Dear readers of ADxS.org, please forgive the disruption.

ADxS.org needs about $19740 in 2023. In 2022 we received donations from third parties of about $ 13870. Unfortunately, 99.8% of our readers do not donate. If everyone who reads this request makes a small contribution, our fundraising campaign for 2023 would be over after a few days. This donation request is displayed 12,000 times a week, but only 140 people donate. If you find ADxS.org useful, please take a minute and support ADxS.org with your donation. Thank you!

Since 01.06.2021 ADxS.org is supported by the non-profit ADxS e.V..

$0 of $19740 - as of 2023-01-03
0%
Header Image
Sleep problems in ADHD

Sitemap

Sleep problems in ADHD

Sleep problems are particularly common in ADHD.12345678 Sources speak of about 75% of those affected, , vion 44.4% in adults with ADHD, others of 12.7% in children 7 to 11 years old with ADHD. One study found no changes in sleep architecture in ADHD.9101112

Sleep disturbances occur more frequently in ADHD sufferers than in their unaffected twin siblings.13 Sleep duration decreases with the intensity of ADHD symptoms.14 At the same time, sleep deprivation causes greater fatigue in ADHD sufferers than in non-affected individuals. ADHD sufferers are thus more sensitive to sleep deprivation than non-affected persons.15

It is open whether sleep problems occur more frequently in ADHD-C16, or in ADHD-HI and ADHD-C than in ADHD-I1317 10 , or whether hyperactive ADHD-HI suffer from sleep problems less frequently than predominantly inattentive ADHD-I sufferers.18
Further research found no subtype differences, but1920 found gender and comorbidity differences: 75% of girls and 53% of boys with ADHD had sleep problems. Anxiety symptoms clearly correlated with later bedtime and sleep anxiety; hyperactive-impulsive symptoms were associated with more frequent nighttime awakenings and more sleep behavior problems (parasomnia). ODD and depressive symptoms correlated with shorter sleep duration. Depression was clearly reflected in increased daytime sleepiness and general sleep problems. Gender did not moderate the correlation between comorbidities and sleep problems.20 A tendency toward increased daytime sleep problems was found in the predominantly hyperactive-impulsive ADHD-HI subtype.19 Another study found a correlation between unstable sleep and inattention in boys with ADHD.21
One study found that sleep problems in ADHD occurred only in those with sensitivity problems (taste and smell sensitivity, hearing sensitivity, and sensation seeking) according to the Short Sensory Profile (SSP) questionnaire.22
In adults with ADHD, higher ADHD severity and with medical or psychiatric comorbidities (especially depression, anxiety disorders, personality disorders, and any substance use disorders) further increased sleep problems.10

CRH impairs deep sleep.23 Insofar, sleep problems can be a direct consequence of an overactivated HPA axis.

Sleep problems should be treated with special priority in ADHD because sleep problems and ADHD form a vicious circle: Sleep problems exacerbate ADHD symptoms, while ADHD symptoms may in turn cause sleep problems.

  • Sleep reduces the stress hormone cortisol. in one study, 1 hour longer sleep reduced the cortisol awakening response by 21%.24
  • Sleep deprivation enhanced the stress response of the HPA axis. In sleep deprivation, the cortisol response to the TSST appears to be increased.25
  • More frequent awakenings the previous night worsened math skills and (somewhat) working memory, independent of ADHD.26
  • Sleep deprivation correlates with decreased mental health in children in relation to27
    • Emotion regulation28
    • Cognition2930
    • Attention30
  • A study in which participants were allowed to sleep only 6 hours for 2 weeks found a decline in sustained attention and working memory equivalent to that of two nights of complete sleep deprivation. Unlike the participants who were completely deprived of sleep for 2 nights, those with 2 weeks a 6 hours of sleep were unaware of their cognitive deficits. Another study reported the same results after 5-7 days of sleep restriction.9
    The cognitive deficits, especially inattention, required more days of normal sleep to fully recover than the duration of the initial sleep restriction, more than 2 weeks.9
    Several other studies concur with these findings.
  • Sleep deprivation causes increased omission errors, commission errors, reaction time, and reaction time variability in ADHD sufferers and nonafflicted individuals alike. However, in ADHD, additional omission errors, commission errors, and greater reaction time variability emerged.31 In addition, sleep deprivation particularly impaired the recognition of emotional facial expressions in ADHD.32
  • Problems falling asleep and staying asleep are not exacerbating causes of executive problems, but daytime sleepiness is.8

Nevertheless, sleep problems are not the (sole) cause of ADHD. However, sleep problems exacerbate existing ADHD symptoms.3334 Thus, sleep training has a positive effect on ADHD symptoms.3536

1. Sleep problems in ADHD

Adolescents with ADHD have higher per-person variability in sleep problems than adolescents without ADHD. These relate to bedtime, wake time, sleep duration, sleep onset latency, sleep quality, and nighttime wakefulness.37

Sleep problems correlate with elevated levels of proinflammatory cytokines. Cytokines regulate sleep. Cytokines released by immune cells, particularly interleukin-1β and tumor necrosis factor-α, affect neuronal activity, behavior (including sleep), hormone release, and autonomic function by addressing neuroendocrine, autonomic, limbic, and cortical areas of the CNS.38 One study found elevated inflammatory markers only in women (not men) with sleep problems.39

