What Is the Connection Between ADHD Medications and Sleep Problems?By Dr. Mary Rooney, Ph.D.
Kids with ADHD often struggle with falling asleep and staying asleep. Studies have shown that kids with ADHD have higher rates of sleep disorders, like sleep-disordered breathing or restless leg syndrome, and experience more daytime sleepiness than kids without ADHD. Many parents worry that giving their child a stimulant medication, like Concerta, Focalin, Ritalin, or Adderall, to treat their ADHD symptoms will only make sleep problems worse or cause new sleep problems for a child who hasn’t had difficulty with sleep up to this point.
For decades, there have been conflicting opinions and research findings about whether ADHD medications cause sleep problems for kids with ADHD. Some professionals have suggested that stimulant medications can ultimately improve sleep for some kids with ADHD. Others have suggested that stimulant medications don’t cause sleep problems in ADHD, but they make sleep difficulties worse in kids who already experience a secondary sleep disorder.
The most definitive answer to the question came from a large study published in Pediatrics in 2015.1 This study pooled data from seven smaller studies in an effort to draw more definitive conclusions. Ultimately, the 2015 paper concludes that stimulant medications do result in sleep problems for some children. In their results, the exact percentage of children experiencing sleep problems was different based on the medication they were taking. As one example, about 20% of kids taking Ritalin experienced greater difficulty falling asleep. However, no single medication caused significantly worse sleep problems than the others.
There were a couple of individual factors that helped explain why some kids were experiencing sleep problems while others were not. First, kids who took ADHD medications multiple times throughout the day, rather than once in the morning, were more likely to experience sleep difficulties. This is likely because kids who took multiple doses still had stimulant medication in their system while they were trying to sleep. As a possible solution, the study authors recommend trying a single extended-release dose in the morning as an alternative to multiple doses. For kids who already take an extended-release formulation but also take a “booster dose” later in the afternoon, the researchers suggest talking with the prescribing doctor about the timing and duration of the booster medication.
A second factor that influenced sleep problems was the number of days the child had been taking the medication during the study period. Kids who had been taking ADHD medication longer experienced sleep problems that were less severe than kids who only began taking the medication recently. The authors suggest it’s possible that a child’s body adjusts to the medication over time, and sleep problems may gradually improve. In addition to these factors, it’s well known that medications affect each child differently, and while one medication may cause sleep problems, it’s possible that another stimulant medication would come with fewer side effects. So, there are many ways that your child’s pediatrician or psychiatrist may be able to help find a medication and dosing schedule that works for your child.
Stimulant medications for ADHD can be very effective for treating ADHD symptoms like inattention, hyperactivity, and impulsivity when they are used alone or in combination with behavioral interventions. They are a first-line treatment for many kids with ADHD or a second-line treatment for kids who don’t respond to behavioral interventions alone. However, medications do come with the potential for side effects, and all parents have to weigh the pros and cons when making the decision to add medication to a child’s ADHD treatment plan.
ABOUT DR. MARY ROONEY
Mary Rooney, Ph.D., is a licensed clinical psychologist in the Department of Psychiatry at the University of California San Francisco. Dr Rooney is a researcher and clinician specializing in the evaluation and treatment of ADHD and co-occurring behavioral, anxiety, and mood disorders. A strong advocate for those with attention and behavior problems, Dr. Rooney is committed to developing and providing comprehensive, cutting edge treatments tailored to meet the unique needs of each child and adolescent. Dr. Rooney's clinical interventions and research avenues emphasize working closely with parents and teachers to create supportive, structured home and school environments that enable children and adolescents to reach their full potential. In addition, Dr. Rooney serves as a consultant and ADHD expert to Huntington Learning Centers.
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