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

Current Psychiatry Reports volume 19, Article number: 98 (2017) Cite this article

Abstract

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.

Summary

Adults with ADHD should be assessed for insomnia, which is frequently comorbid, and both conditions should be treated.

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Acknowledgements

The authors would like to thank Prof. Philip Asherson and Prof. Sidra Goldman-Mellor for their helpful comments.

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Authors and Affiliations

  1. PsyQ Expertise Center Adult ADHD, Carel Reinierszkade 197, 2593 HR, The Hague, The Netherlands

    Dora Wynchank, Denise Bijlenga & J. J. Sandra Kooij

  2. Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands

    Aartjan T. Beekman, J. J. Sandra Kooij & Brenda W. Penninx

Authors
  1. Dora Wynchank
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  2. Denise Bijlenga
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  3. Aartjan T. Beekman
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  4. J. J. Sandra Kooij
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Corresponding author

Correspondence to Dora Wynchank.

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Conflict of Interest

Dora Wynchank served on the advisory boards of Janssen BV; and until 2014, Novartis and Eli Lilly until 2014.

Dr. Bijlenga declares no conflict of interest.

Aartjan T. Beekman has been a speaker for Lundbeck and Eli Lilly and received research grants from Astra Zeneca, Eli Lilly, and Shire for other studies.

J.J. Sandra Kooij was on the speakers’ bureau of Janssen, Eli Lilly, and Shire until 2012.

Brenda W. Penninx has received research grants from Johnson & Johnson, Boehringer Ingelheim, NWO, BBRMI-NL, NIMH, and the EU-FP7 program for research in NESDA.

Aartjan T. Beekman has been a speaker for Lundbeck and Eli Lilly and received research grants from Astra Zeneca, Eli Lilly, and Shire for other studies.

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This article does not include any studies with human participants or animals performed by any of the authors that would need ethical approval.

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This article is part of the Topical Collection on Attention-Deficit Disorder

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Wynchank, D., Bijlenga, D., Beekman, A.T. et al. Adult Attention-Deficit/Hyperactivity Disorder (ADHD) and Insomnia: an Update of the Literature. Curr Psychiatry Rep 19, 98 (2017). https://doi.org/10.1007/s11920-017-0860-0

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  • DOI: https://doi.org/10.1007/s11920-017-0860-0

Keywords

  • Adult attention-deficit/hyperactivity disorder
  • Sleep
  • Insomnia
  • Psychostimulants