Sleep deprivation and disturbed sleep result in increased levels of IL-6, tumor necrosis factor (TNF) (men only), and C-reactive protein (CRP) compared with undisturbed sleep.404142
Sleep problems apparently increase IL-6 and soluble intercellular adhesion molecule (slCAM) even more than major depression.43
Sleep deprivation correlates with increased IL-6 levels, although the stimulatory effect of catecholamines on Il6 secretion is reduced; this change may result from concomitant reduced cortisol-induced inhibition, which is omitted by deficient cortisol. The stress hormones norepinephrine and CRH also increase IL-6.44

Sleep problems in 5-13 year olds with ADHD correlated weakly but statistically significantly with maternal mental health problems.45

1.1. Circadian rhythm

1.1.1. Circadian rhythm and ADHD

Circadian problems are associated with multiple mental disorders.46

Some voices discuss whether ADHD - at least for a subgroup of affected persons - is primarily the consequence of a shifted chronorhythm.9
For a subgroup, this may be true. Likewise, most ADHD sufferers with a chronobiorhythm that is shifted backwards would benefit greatly if the shift could be reduced or eliminated. However, it must be taken into account that the chronorhythm is controlled to a large extent by life circumstances and habits.

in the Corona pandemic, a shift of the chronorhythm to the back was observed in 2/3 of the test persons in quarantine as well as in home office. The time of going to bed as well as the time of getting up were delayed. At the same time, sleep quality deteriorated.4748 In a good 16 %, home office led to a complete deregulation of the chronobiorhythm.49

There are several points of contact of the neurophysiological regulation of the circadian rhythm on the one hand and ADHD on the other hand.

1.1.1.1. Norepinephrine and circadian rhythm

Norepinephrine is thought to be a key synchronizer of circadian rhythms. Norepinephrine regulates nocturnal melatonin secretion and circadian gene expression.5049

1.1.1.2. Stress systems and circadian rhythm

Chronic stress (which we believe mediates its symptoms through very similar neurotransmitter shifts as ADHD) often leads to circadian system disruption. For more on this topic, see Changes of the circadian system due to chronic stress In the article Stress damage due to early / prolonged stress in the section ADHD as a chronic stress regulation disorder in the section Stress.

1.1.2. Circadian sleep-wake rhythm disturbances

1.1.2.1. Difficulty falling asleep

ADHD sufferers often need much longer to fall asleep. Typical is the description of a circle of thoughts.

1.1.2.1.1. Sleep phase shift (later sleep rhythm)

ADHD often shows an altered sleep rhythm.51452 Up to 75% of ADHD affected children and adults suffer from a shifted chronobiorhythm.9
ADHD sufferers with a pronounced later sleep rhythm (“eveningness”, owls) showed in a small study increased self-ratings of inattention and sleepiness during the day as well as slower reaction times than sufferers with an early day rhythm (“morningness”, larks). The severity of overall symptomatology did not differ.53

Eveningness correlated in studies

  • (other than problems falling asleep and insomnia) with shortened leukocyte telomeres, which actually correlates with older biological age.54
  • 2.4 times more often with obesity-related BMI than morningness (independent of ADHD). In addition, higher BMI levels correlated with increased levels of ODD and ADHD.55
  • With increased sleep problems and increased daytime sleepiness, regardless of the duration of nighttime sleep.56
  • With a birth at times of long brightness (June, July), with at the same time significantly reduced prevalence with a birth date in December or January. Together with other studies, this strongly suggests a clear imprinting in the first months of life.9
  • With little time spent outdoors. People who typically spend their day outdoors go to bed earlier and sleep longer than people who typically spend their day indoors.57
  • With the latitude of the center of life / growing up. In countries and geographical areas with lower solar intensity and thus less adaptation to day and night by the central biological clock, a higher ADHD prevalence is shown.9
    • There are contradictory results on the question whether carriers of DRD4-7R, a gene variant of the dopamine D4 receptor gene, are more frequently affected by ADHD, especially if they were born in spring or summer. It is conceivable that the contradictions will be resolved if it is taken into account that people with a northern genetic background are less sensitive to variations in sunlight intensity.9
1.1.2.1.2. Delayed evening melatonin rise

In ADHD sufferers, as in those with sleep problems, the evening rise in melatonin is often delayed.58 In children between 6 and 12 years of age with ADHD and sleep problems, sleep onset was delayed by 50 minutes compared with children with ADHD without sleep problems, which corresponded to the delay period of the melatonin rise. Otherwise, sleep did not differ significantly.
Since the start of school and consequently the time of getting up is the same for all children, this explains that ADHD sufferers with sleep problems get less sleep and therefore have additional difficulties in everyday life.

