Adult Attention-Deficit/Hyperactivity Disorder (ADHD) and Insomnia: an Update of the Literature

Nov 1, 2017Current psychiatry reports

Adult ADHD and Insomnia: Updated Research Findings

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Circadian Biology on OpenScience ↗PubMed ↗DOI ↗

Abstract

Insomnia prevalence in adults with ADHD ranges from 43% to 80%.

Insomnia is diagnosed based on dissatisfaction with sleep quantity or quality.
Mixed longitudinal evidence exists regarding the link between childhood ADHD and later insomnia.
Insomnia occurs significantly more often in adults with ADHD undergoing pharmacological treatment compared to those receiving placebo.
Specific medications associated with insomnia as a side effect include mixed amphetamine salts (40-45%), dasotraline (35-45%), and others.
Genetic and environmental factors may contribute to the relationship between ADHD and sleep problems.

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PURPOSE OF REVIEW: Insomnia is diagnosed when there is dissatisfaction with sleep quantity or quality. It has a prevalence in the general population ranging from 31 to 56%. Insomnia has previously been associated with adult attention-deficit/hyperactivity disorder (ADHD). In this review, we address three topics: (1) the cross-sectional relationship between ADHD and insomnia in adulthood, (2) the longitudinal relationship between ADHD and insomnia, and (3) insomnia as a side effect of pharmacological treatments for adult ADHD.

RECENT FINDINGS: Three cross-sectional, clinical, and population studies report a prevalence of insomnia in ADHD adults ranging from 43 to 80%. Longitudinal evidence for a link between childhood-onset ADHD and insomnia at later age is mixed, with one study confirming and another study not supporting such a longitudinal association. In randomized, placebo-controlled trials, insomnia is reported significantly more often in the treatment arm than in the placebo arm. In varying percentages of trial participants, insomnia is a treatment-emergent adverse effect in triple-bead mixed amphetamine salts (40-45%), dasotraline (35-45%), lisdexamfetamine (10-19%), and extended-release methylphenidate (11%). Ten to seventeen percent of subjects in placebo-controlled trials of atomoxetine report insomnia, possibly related to poor metabolizer status. The mechanisms explaining the relationship between ADHD and sleep problems are incompletely understood, but both genetic and non-shared environmental influences may be involved. Adults with ADHD should be assessed for insomnia, which is frequently comorbid, and both conditions should be treated.

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Adult Attention-Deficit/Hyperactivity Disorder (ADHD) and Insomnia: an Update of the Literature

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