Chapter 6 - ADHD Medications and Sleep

Abstract

Difficulties with sleep initiation and maintenance frequently occur in children with attention-deficit hyperactivity disorder (ADHD). All stimulants can produce insomnia, with little empirical data to suggest that there are substantial differences in sleep onset latency for the different stimulant formulations. While most children fall asleep with 15–20minutes, children taking stimulant medications often take longer to fall asleep, especially during initial treatment and with dose increases. Insomnia related to stimulant medication appears to be dose-dependant, with 20%–30% of children treated in controlled trials taking more than 30minutes to fall asleep when using low to moderate stimulant dosages. When initiating pharmacotherapy for ADHD, sleep patterns should be closely monitored. Sleep hygiene and behavioral procedures to reduce bedtime problems should be emphasized at all phases of ADHD treatment. If insomnia persists after initiating an effective ADHD treatment, alternative dosages, formulations, timing of administration or medications should be considered to produce optimal benefit during the day without compromising sleep. Presumably, reducing the variability in sleep–wake cycles due to ADHD pharmacotherapy will promote attention and alertness during the day.