1.1.2.2. Sleep Through Disorder

Waking up during the night, often after 3 to 4 hours of sleep. Trouble sleeping through the night is one of the most common sleep disorders in ADHD.5452

1.1.2.3. Shortened sleep duration

A meta-study found a correlation of shortened sleep duration and ADHD symptoms, especially hyperactivity.59 Increasing sleep duration significantly improved inhibition in children with ADHD.60

Interestingly, children’s sleep duration has steadily shortened in recent decades. The evening bedtime for three-year-olds was 19:08 Uh in 1974, 19:53 in 1979, and 20:07 in 1986.61
10- to 15-year-old children slept 30 minutes more per night in 1985 than their peers in 2005, with earlier sleep times in 1985 at the same time.62
A large analysis of 690,747 children showed that sleep duration decreased by 0.75 minutes per year from 1905 to 2008, for a total of 1:15 hours over 100 years.63 Further, a metastudy of 20 studies showed that the likelihood of obesity in ADHD-HI correlated with shorter sleep duration in children.64

1.2. Sleep related breathing disorders

Breathing pauses during sleep are often a cause of ADHD-like symptoms.

In chronic adenotonsillar hypertrophy, adenotonsillectomy improves any or putative AD(HHD) symptoms.65
High weight increases the likelihood of sleep apnea.66
Sleep apnea appears to be associated with a higher likelihood of ADHD in adults.67

A sleep study of 27 medication-naive children with ADHD found one or more sleep disorders in all of them:68

  • 11 cases of obstructive sleep apnea
  • 6 cases of a movement disorder phenotype
  • 6 cases of sleep-related epileptiform discharges
  • 3 cases of difficulty in falling asleep
  • 2 cases of narcolepsy-like phenotype
  • 1 case of arousal disorder

A test for sleep apnea does not require an overnight stay in a sleep lab. Sleep physicians give sufferers a device to take home, wear it for one night and return it the next day. The recorded data reliably indicate breathing problems during sleep.

1.3. Sleep related movement disorders

Restless legs symptoms, insomnia, and frequent snoring appear to be significant predictors of subsequent ADHD-HI symptoms.6

1.4. Central disorders of hypersomnolence (hypersomnia)

Narcolepsy is a common comorbidity of ADHD.

1.5. Severe daytime sleepiness

In ADHD sufferers, problems with severe daytime sleepiness694 52 or increased sleepiness67 are sometimes observed.

One study found a correlation of daytime sleepiness and cognitive problems in ADHD.70

In this case, treatment with modafinil is obvious.
Further, orexin levels should be checked. See more atOrexin / Hypocretin Modafinil apparently increases orexin levels. This could be one of the pathways of action of modafinil in the treatment of narcolepsy.71

The selective D1 receptor agonist SKF38393 was shown to improve excessive daytime sleepiness and restore REM sleep in animal studies.7273

1.6. Prolonged REM sleep

5 studies found prolonged REM sleep phases in ADHD sufferers,12 one study found shortened REM sleep.4

1.7. Slow wave sleep increased

Some studies found an increased slow-wave sleep proportion within and outside REM sleep phases in ADHD.12

1.8. EEG peculiarities during sleep in ADHD

There are reports of specific EEG peculiarities in ADHD.74

1.8.1. Sleep spindles in the EEG in sleep phase 2 reduced in ADHD

While more sleep spindles (higher sigma power) in the EEG correlated with higher IQ in non-affected individuals in the light sleep phase (sleep phase 2), fewer sleep spindles correlated with ADHD.75

1.8.2. Gamma connectivity altered in light sleep in ADHD

Children with ADHD showed altered gamma phase delay index in light sleep.76

1.8.3. Slow-waves in EEG reduced in non-REM deep sleep in ADHD

ADHD-HI-affected children and adolescents showed a reduction of over 20% in the EEG power of low-frequency waves from 1 to 4.5 Hz (SWA) in non-REM deep sleep throughout the brain compared with healthy controls. Regular use of stimulants eliminated this abnormality. Assuming that SWA reflects synaptic density, this is consistent with previous neuroimaging studies that found smaller gray matter volumes in ADHD-HI sufferers and their normalization with regular stimulant use.77

1.9. Frequent snoring

Insomnia, RLS, and frequent snoring appear to be significant predictors of subsequent ADHD-HI symptoms.6

1.10. Immunological consequences of sleep problems

Single as well as chronic sleep fragmentation increased mRNA and protein levels of cytokines in body tissues in mice. Changes in inflammatory responses reflected activation of stress axes with increased corticosterone and norepinephrine. Treatment with 6-OHDA significantly reduced sleep fragmentation-induced inflammation. This suggests regulation of sleep fragmentation-induced inflammation in body tissues by the autonomic nervous system (sympathetic/parasympathetic).
Chronic sleep fragmentation showed more severe consequences than single (acute) sleep fragmentation. One-week recovery from sleep fragmentation sufficiently alleviated peripheral inflammatory responses but not noradrenergic responses.78

2. Measures to improve sleep (sleep hygiene)

ADHD sufferers have poorer sleep hygiene than non-affected individuals and poorer sleep hygiene leads to increased sleep problems in ADHD. Nevertheless, poor sleep hygiene is not the cause or of ADHD, nor would its remediation be suitable as a monotherapy for ADHD.9

A meta-study of 15 studies found sleep hygiene can be helpful in children with ADHD in 14 studies.79

2.1. Increase sleep pressure

  • Getting up when lying awake in bed for more than 40 minutes
    In the case of ADHD, the otherwise usually mentioned period of 20 minutes should be extended, since ADHD sufferers typically need longer periods to fall asleep than non-affected persons
  • Nap no more than thirty minutes and before 2 p.m
  • Slept badly? Endure fatigue to sleep earlier and better in the evening.

