A new research review has found that medications commonly used to treat attention deficit hyperactivity disorder (ADHD) may reduce the quantity and quality of sleep for many of the estimated 3.5 million U.S. kids taking the drugs.
Stimulant medications increase alertness, and some studies have found a detrimental effect on children’s sleep. But, other studies have concluded that the medications may improve sleep by reducing bedtime-resistant behavior. The drugs include amphetamines (Adderall) and methylphenidate (Ritalin).
The researchers, from the University of Nebraska-Lincoln, screened thousands of articles and analyzed data from several previous studies that, individually, showed contradictory findings. They selected nine studies of sufficient scientific rigor to review in depth.
The new analysis found that children on these medications take significantly longer to fall asleep, have poorer quality sleep, and sleep for shorter periods.
They found that the more doses of medication a child took per day, the longer it took for that child to fall asleep at night. The study suggests that extended-release versions of stimulants, which are taken once a day, have less of an impact on how long it takes to fall asleep than immediate-release formulas, which are sometimes taken three times a day, with the last dose close to bedtime.
Furthermore, the quality of sleep, or sleep efficiency — the percentage of time one is asleep while in bed — was worse for those on stimulant medications, although those kids who had been on the drugs longer fared better than those who had just begun taking the medication. There was also a gender difference, with boys on stimulant medication getting poorer-quality sleep than girls.
Finally, stimulants reduced the total amount of sleep children got at night.
Poor sleep makes ADHD symptoms worse. When children with ADHD don’t sleep well, they have problems paying attention the next day, and they are more impulsive and emotionally reactive.
Families and pediatricians need to be aware that sleep problems are a real effect of stimulant medication.
Kidwell urged pediatricians to monitor sleep disturbances of children taking the medication so they can adjust timing of doses or provide referrals for behavioral treatment of ADHD. She said parents can help children sleep by encouraging nightly routines such as quiet activities and bedtime stories.
The study, titled Stimulant Medications and Sleep for Youth with ADHD: A Meta-analysis, will be published in the December 2015 issue of Pediatrics.