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ADHD, Adderall and Sleep

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Updated March 16, 2009

About.com reader, JoAnne, wrote in with a question regarding her teenage son.

Question: I have two boys, one ADD and the other ADHD. The one with ADHD is a junior in high school and has been dealing with ADHD since he was in first grade. He has been on medication since then, as well. He is presently on Adderall and takes 60 mg a day. As much as I hate that he has to be on this medication, he himself does not like to be as out of control as he can become when he is not on it. My concerns are the eventual “crashes” that happen about every 4 months where he goes and goes until he sleeps for 12 plus hours straight. If you have any information that would help, please let me know.

Answer: It is possible that your son’s medication is affecting his sleep patterns. Adderall can sometimes make it more difficult to fall asleep at night. The “crashes” you describe may be related to your son simply not getting enough sleep on a regular basis.

Sleep issues in children and adolescents with ADHD are a common occurrence. Sometimes the stimulant medication affects sleep. Other times the restlessness that accompanies ADHD causes difficulty falling asleep. The key? Finding a happy medium between 1) when your child's medication has completely worn off (making him too restless for sleep) and 2) when your child's medication is in effect but still too stimulating for sleep. Discuss the issue with your teen’s doctor.

Studies have shown that adolescents require 8.5 to 9.25 hours of sleep per night, but our teenagers often get considerably less. Helene A. Emsellem, MD, is the director for The Center for Sleep & Wake Disorders in Chevy Chase, Maryland. She is also the author of Snooze…or Lose! Ten ‘No-War’ Ways to Improve Your Teen’s Sleep Habits. “The restriction in total sleep time experienced by teens worsens as they progress through high school,” notes Dr. Emsellem, “with 12th graders significantly more sleep restricted than 7th graders. ‘Crashes’ are inevitable and may occur far more frequently than every four months.”

What Is Sleep Debt?

Dr. Emsellem explains: “Many teens regularly sleep for 10 to 12 hours on weekends as their bodies try to pay back the cumulative weekday sleep debt. If a teen needs a minimum of 8.5 hours of sleep per night but only gets 6.5 hrs, he/she may have accumulated a sleep debt of 10 hours by the end of an average school week. Even sleeping 12 hours per weekend night might only catch you up on 8 of those 10 hours. The cumulative sleep debt can become overwhelming and lead to the ‘crashes’ that your reader describes.”

Sleep and ADHD

Dr. Emsellem says that it is important to be aware of the symptomatic overlap between ADD/ADHD and sleep restriction. “Difficulty with attention, focus and concentration are key symptoms of both sleepiness and ADD/ADHD. The presence of sleep restriction will aggravate ADD/ADHD symptoms. If the worsened symptoms are managed with higher medication doses rather than with the much needed sleep then symptoms may snowball.”

Be sure to talk with your son’s doctor about your concerns. It may be that he or she can adjust the dosage and timing of the medication. This is particularly important “to avoid the spill-over effects in the evening hours which may make it difficult for your teen to wind down and fall asleep,” notes Dr. Emsellem. “It may be a challenge to adjust for adequate dosage to allow for evening studying, yet not interfere with sleep onset.” These are all issues you will want to discuss with the doctor.

Additional Reading:

Source:

Helene A. Emsellem, MD. “Re: Request for Expert Quotes.” Email to Keath Low. 12 Dec. 07.

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