2.2. Train a regular sleep rhythm

  • Keep regular rising and going to bed times
  • Nevertheless go to bed only when tired, get up regularly at the same time in the morning
    • So if possible, do not combat sleep problems with extended sleep that night, but maintain rhythm
    • Get through fatigue and sleep well the next night with gained bedtime energy
  • Regular exercise, up to a maximum of three hours before bedtime

2.3. Sleep phase shifting (chronotherapy)

ADHD-HI sufferers have an above-average frequency of an individually deviating day-night profile that is shifted far back, so that they are tired later and awake later again. The sleep rhythm is shifted backwards by up to several hours. This is attributed, among other things, to an altered melatonin balance, whereby melatonin, the body’s own “sleep signal,” is either not released sufficiently or at the wrong time (too late at night).

2.3.1. Shift daily rhythm to the light hours

2.3.2. Light therapy

Treatment with bright bluish light early in the morning, especially during the darker seasons of the year (in addition to avoiding bluish light after 7 pm, which is recommended anyway) can help support an early daily rhythm.
For treatment have proven effective:80

  • Lamps with 7,000 to 10,000 lux
  • At a distance of 20 to 35 cm.
  • Protective screen and UV filter are required
  • Illumination from oblique above so that it does not dazzle

Light therapy that succeeds in bringing sleep forward is likely to improve ADHD symptoms.8182

2.3.3. Melatonin treatment

Targeted treatment in the evening with melatonin.83 See above at Delayed evening melatonin increase As well as below at Melatonergic antidepressants as well as at Melatonin in ADHD in the section Appropriate medication for ADHD.

As an alternative to treatment, it is also conceivable to integrate the shifted sleep rhythm into everyday life by regularly going to bed later and getting up later. As always, a consistent rhythm is required throughout to ensure a sufficiently long sleep. However, this is likely to be socially compatible for only a few people and, moreover, does not solve the basic problem that the shifted circadian rhythm can have a negative influence on the regulatory capacity of the HPA axis.

2.3.4. Neurofeedback - SMR Training

SMR neurofeedback training (frequency band training 12 - 15 Hz) should help reduce circadian sheep phase shift.9

SMR Training

  • Improved the frequency of sleep spindles8485
  • Reduced the delay in falling asleep84
  • Increased the total sleep time8684

2.3.5. Light hygiene - avoid melatonin suppression

  • Do not make bright light before going to bed or when getting up in the night. Dimmed yellowish/reddish light avoids melatonin suppression, thus promotes melatonin release.
  • Warm light has a color temperature of 2700 Kelvin, better still lower.
    Most LED bulbs retain their color temperature when dimmed; halogen and incandescent bulbs lose color temperature when dimmed, so give an even warmer light with less blue components when dimmed.
  • Bluish and bright light has an immediate effect on the melatonin balance and signals the body: it’s morning, wake up, get active.
    3000 Kelvin is already perceived as daylight color in lamps. Optimal daytime working light has 5000 Kelvin.
    Fluorescent tubes make cold, bluish bright light: good in the morning, unfavorable in the evening.
  • Do not use bluish light and bright light in the evening
    • Bright bluish light suppresses melatonin
      • Melatonin is sleep-inducing
    • Avoid computers and smartphones 1 to 2 hours before sleep time
    • Set screen color scheme (only for evenings!) reddish dark.
      Apple introduced its own color schemes for its smartphones in 2016 for this reason, which give a more reddish light in the evening, and Windows 10 has enabled this since October 2017.
      This can be set up on any computer and TV.
    • There are so-called computer glasses that filter out the bluish light components. These help to avoid the suppression of melatonin formation by blue light components during evening screen work, watching TV or reading.
  • Working light during the day bright, white, bluish
    • Blue-enriched white light during the day at work improves alertness, performance and sleep quality by suppressing melatonin.87
    • Relevant seems to be the change of bluish bright light during the day to reddish darker light in the evening
      • In one study, people who were implanted with lenses that filtered out bluish light, i.e., who constantly received the same level of blue light components, were found to have no improvement but also no worsening of sleep.88
  • At least 30 minutes of bright daylight outdoors every day
    • According to the basic principle that the alternation of bright blue light in the morning/midday and less bright reddish light in the evening stimulates sleep-promoting melatonin production, a daily walk around midday in bright light should be helpful - especially in the darker winter months. The light brightness outdoors is dimensions greater than in brightly lit indoor spaces, even in overcast weather.
    • In addition, bright daylight (preferably direct sunlight around midday) helps vitamin D3 production. Vitamin D3 is only formed above a threshold value of 18 mj/cm² light exposure. Even the most transparent types of glass reduce the light energy below this value, so that indoors, even on the sunniest days, the threshold value of light energy at which D-3 vitamin production begins is not reached. In Germany, sufficient D-3 production is achieved outdoors during midday in June within about 15 minutes, and in September within about 30 minutes. In December, even with clear skies, this is not even achieved if one were to spend the entire day outdoors - precisely because solar radiation does not exceed the required threshold. While a maximum melatonin suppression during the day (correlating with subjective alertness) already reaches its maximum at a light level of 1000 lux and at 100 lux still 50% of the maximum, the optimum of the circadian rhythm influence by bluish light during the day is only reached at 9100 lux, whereby the 50% value is also already reached from 100 lux. Melatonin suppression or circadian effectiveness is not suppressed indoors in contrast to D3 formation, but it is halved. This should therefore be compensated by bright bluish working light.89
      10.000 lux is roughly equivalent to a 300-watt halogen lamp shining on a tabletop 45 cm away. That is already quite a bit above what is usual for normal lighting in workplaces.
  • Light intensity in lux on average
    • Parking lot - 20-25 lux
    • Living area - 50 to 200 lux
    • Public rooms - 200 lux
    • Desk - 500 lux (target)
    • Sunlight in summer - up to 50,000 lux90
  • Color temperature in Kelvin
    • Daylight: from 3000 Kelvin and more. Optimal daylight lamps have up to 5000 Kelvin (the higher, the bluer/colder)
    • Evening light: up to 2700 Kelvin and less (the less, the more yellowish/warm).

