Sleep Problems Associated with Stimulant Medications: Trading Attention Deficit for Sleep Deficit

BY: Nicole Beurkens
February 9, 2016

Sleep problems caused by stimulant medications commonly used to treat ADHD could negate the benefits of these drugs.

It’s estimated that Attention Deficit Hyperactivity Disorder (ADHD) affects 11% of children and adolescents in the United States. Despite the fact that there are many effective non-medication treatments available, the most common treatment is medication. Over 3.5 million children receive prescriptions for stimulant medications in the US alone.

Stimulants like methylphenidate and amphetamine, commonly known by the brand names Ritalin and Adderall, are thought to work by increasing dopamine availability in the brain. An increase in dopamine may improve concentration in some people diagnosed with ADHD. However, the ways these medications work are poorly understood and there are many known negative side effects.

While stimulants can alleviate the symptoms of ADHD for some people, doses may linger in the brain into the night and have a negative impact on sleep. Lack of sleep, especially in children, is associated with reduced cognitive ability and focus. Because of these effects, it is important for parents to understand the implications of stimulant use before deciding to medicate their child.

A 2015 study conducted at the University of Nebraska (Kidwell et al., 2015) collected data comparing stimulant use and sleep in children. The researchers graded sleep by three factors: how long it took to fall asleep, how long the child slept, and the quality of sleep. Medications were separated into two groups: methylphenidate and amphetamine. Stimulants were also categorized as instant release or extended release. Extended release tablets are typically taken once a day, while instant release tablets are taken 2 times per day. In children, a third dose may be taken after school in order to prevent a “rebound” effect associated with withdrawal. While extended release pills take longer for the body to process, instant release doses timed later in the day are more likely to remain in the body during sleep.

The study found that all forms of stimulants negatively affected sleep. These medications made it harder for children to fall asleep, reduced sleep quality, and shortened sleep duration. This effect was greater in children using instant release forms, and the greatest effect was found in children taking three separate doses on a daily basis. These problems were worse at the start of medication treatment.

This information is very important for parents and professionals to understand, as sleep problems negatively impact brain function. Children who are not getting good quality sleep for enough hours each night are at risk for increased problems with attention, impulse control, and functioning in general. Parents must carefully weigh any potential benefits of these medications against the real risks of poor sleep. There are many effective non-medication treatments that improve attention and hyperactivity symptoms without causing sleep problems, and parents should be informed of all options before stimulant medication is prescribed.

Reference:

Kidwell, K.M., VanDyk, T.R., Lundahl, A., & Nelson, T.D. (2015). Pediatrics stimulant medications and sleep for youth with ADHD: A meta-analysis. Pediatrics, 136(6). Retrieved from: http://pediatrics.aappublications.org/content/pediatrics/early/2015/11/18/peds.2015-1708.full.pdf

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