Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder marked by persistent inattention, hyperactivity, and impulsivity. A growing body of research highlights a significant association between ADHD and sleep disturbances, with evidence suggesting that sleep issues both exacerbate ADHD symptoms and may play a role in the disorder’s presentation.
A recent study found that 43% of adults with ADHD reported significant insomnia and 41% with short sleep duration (Wynchank et al., 2018). These disturbances were then, in turn, linked to worsening ADHD symptoms, including heightened impulsivity and inattention (Wynchank et al., 2018).
The mechanisms underlying this relationship are complex. However, one key factor is thought to be the disruption of the body’s circadian rhythm (the body’s internal clock). This involves the delayed secretion of melatonin, the primary hormone controlling our sleep-wake cycle, resulting in later sleep onset and reduced total sleep duration (Van Veen et al., 2010).
Additionally, pharmacological treatments for ADHD, particularly stimulant medications such as methylphenidate and amphetamines, can further disrupt sleep. These medications, which enhance neurological hormone activity, consequently improving attention and focus, have been shown to reduce sleep duration and delay sleep onset, especially when administered late in the day(Faraone, 2019). However, worse sleep will intrinsically result in worse cognitive function, impairing focus and attention even with medication intervention (Van Veen et al., 2010)(Santisteban et al., 2014).
Given the bidirectional relationship between sleep and ADHD, addressing sleep disturbances is crucial for managing ADHD symptoms. Behavioural interventions, including improved sleep hygiene and consistent sleep-wake schedules, have been shown to improve both sleep and symptom severity (Martin, 2020). Pharmacologic treatments, such as melatonin supplementation, may be considered in certain cases, though they should be used cautiously and under medical supervision.
References
1. Wynchank D, Ten Have M, Bijlenga D, et al. The Association Between Insomnia and Sleep Duration in Adults With Attention-Deficit Hyperactivity Disorder: Results From a General Population Study. J Clin Sleep Med. 2018; 14(3):349–57. https://doi.org/10.5664/jcsm.6976
2. Van Veen MM, Kooij JJS, Boonstra AM, Gordijn MCM, Van Someren EJW. Delayed Circadian Rhythm in Adults with Attention-Deficit/Hyperactivity Disorder and Chronic Sleep-Onset Insomnia. Biol psychiatry. 2010;67(11):1091-6. doi:10.1016/j.biopsych.2009.12.032
3. Faraone SV, Po MD, Komolova M, Cortese S. Sleep-Associated Adverse Events During Methylphenidate Treatment of Attention-Deficit/Hyperactivity Disorder: A Meta-Analysis. J Clin Psychiatry. 2019;80(3):18r12210. https://doi.org/10.4088/JCP.18r12210
4. Santisteban JA, Stein MA, Bergmame L, Gruber R. Effect of Extended-Release Dexmethylphenidate and Mixed Amphetamine Salts on Sleep: A Double-Blind, Randomized, Crossover Study in Youth with Attention-Deficit Hyperactivity Disorder. CNS drugs. 2014;28(9):825-833. doi:10.1007/s40263-014-0181-3
5. Martin, CA, Hiscock H, Rinehart N, et al. Associations Between Sleep Hygiene and Sleep Problems in Adolescents With ADHD: A Cross-Sectional Study. J Atten Disord. 2020;24(4):545-54. https://doi.org/10.1177/1087054718762513