2.4. Regular sleeping hours

  • Regular and fixed times to go to bed

2.5. Bed use

  • Use bed exclusively for sleeping
  • Never eat, read, watch TV, work in bed
  • At the appropriate age, sex is a good sleeping pill - with or without a partner

2.6. Sleep rituals

  • Find your own sleep ritual
    the habit of a ritual helps to pave the way for the ritualized action after about 6 weeks
    Examples of appropriate sleep rituals
    • Walk before bedtime
    • Read fiction (not non-fiction/technical books that pertain to a personal passion)
    • Listen to audiobooks (not non-fiction/technical books that relate to a personal passion)
    • Drink warm herbal tea
    • Warm milk (with honey if necessary) before bedtime
    • Listen to binaural theta music (see below at Binaural Theta Wave Music

2.7. Sleeping environment

  • Alarm clock / Clock
    • Alarm clock out of sight
    • Do not look at alarm clock at night
  • Mobile
    • Cell phone is not in the room
    • Cell phone does not serve as an alarm clock
      Otherwise, all intermediate messages would be displayed when looking at the clock, as well as when waking up in the morning. There is hardly anything more harmful for relaxation and switching off.
  • Dinner
    • Take evening meal on time
    • Dinner light hold
  • Bedroom choice
    • Quiet and secluded space
      • Not facing the street or other sources of disturbance
      • If not possible in this apartment: move!
        A quiet bedroom is absolutely essential with ADHD!
    • If possible, no use as a dining room/TV room/study
    • If sleeping next to your partner is difficult, use a separate bedroom from your partner, where you can retire after a good night’s cuddle
      The partner will be able to weigh the increase in quality of life during the day against the separate night’s rest
  • Choice of the bed
    • If necessary separate mattresses / grate to sleeping companions
    • Bed wide enough to sleep undisturbed

2.8. Eliminate external sources of interference

With ADHD, even the smallest disturbances that do not bother other people at all can lead to massive sleep problems due to the wide-open stimulus filter. Observe your own standards and do not fall into the “normal” trap. ADHD always includes high sensitivity.

  • Temperature / Ventilation
    • Pay attention to the special temperature sensitivity of ADHD sufferers
    • Allow sufficient oxygen
  • Light
    • Tape off LED from electrical appliances
    • Close shutter
    • Lightproof interior curtains
    • Consider sleep goggles
  • Sounds
    • Earplugs help a lot
      We know sufferers who were able to sleep through the night without interruption for the first time after getting used to earplugs
      • Acclimatization period a few days
      • Try different types of earplugs
        • Silicone earplugs
          • Insulate very well
          • Before first use lightly grease the skin, otherwise difficult to get out of the ear. From 2. use more problem-free
          • Fit well to the shape of the ear
        • Foam earplugs
          • Hold in ear for 10 seconds
        • Cotton Wax Earplugs
        • Customized earplugs
          • Precise shape closes even tighter than silicone earplugs if necessary
          • You do not feel when you lie on it

2.9. Sleep techniques

Mindful breathing exercises that increase oxygen intake can help you fall asleep.
e.g.: 4-7-8 technique according to Weil.91

2.10. Dealing with circles of thought

Many ADHD sufferers are familiar with the phenomenon of the head not stopping to roll thoughts - and the sleep-preventing effect of this symptom. There are a few ways to counter this.

  • Get up again after 40 minutes. Leave bed and bedroom.
  • Turn on dimmed light, but not bright light: candle or very dimmed and warm (reddish) light with little blue components.
  • If you can’t get a certain topic out of your head: write down all arguments pro/contra on a sheet or in an Excel table. Most of the time, you will be amazed to find that it hardly takes more than half a sheet of A4 paper.
    Important: note down all arguments / motives / aspects that come to mind.
    What is once written away and on the paper / in the file can no longer be lost. This facilitates immensely and saves you from having to “hold” a thought in your head
    • If necessary, place a dictation machine next to the bed so that thoughts can be stored away in the dark without getting up.
      Paper and pen next to the bed also work, but are not quite as good because you have to make light for it.
      If necessary, get a pen with a built-in light.
  • Take in other thoughts - read book / newspaper (NO activating activities like TV, internet, cell phone or similar).
  • Only go back to bed when you really feel tired
  • If necessary, take mild sedative and/or anxiolytic medications
    e.g.
    • Trimipramine
      5 - 20 mg/drops 1 hour before bedtime
      Trimipramine is an old tricyclic antidepressant and is known to promote sleep. Unlike many other antidepressants and sleep aids, it does not interfere with REM sleep.
      Trimipramine in ADHD
    • Trazodone
      Trazodone in ADHD
  • For some sufferers, a small dose of stimulants (1/3 to 1/2 of a daily single dose unretarded) helps them find inner peace and stop their mind spinning.

