ADHD and Sleep
Attention deficit hyperactivity disorder (ADHD) is a psychiatric disorder known to be highly prevalent in children (1). Symptoms of ADHD include increased inattentiveness, hyperactivity, and impulsivity. The underlying cause of ADHD is unknown but there are a few suggested beliefs. Lewin and Pinto postulate that sleep disorders are correlated to ADHD however, “not all children with sleep disorders present with ADHD or behavior disturbances” (2). Furthermore, they claim that people with ADHD have shown significantly increased rates of obstructive sleep apnea” and hyperarousal deficiencies which are an essential part of ADHD, stemming from dysfunctional “prefrontal-cortex and noradrenergic and dopaminergic centers”(2), the area that controls complex cognitive behavior.
There are three contributors to the presence of ADHD: genetics, environment, and development. This idea is parallel to the article by Lewin and Pinto, as sleep orders like obstructive sleep apnea (OSA) have been linked to genetic causes (3). Environmental and developmental effects encapsulate home-life and abnormalities during the development of the central nervous system (CNS).
Sleep is critical for memory consolidation. Deep sleep is known to consolidate motor memory while REM sleep consolidates factual memory. Protein synthesis in neurons increase during sleep, this is important for learning and memory. Inadequate sleep will lead to disturbances in levels of dopamine, serotonin, and melatonin which results in altered mental function. For optimal sleep, the environment must be dark and quiet. This allows the brain to produce less action potential or wake activity.
In ADHD individuals, goal oriented behavior is disrupted by the delay of cortical width—the outer layer of the cerebrum is found to be thicker in non-ADHD individuals (4). Additionally, the cerebrum, cerebellum, and four cerebral lobes were smaller in those with ADHD, showing no change in size over time (5).
Stimulants are widely prescribed for the treatment of ADHD. These stimulants include: Adderall, Concerta, Methylin, and Ritalin. The mechanism by which it works is under debate, but it is mutually agreed that ADHD involves a disrupted prefrontal cortex (6). Stimulants also work to amplify the frequency and magnitude of stimuli-induced dopamine. It is important to note that effect on dopaminergic centers is not completely understood and may or may not affect ADHD.
Although the use of stimulants has been shown to improve symptoms of ADHD, it also comes with many adverse side effects that can be even more debilitating than the original symptoms. Side effects include loss of appetite, sleep disturbances, and an increase risk for drug abuse. Nonpharmacological treatments should be pursued prior to taking stimulants. Suspected ADHD patients should change diets to improving their microbiota and necessary nutrient intake to decrease minor inflammation. Revaluating one’s lifestyle may be necessary to improve amount and quality of sleep. It is important to use a holistic approach.
1. Biederman J (2005) Attention-deficit/hyperactivity disorder: a selective overview. Biol. Psychiatry 57: 1215–1220.
2. Daniel S. Lewin, PhD; Marcos Di Pinto, M.S. Sleep disorders and daytime sleepiness in children with attention-deficit/hyperactive disorder. SLEEP 2004; 27(2):261-6.
3. Colten HR, Altevogt BM. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Washington (DC): National Academies Press (US); 2006.
4. Wilens TE, Spencer TJ. Understanding Attention-Deficit/Hyperactivity Disorder From Childhood to Adulthood. Postgraduate medicine. 2010;122(5):97-109. doi:10.3810/pgm. 2010. 09.2206.
5. Castellanos FX, Lee PP, Sharp W, et al. Developmental trajectories of brain volume abnormalities in children and adolescents with attention-deficit/hyperactivity disorder. Journal of the American Medical Association. 2002; 288(14):1740–1748.
6. Veronika Engert and Jens C. Pruessner. Dopaminergic and Noradrenergic Contributions to Functionality in ADHD: The Role of Methylphenidate. Current Neuropharmacology, 2008, 6, 322-328.