Abstract
BackgroundSleep disturbances, including insomnia, are common in adult Attention Deficit Hyperactivity Disorder (ADHD). Treatment of choice for insomnia is cognitive behavioral therapy (CBT-i), but evidence is lacking for CBT-i in patients with ADHD.The purpose of this study was to investigate if patients with insomnia and other sleep problems, at a specialist clinic for ADHD, benefit from a group delivered behavioral treatment based on CBT-i; whether insomnia severity improves following this treatment.MethodsThis pragmatic within-group pilot study with a pre to post and three-month follow-up design was set at a specialist psychiatric out-patient clinic for adult ADHD.As an adjunct to care-as-usual at the clinic, a CBT-i-based group treatment targeting several sleep problems prevalent in the ADHD–population, was offered as 10 weekly 90-min group sessions and scheduled telephone support.All outcome measures were subjectively reported by participants. Data analyzed with dependent t-tests according to intent-to-treat.ResultsNineteen patients (37 [SD 13.7] years; 68% female) with ADHD and subjectively reported sleep problems provided informed consent and pre-treatment measures. Patients had suffered from sleep problems for 15.3 [SD 13.4] years, 42% used sleep medications, 79% used stimulant medication(s).At post-treatment, insomnia severity (Insomnia Severity Index; score range 0–28) had improved with 4.5 points (95% CI, 2.06–6.99, p = .002), at 3 months with 6.8 points (95% CI, 4.71–8.91, p < .0001) from pre-treatment.ConclusionsCBT-i adjusted for ADHD is promising for improving insomnia severity in adult patients at specialist psychiatric out-patient clinics, who suffer from ADHD and sleep disturbances.Trial registrationStudy registered with the Regional ethical review board in Stockholm, January 13th 2016, Study id: 2015/2078–31/1. Study registered retrospectively with Clinicaltrials.org, February 21st 2019, ID: NCT03852966.
Highlights
Sleep disturbances, including insomnia, are common in adult Attention Deficit Hyperactivity Disorder (ADHD)
Telephones in bed and other Sleep hygiene practices. In this pragmatic within-group pilot study, a novel group intervention based on Cognitive behavioral therapy (CBT) for insomnia, adjusted for patients with ADHD (CBT-i/ADHD), was investigated in a clinical setting
We found an improvement in ADHD symptoms at three-month follow-up compared to pre-treatment
Summary
Sleep disturbances, including insomnia, are common in adult Attention Deficit Hyperactivity Disorder (ADHD). Patients with ADHD often have several comorbid conditions [6], including sleep-wake problems. Adults with ADHD report more sleep problems than healthy controls [7, 8]. I.e. a delayed circadian rhythm, is common [12,13,14], and can cause difficulties with both falling asleep and waking up early. These difficulties may be due to an altered endogenous rhythm, but may be maintained by late habits due to executive difficulties
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