Associations of sleep disturbance with ADHD: implications for treatment

Atten Defic Hyperact Disord. 2015 Mar;7(1):1-18. doi: 10.1007/s12402-014-0151-0. Epub 2014 Aug 17.

Abstract

Attention-deficit/hyperactivity disorder (ADHD) is commonly associated with disordered or disturbed sleep. The relationships of ADHD with sleep problems, psychiatric comorbidities and medications are complex and multidirectional. Evidence from published studies comparing sleep in individuals with ADHD with typically developing controls is most concordant for associations of ADHD with: hypopnea/apnea and peripheral limb movements in sleep or nocturnal motricity in polysomnographic studies; increased sleep onset latency and shorter sleep time in actigraphic studies; and bedtime resistance, difficulty with morning awakenings, sleep onset difficulties, sleep-disordered breathing, night awakenings and daytime sleepiness in subjective studies. ADHD is also frequently coincident with sleep disorders (obstructive sleep apnea, peripheral limb movement disorder, restless legs syndrome and circadian-rhythm sleep disorders). Psychostimulant medications are associated with disrupted or disturbed sleep, but also 'paradoxically' calm some patients with ADHD for sleep by alleviating their symptoms. Long-acting formulations may have insufficient duration of action, leading to symptom rebound at bedtime. Current guidelines recommend assessment of sleep disturbance during evaluation of ADHD, and before initiation of pharmacotherapy, with healthy sleep practices the first-line option for addressing sleep problems. This review aims to provide a comprehensive overview of the relationships between ADHD and sleep, and presents a conceptual model of the modes of interaction: ADHD may cause sleep problems as an intrinsic feature of the disorder; sleep problems may cause or mimic ADHD; ADHD and sleep problems may interact, with reciprocal causation and possible involvement of comorbidity; and ADHD and sleep problems may share a common underlying neurological etiology.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Attention Deficit Disorder with Hyperactivity / drug therapy
  • Attention Deficit Disorder with Hyperactivity / epidemiology*
  • Attention Deficit Disorder with Hyperactivity / therapy*
  • Central Nervous System Stimulants / adverse effects
  • Central Nervous System Stimulants / therapeutic use
  • Comorbidity
  • Disease Management
  • Humans
  • Movement Disorders / drug therapy
  • Movement Disorders / epidemiology
  • Movement Disorders / therapy
  • Restless Legs Syndrome / drug therapy
  • Restless Legs Syndrome / epidemiology*
  • Restless Legs Syndrome / therapy*
  • Sleep Apnea, Obstructive / drug therapy
  • Sleep Apnea, Obstructive / epidemiology*
  • Sleep Apnea, Obstructive / therapy*
  • Sleep Disorders, Circadian Rhythm / drug therapy
  • Sleep Disorders, Circadian Rhythm / epidemiology*
  • Sleep Disorders, Circadian Rhythm / therapy*

Substances

  • Central Nervous System Stimulants