From the Research
Treating insomnia in adolescents with ADHD requires a multi-faceted approach, with cognitive behavioral therapy for insomnia (CBT-I) as the first-line treatment, as it has been shown to be highly effective in improving sleep and associated outcomes in this population 1.
Key Components of Treatment
- Establish good sleep hygiene practices, including a consistent bedtime routine, limiting screen time 1-2 hours before bed, keeping the bedroom dark and cool, and avoiding caffeine after noon.
- CBT-I should be tailored to address the specific sleep difficulties and ADHD symptoms of the adolescent, and may include components such as sleep restriction therapy, stimulus control therapy, and cognitive therapy 2, 3.
- Medication options, such as melatonin (0.5-5mg) taken 1-2 hours before bedtime, may be considered to help regulate sleep onset, but should be used under medical supervision and with careful monitoring of the individual's response and needs.
Considerations for ADHD Medications
- If stimulant ADHD medications are contributing to sleep problems, consider adjusting the timing of doses or switching to non-stimulant options like atomoxetine or guanfacine.
- Short-term use of sleep medications such as trazodone (25-50mg) might be considered in severe cases under medical supervision.
Importance of Addressing Insomnia
- Poor sleep can worsen ADHD symptoms, creating a negative cycle, and addressing insomnia is crucial to improve overall outcomes in adolescents with ADHD.
- Sleep problems in ADHD often stem from delayed circadian rhythm, difficulty with sleep onset, and the effects of stimulant medications, making a comprehensive treatment approach essential.
Evidence-Based Recommendations
- The effectiveness of CBT-I in patients with mental disorders and comorbid insomnia has been demonstrated in several studies, with moderate to large effect sizes for reducing insomnia severity and improving mental health symptoms 4.
- A systematic review of sleep hygiene in children with ADHD found that sleep hygiene interventions were effective in improving sleep quality, although the evidence was limited by a high risk of bias 5.