Child ADHD & Insomnia

About ADHD l Sleep & Insomnia in Children l Insomnia & ADHD

When it comes to bedtime, feeling tired doesn’t come naturally to him and he can lie in bed awake until midnight - his mind is racing.

/ A mother to a boy diagnosed with ADHD

Insomnia & ADHD

Sleep disorders are one of the most common comorbidities reported in individuals with ADHD, affecting approximately 70% of children and adolescents. In 45% of cases, parents reported higher moderate or severe sleep problems when compared with typically developing children. Sleep problems are persistent and reported by up to 80% of adults with ADHD.

Most of the sleep complaints in children and adolescents with ADHD are not only difficulty in falling asleep (sleep onset) but also maintaining sleep due to irregular midsleep awakenings. Both contribute to a shortened night sleep duration.

People affected by ADHD already have numerous difficulties engaging in social interaction. Lack of sleep can make this even worse by causing daytime impairments such as increased hyperactivity and irritability, greater anxiety and higher sensory sensitivity. If left untreated, especially in children under 6 years of age, insomnia has the potential to exacerbate the core symptoms of ADHD.

Sleep disturbances may exacerbate the symptoms of ADHD - especially over the next day. In children with ADHD, sleep restriction deteriorated from subclinical levels to the clinical range of inattention. Therefore, the therapy of sleep disorders, in particular improving sleep duration. is associated with improved functioning in both children with ADHD and their whole family.

Etiology of insomnia in children with ASD

Neurobiological Factors

Altered dopamine activity‭, ‬disrupted circadian rhythm‭, ‬changes in brain regions controlling sleep‭.

Behavioral Factors‭

Inconsistent bedtime routines‭, ‬difficulty with time management‭, ‬trouble self-regulating‭.

Medication Effects ‬‭

Some ADHD medicines‭, ‬especially stimulants‭, ‬can delay or disturb sleep‭.

Melatonin Imbalance ‬‭

‬Many children with ADHD have irregular or delayed melatonin secretion patterns‭.

Insomnia treatment goals

When treating insomnia in children with ADHD we should evaluate the child sleep according to the following DSM5 treatment goals:

Total sleep time (TST) within the acceptable range recommended by the national sleep foundation (NSF)
Sleep onset latency (SOL) < 30 minutes
Longest (uninterrupted) sleep episode (LSE)>6 hours

When evaluating treatment success, a clinician should also evaluate the improvement in the child’s behavior and parents’ satisfaction from child sleep.

Sleep duration recommendation by the National Sleep Foundation:

Current insomnia treatment in children with ADHD

Current practices recommend sleep hygiene interventions including establishing bedtime routines as first-line treatment for pediatric insomnia in ADHD‭. ‬Pharmacotherapy is often provided when sleep hygiene intervention is insufficient‭.‬

Research on the management of sleep disorders in individuals with ADHD is limited‭. ‬To date‭, ‬evidence supports behavioral interventions and melatonin‭- ‬especially prolonged-release melatonin to improve both sleep initiation and maintenance‭.‬‬

Why prolonged-release matters

Prolonged-release melatonin‭: ‬maintains melatonin levels through the night‭, ‬improves sleep‭, ‬and restores the daily sleep-wake cycle‭.‬

Immediate-release melatonin‭: ‬helps children fall asleep but wears off quickly‭, ‬leading to early awakenings‭. ‬unlicensed melatonin‭ ‬preparations or food supplements are also used‭, ‬despite considerable concerns over the quality‭, ‬efficacy and potential safety hazards‭.‬

The USA National Sleep Foundation summarized the profile of the ideal pharmacological therapy for pediatric insomnia‭. ‬One such therapy should be able to positively affect sleep parameters‭, ‬be easy to administer‭, ‬be dose adjustable‭, ‬have a good safety profile‭, ‬offer sustainable benefits and will not impair sleep architecture‭. ‬

Optimal pharmacological therapy for pediatric insomnia?

Slenyto® is the only prolonged-release melatonin (PRM) formulation designed to mimic the endogenous profile by releasing melatonin throughout the night helping to improve both sleep initiation and sleep maintenance without early awakenings.

Slenyto® is approved by EMA and other regulatory authorities for treating insomnia in children and adolescents with ASD, neurogenetic disorders and ADHD.

Learn about Insomnia in Children >

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