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December 9, 2015
ADHD Drugs Disrupt Sleep in Children Who Use Them
Lincoln, NE—Pharmacists regularly hear the complaint from parents: Their children who use of stimulant medications for attention-deficit/hyperactivity disorder (ADHD) have trouble sleeping. Yet some research has argued that is not the case. A new study published online recently by the journal Pediatrics sought to resolve the dispute. The meta-analysis from the University of Nebraska-Lincoln found that children on the medicines take significantly longer to fall asleep, have poorer quality sleep, and sleep for shorter periods. “We would recommend that pediatricians frequently monitor children with ADHD who are prescribed stimulants for potential adverse effects on sleep,” said lead author Katie Kidwell, a psychology doctoral student. With about 3.5 million prescriptions for stimulant medications such as Ritalin and Adderall, numerous research articles have been written in the past 30 years on whether ADHD medications harm the ability to sleep. While some researchers found that the drugs do interfere with sleep, particularly if taken later in the day, others have maintained the stimulants actually improve ADHD patients’ ability to sleep, by relieving symptoms and reducing resistance to bedtime. A third view is that sleep problems are caused by the medication wearing off near bedtime, creating withdrawal symptoms. “One reason we did the study is that researchers have hypothesized different effects, and there are some conflicting findings in the literature,” said co-author Timothy Nelson, PhD. For the study, Kidwell and her colleagues screened nearly 10,000 articles and then reviewed 167 full texts before selecting nine studies of sufficient rigor for their analysis, i.e., peer-reviewed, randomized experiments. Studies selected did not rely on parental reports of their children’s sleeping patterns but required objective measures obtained through clinical sleep studies or wristband monitors used at home. Both methylphenidate medications and amphetamines cause sleep problems, the authors report, without identifying differences between the two. While the researchers were unable to determine whether varying dosage amounts changed the effect on sleep, they found that more frequent dosages made it harder for children to fall asleep, especially for boys. “We're not saying don't use stimulant medications to treat ADHD,” Nelson added in a University of Nebraska-Lincoln press release. “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.” |
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