2.11. Diet / nutrition for sleep problems

2.11.1. Avoid food stimulants

Food stimulants means stimulants that may be contained in food or stimulants.

  • No caffeine (teein) / guarana / mate / dark chocolate after 2 p.m
    Caffeine binds antagonistically to adenosine A1 receptors, which regulate the need for sleep in the brain. Adenosine A1 receptors inhibit the enyzm adenylate cyclase, which is needed for the conversion of ATP into cAMP. This inhibition is prevented by caffeine, and cAMP levels remain high. This increases alertness.92
    • Caffeine
      • Coffee
        • Instant coffee: 39 mg / 100 ml92
        • Filter coffee: 55 mg / 100 ml92
        • Decaffeinated coffee: 2 mg / 100 ml92
        • Espresso: 133 mg / 100 ml92
      • Cola
        • Cola with sugar 10 mg / 100 ml92
        • Cola light: 12 mg / 100 ml92
      • Energy drinks
        • Red Bull, Effect: 32 mg / 100 ml92
      • Cocoa / Chocolate
        Chocolate consumption in the afternoon or evening is rarely recognized as a cause of sleep problems, but it can trigger just that
        • Caffeine: the higher the cocoa content, the more caffeine
          • From 10 mg / 100 g (35% cocoa mass)92
          • Up to 142 mg / 100 g (99 % cocoa mass)92
        • Theobromine: the higher the cocoa content, the more theobromine.
          Like caffeine, theobromine is a methylxanthine. Although the CNS-stimulating effect is weaker than that of caffeine, cocoa contains significantly higher amounts.92
          • From 120 mg / 100 g (35% cocoa mass)92
          • Up to 1200 mg / 100 g (99 % cocoa mass)92
      • Tea
        • Black tea: 20 mg / 100 ml92
        • Green tea: 19 mg / 100 ml92
        • Mate tea: 35 mg / 100 ml92
  • No alcohol after 5 pm
  • No alcohol as a (sleep) aid
    • Even if sleep is possible with alcohol, the following day shows significantly increased stress levels of the autonomic nervous system (measurable by decreased heart rate variability).

2.11.2. Eliminate food allergies/food intolerances

A diet that limited sugar and excluded caffeine, chocolate, food additives, artificial colors, glutamate, and, for each child individually, potentially allergenic foods (such as milk) produced significant behavioral improvement in 45% of the participating children, including improvement in sleep problems phenotypic of ADHD (including delay in falling asleep).93

For more on this topic, see Nutrition and diet in ADHD In the section Non-drug treatment and therapy of ADHD in the chapter Treatment and therapy.

2.11.3. Eat/drink little/no carbohydrates in the evening

An evening intake of carbohydrates leads to increased insulin secretion. Insulin slows down the rest and regeneration hormones and fat burning. Sleep is less restful.94

2.12. Sleep disturbing effect of drugs

Sleep disorders can be caused in particular by

  • SSRI
    SSRIs may exacerbate sleep problems in ADHD95
  • Hypnotics96
  • Beta-blocker96
  • Alpha agonists96
  • Alpha Blocker96
  • Theophylline96
  • Glucocorticoids (cortisol)96
  • Thyroid hormones96
  • Antidepressants
    • A large study of antidepressants found very different effects on the risk of sleep problems:97
      Explanation:
    • Antidepressant active ingredient
      • Risk increase of sleep disturbances (odds ratio) by the respective drug
        • Note: some of the drugs mentioned here have a sleep-inducing effect when taken at low doses
      • Mechanism of action of the active ingredient
    • Amoxapine
      • 7,1
      • Tetracyclic AD
    • Atomoxetine
      • 6,6
      • NRI (norepinephrine reuptake inhibitor)
        ADHD drug
    • Maprotiline
      • 6,3
      • Tetracyclic AD
    • Mianserin
      • 5,9
      • Tetracyclic AD
    • Phenelzine
      • 5,0
      • Monoamine oxidase inhibitor
    • Clomipramine
      • 4,2
      • Tetracyclic AD
    • Fluvoxamine
      • 4,1
      • SSRI
    • Olanzapine/fluoxetine
      • 3,8
      • Atypical antipychotic / SSRI
    • Esketamine
      • 3,8
      • Noncompetetive NMDA glutamate tretor antagonist
    • Imipramine
      • 3,6
      • Tricyclic AD
    • Mirtazapine
      • 3,6
      • Tetracyclic AD
    • Doxepin
      • 3,4
      • Tricyclic AD
    • Escitalopram
      • 3,2
      • SSRI
    • Desvenlafaxine
      • 3,2
      • SNRI
    • Nortriptyline
      • 3,1
      • Tricyclic AD
    • Paroxetine
      • 3,1
      • SSRI
    • Venlafaxine
      • 3,1
      • SNRI
    • Citalopram
      • 3,0
      • SSRI
    • Vilazodon
      • 3,0
      • Serotonin modulator and stimulator
    • Duloxetine
      • 3,0
      • SNRI
    • Selegiline
      • 2,8
      • Monoamine oxidase inhibitor
    • Trazodone
      • 2,8
      • Serotonin antagonist and SRI
    • Amitriptyline
      • 2,8
      • Tricyclic AD
    • Tranylcypromine
      • 2,7
      • Monoamine oxidase inhibitor
    • Fluoxetine
      • 2,6
      • SSRI
    • Sertraline
      • 2,6
      • SSRI
    • Bupropion
      • 2,2
      • Norepinephrine/dopamine reuptake inhibitors
      • ADHD drug of the 5th choice
    • Milnacipran
      • 2,1
      • SNRI
    • Vortioxetine
      • 1,3
      • Serotonin modulator and stimulator
    • Levomilnacipran
      • 0,4
      • SNRI

