This review looked at sleep treatment studies in adults with ADHD. The authors searched one research database and added one study they knew. They found only six studies, with 13 to 51 adults each. Two did not fully confirm an ADHD diagnosis in everyone.
Three bright light studies, with 96 adults in total, found morning light moved sleep timing earlier. In the largest one, melatonin also moved sleep timing earlier, and adding bright light moved it further. A placebo did not. Melatonin also eased ADHD symptoms, but symptoms went back to where they started 2 weeks after treatment ended.
Every other treatment had one study, never repeated. A behavioral therapy for insomnia (CBT-i) was followed by less severe insomnia. Heavy chain blankets eased insomnia more than light plastic ones. A prescription sleep medicine gave mixed results. It moved sleep timing slightly earlier, while placebo moved it later. But more than twice as many people became very sleepy in the daytime.
The authors note that only the largest light study and the blanket study compared a treatment with a control condition. The others were mostly open treatment. Measures differed between studies. Many common treatments have not been studied in adults with ADHD at all.
The authors suggest that clinicians screen adults with ADHD for sleep problems, and they describe morning bright light as low risk with promising evidence for this group.
If sleep is a struggle for you, talk to a clinician about your own situation.
The numbers Stats and what the terms mean
The statistics behind the plain-language claims above.
- Van Andel, 2021: how much earlier melatonin started to rise in dim light (dim light melatonin onset) with melatonin, 1 h and 28 min (p = 0.001).
- Van Andel, 2021: the same timing change with melatonin plus bright light, 1 h and 58 min (p < 0.001).
- Van Andel, 2021: the drop in ADHD symptoms with melatonin, 14% (p = 0.038).
- Fargason, 2017: how much earlier dim light melatonin onset came with bright light, 31 min (p = 0.002).
- Fargason, 2017: how much earlier the middle of the night's sleep came with bright light, 57 min (p = 0.004).
- Rybak, 2006: the shift toward an earlier daily rhythm preference with bright light, p = 0.016.
- Rybak, 2006: the drop in self-reported ADHD symptoms, p = 0.001.
- Jernelov, 2019: the drop in insomnia severity after CBT-i, p = 0.002.
- Ekholm, 2020: how much more insomnia improved with heavy chain blankets than with light plastic chain blankets, p = 0.003.
- Fargason, 2011: the timing change with a prescription sleep medicine (8 mg) versus placebo, a 7.0 ± 32.3 min phase advance versus a 39.2 ± 44.6 min phase delay (p = 0.046 for both).
- Fargason, 2011: the rise in people with a high daytime sleepiness score (Epworth Sleepiness Scale) on the sleep medicine, more than doubled (p < 0.017). What the terms mean:
- p A number from a statistical test that shows how unusual a result would be if there were really no effect; here each one comes from a single small study.
- Placebo A look-alike treatment with nothing active in it, given to a comparison group so people can't tell which group they're in.
- Open treatment A study where both the people taking part and the researchers know who is getting which treatment.
- Self-reported People answered questions about themselves, here rating their own ADHD symptoms.
- Phase advance and phase delay A shift of the body's daily timing earlier (advance) or later (delay).
- ± (plus or minus) Shows the spread around the average figure.
Source: Surman C, Walsh D. Managing Sleep in Adults with ADHD: From Science to Pragmatic Approaches. Brain Sciences (2021). doi:10.3390/brainsci11101361