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ADHD and Sleep

ADHD and Sleep. Roberto Olivardia, Ph.D. Harvard Medical School Roberto_olivardia@hms.harvard.edu. Common Sleep Issues/Disorders. Difficulty falling asleep (even as an infant) Unwilling to nap even when exhausted Feel more alert/energized after dark (10PM) Go to bed late (2AM)

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ADHD and Sleep

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  1. ADHD and Sleep Roberto Olivardia, Ph.D. Harvard Medical School Roberto_olivardia@hms.harvard.edu

  2. Common Sleep Issues/Disorders • Difficulty falling asleep (even as an infant) • Unwilling to nap even when exhausted • Feel more alert/energized after dark (10PM) • Go to bed late (2AM) • Difficulty awakening (regardless of ample sleep) • Difficulty in maintaining alertness during day (borderline narcolepsy) “Primary Disorder of Vigilance” • Sleep talking, sleepwalking, bruxism, bedwetting

  3. Sleep Disorders • Obstructive Sleep Apnea • Narcolepsy • Restless Leg Syndrome • Night Terrors • Sleep Walking

  4. How Sleep Issues Affect ADHD • Increased hyperactivity • Increased inattentiveness • Moodiness, Irritability • 1 hour of sleep loss, 3 nights in a row impacts vigilance on Continuous Performance Test • Lower metabolism, Increased appetite. Lead to obesity

  5. Studies looking at sleep in ADHD populations • Cortese et al meta-analysis: 722 kids with ADHD and 638 Controls: ADHD had significantly higher bedtime resistance, more sleep onset difficulties, night awakenings, difficulties with morning awakenings, sleep disordered breathing, and daytime sleepiness compared with controls. Apnea-hypopnea index sig higher in ADHD children than controls. Lower sleep efficiency, true sleep time

  6. Theories: ADHD and Sleep • Biological/Neurological • Behavioral • Genetic

  7. Treatment • GET SLEEP STUDY • Melatonin • Modafinil (Provigil) • Stimulants • SSRI’s (if depression/anxiety is comorbid) • Caffeine? • Surgical Procedures: Tonsillectomy, Septoplasty • CPAP (noncompliance common) • No naps • Work on getting to bed early 20 minute intervals earlier

  8. Treatment • Introduce stimulating sensory to daytime sleepiness • Relaxation exercises/Deep breathing • Warm bath • UNPLUG • Change in pajamas • Dim lights • Climate control • Sound machines • Light music on repeat • Eye masks/dark rooms • Singing to child, co-sleeping • Assess patient’s motivation to change sleep pattern

  9. ADHD and Sleep Roberto Olivardia, Ph.D. Harvard Medical School Roberto_olivardia@hms.harvard.edu

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