Stimulant medications that treat attention deficit hyperactivity disorder (ADHD) in children can interfere with their slumber, say researchers from the University of Nebraska-Lincoln. The study was published online on Nov. 23, 2015, by the journal Pediatrics.
Past studies within the past 30 years have studied the impact of ADHD drugs had conflicting opinions and evidence on how the meds affect sleep. Katie Kidwell, a psychology doctoral student and lead author of the current study selected 167 full texts for review and then focused on nine studies. The researchers combined and analyzed past data and found that children who were treated with ADHD medications took much longer to fall asleep, had poorer quality slumber, and slept for shorter periods.
The analysis found that amphetamines such as Adderall and methylphenidate medications such as Ritalin do cause sleep problems. The researchers were not able to gauge how various dosage amounts affect children’s slumber, but they did find that children treated with more frequent dosages had difficulty falling asleep. Boys taking ADHD meds tended to have more problems falling asleep. The sleep issues decreased over a long time of being treated for ADHD but did not completely disappear.
Some past studies found that ADHD medications do interfere with sleep, especially if they are taken later in the day. Other researchers felt that the medications relieved ADHD symptoms and reduced the child’s resistance to bedtime, improving the study participant’s ability to catch some ZZZs. Others suggest that ADHD medications wear off close to bedtime, causing withdrawal symptoms that can cause sleep problems.
“One reason we did the study is that researchers have hypothesized different effects, and there are some conflicting findings in the literature,” said Timothy Nelson, an associate professor of psychology. “This is when a meta-analysis is most useful. By aggregating and summarizing previous research in a rigorous and statistical way, we can identify the main findings that we see across all these studies. It’s essentially a study of studies.”
“Sleep impairment is related to many cognitive, emotional and behavioral consequences, such as inattention, irritability and defiance,” Kidwell said. “Sleep adverse effects could undermine the benefits of stimulant medications in some cases. Pediatricians should carefully consider dosage amounts, standard versus extended release, and dosage frequencies to minimize sleep problems while effectively treating ADHD symptoms.”
“We’re not saying don’t use stimulant medications to treat ADHD,” Nelson said. “They are well tolerated in general and there is evidence for their effectiveness. But physicians need to weigh the pros and cons in any medication decision, and considering the potential for disrupted sleep should be part of that cost-benefit analysis with stimulants.”