al., 2023).

A late bedtime alone is therefore insufficient reason to blame reluctance to stop an activity or poor self-control.

Monitoring cannot replace reported sleep difficulties

Research-backed

An adult ADHD meta-analysis found more self-reported sleep difficulties than in adults without ADHD. Actigraphy, which estimates sleep from movement, also showed longer times to fall asleep and lower sleep efficiency. Polysomnography, which records brain activity and other signals, found no significant group differences(Díaz-Román et al., 2018).

Sleep efficiency is the proportion of time in bed spent asleep. Time to fall asleep and daytime effects remain worth recording when describing sleep difficulties. A monitoring result cannot replace this information(Riemann et al., 2023).

Sleep changes during medication need a separate record

Research-backed

A meta-analysis of randomized controlled trials in children and adolescents found that stimulants increased time to fall asleep on average. They also reduced sleep efficiency and total sleep time. These findings may not apply to all adults(Kidwell et al., 2015).

NICE guidelines recommend recording sleep changes during medication, for example in a sleep diary, so a clinician can adjust treatment accordingly. The record supports a medication review; it is not a reason to stop medication independently(NICE, 2018).

Evidence

References (5)
  1. ConsensusAssessment and Management of Sleep Problems in Youths With Attention-Deficit/Hyperactivity DisorderCortese, Brown, Corkum, Gruber, O’Brien, Stein, Weiss, Owens (2013). Journal of the American Academy of Child & Adolescent Psychiatry
  2. GuidelineThe European Insomnia Guideline: An update on the diagnosis and treatment of insomnia 2023Riemann, Espie, Altena, Arnardottir, Baglioni, Bassetti, Bastien, Berzina, Bjorvatn, Dikeos, Dolenc Groselj, Ellis, Garcia‐Borreguero, Geoffroy, Gjerstad, Gonçalves, Hertenstein, Hoedlmoser, Hion, Holzinger, Janku, Jansson‐Fröjmark, Järnefelt, Jernelöv, Jennum, Khachatryan, Krone, Kyle, Lancee, Leger, Lupusor, Marques, Nissen, Palagini, Paunio, Perogamvros, Pevernagie, Schabus, Shochat, Szentkiralyi, Van Someren, van Straten, Wichniak, Verbraecken, Spiegelhalder (2023). Journal of Sleep Research
  3. Meta-analysisSleep in adults with ADHD: Systematic review and meta-analysis of subjective and objective studiesDíaz-Román, Mitchell, Cortese (2018). Neuroscience & Biobehavioral Reviews
  4. Meta-analysisStimulant Medications and Sleep for Youth With ADHD: A Meta-analysisKidwell, Van Dyk, Lundahl, Nelson (2015). Pediatrics
  5. GuidelineAttention deficit hyperactivity disorder: diagnosis and managementNICE (2018). NICE guideline NG87