2.13. Check underlying sleep disorders with doctor

Examples:

  • Depression96
    • In case of melancholic depression (falling asleep well, waking up after midnight, shortened night sleep) consider a combined intake of GABA, glycine, taurine and possibly L-theanine 2 hours before the time of falling asleep. This may increase sleep-through quality. These are inhibitory neurotransmitters or substances that support them, all of which are freely available as dietary supplements. Nevertheless, they should not be taken without consulting a physician, and the agents should be taken one at a time, not all at once. GABA taken orally does not cross the blood-brain barrier and therefore acts only in the body. Drugs that increase GABA in the brain, on the other hand, quickly become addictive.
  • Anxiety disorders96
  • Chronic pain96
  • Rheumatic diseases96
  • Coronary heart disease96
  • Asthma96
  • COPD96
  • Sleep Apnea Syndrome96
    Suspended breathing can cause symptoms that resemble ADHD.98
    Breathing disorders during sleep in ADHD-HI could be due to dysregulation of the mesencephalic serotonin system.99
  • Restless Legs Syndrome96

2.14. ADHD treatment during the day improves sleep

A combined treatment of medication and behavioral therapy proved to be more effective in improving sleep problems than treatment each with medication or therapy alone. There was no worsening of sleep with any type of treatment, not even with the usual treatment with methylphenidate.100

3. Non-drug treatment of sleep problems in ADHD

3.1. Binaural Theta Wave Music

Before going to bed, listen to 1 (to 2) hours of binaural theta waves music through headphones. (Attention: not alpha, as this increases concentration and - listened to immediately before going to bed - would increase sleep problems!) Depending on the selected theta music (there are also pure sounds), you can read (fiction), watch TV or surf (set the screen darker and redder) at the same time.
For more details, see Binaural music as therapy for ADHD and sleep problems.

3.2. Brain-Tapping

Similar to binaural theta music, brain tapping uses the brain’s synchronization to predetermined rhythms. Brain tapping uses light alternating drumming/tapping on the thighs for about 4 minutes, slowing down over time. This is combined with slow breathing.101

3.3. Sleep training

One study reported a halving of sleep problems with sleep training in ADHD-affected children between the ages of 5 and 8.102
Sleep Training provides oral and written information on normal sleep, sleep cycles, sleep disorders, sleep hygiene, and common strategies for treating behavioral disorders.103 Among other topics, it covers the importance of sleep hygiene methods such as consistent sleep routines and media-free sleep, and references standard sleep intervention strategies recommended by the American Sleep Association.104

3.4. Endurance sports

Individuals who exercised moderately to intensively for at least 150 min per week were less likely to suffer from problems falling asleep and daytime sleepiness than less active comparison subjects.((Gerber, Fuchs (2020) Stress regulation through sport and
Exercise. How everyday stresses can be better managed through physical activity.)) In older people, the number of daily steps correlated with sleep quality and reduced time to fall asleep.105

3.5. Weight blanket

A weighted blanket is a sleeping blanket with a weight of 7 to 12% of the body weight. Children must always be able to remove the blanket independently.
The increased body pressure is comfortable for most sufferers and can help eliminate anxiety, depression and sleep disturbances.
An immediate improvement of ADHD symptoms should not be expected primarily, even though one study suggests this, which also reports a normalized time to sleep.106 Improved sleep, however, is expected to result in reduced daytime sleepiness and thus increased daytime activity. These are likely to be associated with improved ADHD symptomatology,
A study of 120 sufferers of psychiatric disorders, including 13 ADHD sufferers, found significant improvements in sleep disturbances within 4 weeks for almost all disorder profiles, including ADHD. The subsequent open-label study over another 11 months showed a reduction in previously severe sleep problems to subthreshold sleep problems in more than 75% of sufferers. Anxiety and depression symptoms also improved.107
A meta-review of 8 studies concluded that weighted blankets can be helpful for anxiety symptoms. With regard to sleep problems, the basis was too weak to form a positive judgment.108
Weight blankets are said to be helpful in terms of anxiety with as little as a 20-minute brief intervention.109

4. Medication for sleep problems in ADHD

4.1. Sleep aids / sleep medications suitable for ADHD

4.1.1. Melatonin

Melatonin is produced in the body from serotonin and is involved in the sleep-wake rhythm. Release is inhibited by light. Highest natural release 3 o’clock at night.

