Many children with attention-deficit hyperactivity disorder, or ADHD, struggle with sleep problems. However, there has been much debate in the ADHD community about whether stimulant medications — the most widely used treatment for ADHD — help children sleep better or only make their struggles worse.
A new study published in the December 2015 issue of Pediatrics may put the debate to bed.
Researchers at the University of Nebraska pulled together previously published studies on ADHD, sleep, and simulant medications and analyzed the data as a whole in a meta-analysis. Taken alone, these studies had contradictory conclusions. When combined, however, a clear picture of sleep disturbance exacerbated by stimulant medications emerged. Psychology doctoral candidate Katherine M. Kidwell and her team concluded that stimulant medications cause kids to have more trouble falling asleep and staying asleep.
Sleep Problems Vary
Some children with ADHD have sleep struggles from the start.
“My son had sleep issues before stimulant medication,” Trisha Blakely, a Missouri mother of one son with ADHD, told Healthline. “That is when I started asking the pediatrician lots of questions because I knew it wasn't normal for a 5-year-old to just go and go.”
Other kids seem to have trouble sleeping only well after starting stimulant medication to treat their ADHD.
Jenn Kirby says she doesn’t remember her oldest son struggling to fall asleep before medication.
“Now, he does struggle to fall asleep,” the North Carolina mom told Healthline. “[He] gets out of bed and whines that he can't sleep. He doesn't seem to have bad dreams or get up very often in the middle of the night, thankfully.”
Some Tricks to Summon Sleep
There are some things that can be done to minimize sleep disturbance caused by stimulant medication.
Kidwell recommends that doctors monitor sleep so they can adjust the timing of medication or offer referrals for behavioral treatment for the ADHD.
Kirby has a few tricks up her sleeve when her son can’t get to sleep.
“Sometimes a snack with a glass of milk helps,” she said. “Sometimes we rub a few drops of lavender oil on the bottoms of his feet. Sometimes, just a hug and another goodnight kiss is enough.”
Sleep issues are more complicated for Blakely’s son. Because he can’t fall asleep and stay asleep at night, he gets little restorative rest before school and that causes him to sleep during school hours.
Stimulant medication helped with his ADHD symptoms, but it only exacerbated the sleep problems. Before bed, they tried a dose of melatonin — a hormone made by the brain to help control the sleep and wake cycles that is available as an over-the-counter supplement.
Melatonin helped, but it wasn’t enough, and Blakely’s son ultimately had to stop taking a stimulant for his ADHD. He is now taking nonstimulant medication for ADHD that will also help him sleep.
“He still struggles daily,” Blakely said.
Some Treatment Options
Kidwell says parents can help children sleep by implementing nightly routines.
Kirby, who has two boys with ADHD, implements a consistent bedtime schedule. “All screens are turned off at 8 p.m.,” she said. “Then it’s time for baths or showers, snacks, and brushing teeth, in that order. They climb in bed at that point, where they can read until 9 p.m.”
The routine helps, but both moms say consistent, restful sleep is an ongoing struggle.
A self-described “veteran” parent of a son with ADHD and autism, Penny Williams is the author of two award-winning books on ADHD, “Boy Without Instructions: Surviving the Learning Curve of Parenting a Child with ADHD” and “What to Expect When Parenting Children with ADHD.” Her third book, “The Insider’s Guide to ADHD: ADHD Adults Reveal the Secret to Parenting Kids with ADHD” will be available in December.