ADHD and Sleep
Roberto Olivardia, Ph.D.
Harvard Medical School
Roberto_olivardia@hms.harvard.edu
Common Sleep Issues/Disorders
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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
Sleep Disorders
Obstructive Sleep Apnea
 Narcolepsy
 Restless Leg Syndrome
 Night Terrors
 Sleep Walking
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How Sleep Issues Affect ADHD
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Increased hyperactivity
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Increased inattentiveness
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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
Studies looking at sleep in ADHD
populations
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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
Theories: ADHD and Sleep
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Biological/Neurological
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Behavioral
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Genetic
Treatment
GET SLEEP STUDY
 Melatonin
 Modafinil (Provigil)
 Stimulants
 SSRI’s (if depression/anxiety is comorbid)
 Caffeine?
 Surgical Procedures: Tonsillectomy, Septoplasty
 CPAP (noncompliance common)
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No naps
Work on getting to bed early 20 minute intervals earlier
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
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ADHD and Sleep
Roberto Olivardia, Ph.D.
Harvard Medical School
Roberto_olivardia@hms.harvard.edu