Will increasing the dose of Adzenys (amphetamine) and Adderall IR (mixed amphetamine salts) exacerbate my insomnia and bedtime procrastination?

Increasing Amphetamine Dose Will Likely Worsen Your Insomnia

Do not increase your Adzenys or Adderall IR dose if you are already experiencing insomnia and bedtime procrastination—amphetamines are well-documented to cause and exacerbate sleep disturbances, particularly delayed sleep onset and insomnia, and this effect is dose-dependent.

Why Amphetamines Worsen Sleep

Direct Sleep-Disrupting Effects

• Insomnia is a recognized adverse effect of amphetamines, listed explicitly in FDA labeling as a common central nervous system side effect 1.
• The FDA specifically warns that "late evening doses should be avoided because of the resulting insomnia" 1.
• Research confirms that stimulants are commonly associated with delayed sleep onset and insomnia, with effects that vary in severity but are present across all age groups 2.
• Sleep disturbances occur even at recommended therapeutic doses and are not limited to excessive dosing 1, 3.

Dose-Dependent Relationship

• Higher doses of stimulants increase the risk and severity of sleep problems 2, 3.
• If you are already experiencing insomnia at your current dose, increasing the dose will almost certainly make this worse.
• The FDA recommends that "if bothersome adverse reactions appear (e.g., insomnia or anorexia), dosage should be reduced" rather than increased 1.

What You Should Do Instead

Optimize Current Medication Timing

• Ensure all amphetamine doses are taken early in the day, with the first dose upon awakening and any additional doses at 4-6 hour intervals 1.
• Avoid any doses after early afternoon to minimize impact on sleep onset 1.
• Even with immediate-release formulations, the stimulating effects can persist and delay sleep if taken too late.

Address the Insomnia Directly

Rather than increasing your ADHD medication dose, you need evidence-based treatment for the insomnia itself:

First-line pharmacologic options for insomnia (based on American Academy of Sleep Medicine guidelines):

• Eszopiclone (2-3 mg): Improves total sleep time by 28-57 minutes with moderate-to-large improvement in sleep quality 4.
• Zolpidem (10 mg): Improves total sleep time by 29 minutes and reduces wake after sleep onset by 25 minutes 4.
• Suvorexant (10-20 mg): Reduces wake after sleep onset by 16-28 minutes 4.
• Low-dose doxepin (3-6 mg): Improves total sleep time by 28 minutes and reduces wake after sleep onset by 22 minutes 4.

Not recommended for insomnia:

• Diphenhydramine (antihistamines) shows minimal efficacy with only 8-minute reduction in sleep latency 4.
• Melatonin provides only 9-minute reduction in sleep latency 4.

Behavioral Interventions Are Essential

• Implement cognitive-behavioral therapy for insomnia (CBT-I) as part of comprehensive treatment 4.
• Maintain consistent sleep-wake schedules with adequate time allocated for sleep 4.
• Practice good sleep hygiene: avoid heavy meals and alcohol, maintain a regular bedtime routine 4.

Important Caveats

The Bedtime Procrastination Component

• Bedtime procrastination may be a manifestation of your ADHD (executive dysfunction around sleep initiation) rather than purely a medication side effect.
• However, worsening insomnia from higher amphetamine doses will compound this problem, creating a vicious cycle.
• Address both the ADHD-related behavioral component AND the medication-induced sleep disruption simultaneously.

Consider Alternative ADHD Management

If your ADHD symptoms are inadequately controlled at your current dose but you cannot tolerate higher doses due to insomnia:

• Discuss switching to a long-acting formulation that can be dosed once daily in the morning, potentially providing more consistent coverage without late-day dosing 1.
• Consider adjunctive non-stimulant options (atomoxetine, guanfacine, clonidine) that may allow lower stimulant doses 2.
• Optimize the timing and formulation of your current regimen before escalating dose 2, 5.

Monitor for Tolerance

• Most sleep effects from stimulants are mild and improve over time in some patients 2.
• However, if you are already experiencing significant insomnia, this suggests you may not be one of those who adapts well to the sleep-disrupting effects.

The bottom line: Increasing your amphetamine dose when you already have insomnia will make your sleep worse, not better. Treat the insomnia with appropriate sleep medications and behavioral interventions while optimizing—not increasing—your current ADHD medication regimen 4, 1, 2.