ADHD News & Research

ADHD Meds May Negatively Affect Children’s Sleep

A recent meta-analysis indicates that children on stimulant medications appear to have more trouble sleeping than their non-medicated peers.

December 2, 2015

Stimulant medications may make it harder for children with ADHD to fall asleep, and may result in less overall time spent asleep, a new study finds. A meta-analysis of nine studies examined stimulant medications and sleep, all conducted before March 2015. Of the nine studies, seven looked specifically at sleep latency (the amount of time it takes to fall asleep), sleep efficiency (the proportion of time each night spent asleep), and total sleep time — the three areas on which the researchers decided to focus.

The meta-analysis found that children on stimulant medications fared worse on all counts. In the area of sleep latency, for example, children on stimulant medications spent significantly more time trying to fall asleep, with an “effect size” of 0.54 — meaning that medicated sleep latency was 0.54 standard deviations higher than unmedicated sleep latency. The effect on sleep time was similarly poor, resulting in an effect size of -0.59. Sleep efficiency demonstrated a smaller effect size of -0.32, which the researchers labeled “small to moderate” but still significant.

To some, these results may seem obvious — of course stimulants make it difficult for kids to unwind at the end of a long day. However, many ADHD experts have argued that stimulant medications may help kids fall asleep. “Some children and teens with ADHD have difficulty going to sleep at night because they ‘can’t turn their head off,'” said Larry Silver, M.D. “For these people, using a medication like Ritalin, Dexedrine, or Adderall at night might be a great help in getting to sleep.” The results of this study seem to indicate otherwise, though Dr. Silver admits that stimulant medications may not be the best choice for everyone who struggles with sleep.

The study did have some limitations. For one, the results varied between studies conducted using polysomnography and those using actigraphy — commonly used objective measures of sleep. The effects of the stimulants were much more apparent in the studies using polysomnography, which could have skewed the results.

Another major issue was the study’s size. By choosing to include only high-quality studies that were randomized and controlled, the researchers write, the meta-analysis was limited to a very small pool. “While our study summarizes the current state of the literature, we really need more quality research,” said Katherine Kidwell, the lead author of the study. “Those studies that are really delving into sleep are kind of few and far between.”

The meta-analysis doesn’t dismiss the usefulness of stimulants. “We’re not saying that pediatricians should not prescribe stimulants — they’re really beneficial for many kids and they’re generally well tolerated,” said Kidwell. “But this study provides one potential cost that should be weighed, especially for children who are already having problems with sleep.