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ADHD and Sleep

Explore the connection between ADHD and sleep issues, the impact on behavior and cognitive function, common disorders, treatment options, and strategies to improve sleep quality. Learn from studies and expert insights for better management.

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ADHD and Sleep

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  1. ADHD and Sleep Roberto Olivardia, Ph.D. Harvard Medical School Roberto_olivardia@hms.harvard.edu

  2. Common Sleep Issues/Disorders • Difficulty falling asleep (even as an infant) • Unwilling to nap even when exhausted • Feel more alert/energized after dark (10PM) • Go to bed late (2AM) • Difficulty awakening (regardless of ample sleep) • Difficulty in maintaining alertness during day (borderline narcolepsy) “Primary Disorder of Vigilance” • Sleep talking, sleepwalking, bruxism, bedwetting

  3. Sleep Disorders • Obstructive Sleep Apnea • Narcolepsy • Restless Leg Syndrome • Night Terrors • Sleep Walking

  4. How Sleep Issues Affect ADHD • Increased hyperactivity • Increased inattentiveness • Moodiness, Irritability • 1 hour of sleep loss, 3 nights in a row impacts vigilance on Continuous Performance Test • Lower metabolism, Increased appetite. Lead to obesity

  5. Studies looking at sleep in ADHD populations • Cortese et al meta-analysis: 722 kids with ADHD and 638 Controls: ADHD had significantly higher bedtime resistance, more sleep onset difficulties, night awakenings, difficulties with morning awakenings, sleep disordered breathing, and daytime sleepiness compared with controls. Apnea-hypopnea index sig higher in ADHD children than controls. Lower sleep efficiency, true sleep time

  6. Theories: ADHD and Sleep • Biological/Neurological • Behavioral • Genetic

  7. Treatment • GET SLEEP STUDY • Melatonin • Modafinil (Provigil) • Stimulants • SSRI’s (if depression/anxiety is comorbid) • Caffeine? • Surgical Procedures: Tonsillectomy, Septoplasty • CPAP (noncompliance common) • No naps • Work on getting to bed early 20 minute intervals earlier

  8. Treatment • Introduce stimulating sensory to daytime sleepiness • Relaxation exercises/Deep breathing • Warm bath • UNPLUG • Change in pajamas • Dim lights • Climate control • Sound machines • Light music on repeat • Eye masks/dark rooms • Singing to child, co-sleeping • Assess patient’s motivation to change sleep pattern

  9. ADHD and Sleep Roberto Olivardia, Ph.D. Harvard Medical School Roberto_olivardia@hms.harvard.edu

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