Melatonin is freely available in D up to 1 mg/dose; if more than 1 mg per dose is recommended, melatonin requires a prescription.
In Austria, capsules up to 5 mg of melatonin are available.
In the USA, melatonin-containing drugs are freely available as dietary supplements.

Trade name: Circadin (EU), sustained-release melatonin 2 mg.

In relation to the elderly (55 years and older), efficacy of slow-release (prolonged-release) melatonin has been quite well established:

  • Sustainable reduction of the time needed to fall asleep110111
  • Improving the quality of sleep111
  • Improving morning alertness and daytime performance112
  • Simultaneous improvement of sleep quality and morning wakefulness in patients with insomnia113

The helpful effect of melatonin on jet lag was confirmed in a Cochrane Review.

Unretarded melatonin appears to be more appropriate for sleep onset disorders, while retarded melatonin appears to be more successful for sleep maintenance disorders.
More about melatonin at Melatonin in ADHD.

4.1.2. Agomelatine

Agomelatine (trade name: Valdoxan) is a melatonergic antidepressant

  • Agomelatine has a chemical structure related to melatonin
  • Affinity for the MT1 and MT2 melatonin receptors
  • Antagonistic properties at the serotonin receptor 5-HT2c (different from melatonin)
  • Sleeping pill, which is also mentioned as a possible ADHD drug
  • Agomelatine was tested against methylphenidate in a randomized double-blind trial with n = 54 children. Both drugs performed comparably in parent and teacher ratings of the children. Naturally, children treated with agomelatine had fewer sleep disturbances.114
  • Agomelatine can cause liver problems. Therefore, liver values must be monitored closely.
  • Effect seems to be very individual.
  • Discussion of over 50 users (mostly depression sufferers) about the effects and side effects of agomelatine (both positive and negative) at psychiatrietogo.de.115
  • Our non-representative experience with agomelatine is rather negative. The sleep reported to us is flat and “cold”. One does not feel refreshed.

See also ⇒ Agomelatine in ADHD

4.1.3. Trimipramine

Trimipramine is a tricyclic antidepressant. In low doses it is sleep-inducing.

  • 10 to 30 mg (instead of 100 to 300 mg as antidepressant) 1/2 to 1 hour before bedtime. For first use, test with even lower dosage.
  • Anxiety-relieving
  • Deep, restful sleep
  • REM phases are preserved (for trimipramine, different for other TZADs such as amitriptyline or doxepin)116
  • Much less addictive than benzodiazepines116
  • The experience with trimipramine reported to us is very positive. Sleep is very restful and dreaming is not reduced. At times - especially in the beginning - a hangover occurred.

4.1.4. Trazodone

Trazodone is a dual-serotonergic antidepressant and is recommended as a sleep aid for ADHD.117

  • Phenylpiperazine
  • Half-life 5 to 9 hours
  • Strongly inhibits α1-receptors
  • Weakly inhibits α2- and H1-receptors
  • Low dose (up to 50 mg)
    • 5HT2A receptor antagonist
      • = Blockade of the 5HT2A receptors
      • → leads to dopamine increase in the striatum due to glutamate reduction
      • → enhances serotonergic neurotransmission via the 5-HT1A receptors
    • Incidentally not serotonergic
  • Higher doses
    • Stronger serotonerg
    • Antihistaminerg
  • Sleep-inducing in ADHD when taken in low doses (25 to 100 mg)
  • No impairment of sexual functions
  • No increase in body weight
  • Attenuating effect on tremor
  • Not contraindicated in glaucoma and prostate disorders
  • No extrapyramidal effect (no motor restlessness)
  • No potentiation of adrenergic transmission
  • No anticholinergic activity, therefore does not have the typical side effects of tricyclic antidepressants
  • Do not combine with MAO inhibitors or (especially if high-dose) with serotonergic medications
  • Sleep promotion by trazodone could also be due to serotonergic effects
    • In hordes of rhesus monkeys, the animals that fall asleep the latest are those with the lowest levels of 5-HIAA in cerebrospinal fluid, a serotonin degrader.(Grawe (2004): Neuropsychotherapy, page 200))

4.1.5. Mirtazapine

Mirtazapine is a tetracyclic antidepressant.
One small study reported positive experiences as a sleep aid in ADHD at low doses of 3.75 to 7.5 mg per hour of sleep.118 Another very small study found comparable results at a dose of 30 mg.119

4.1.6. ADHD stimulants

  • Methylphenidate, amphetamine medication
  • To test sleep-promoting effect individually
    Although stimulants generally have a more activating effect, a low dose of MPH or amphetamine before bedtime actually helps some sufferers by curbing their mind’s wandering. The effect can be individually significantly better than sleeping pills.
    For most, it is too stimulating, so medication should be reduced throughout the day toward evening and stopped in time.
  • A number of people report sleeping better at night with amphetamine medication (during the day) than with methylphenidate medication

As a rule, stimulants are more likely to inhibit sleep. However, it is not just isolated cases that report that an evening dose of unretarded MPH, equivalent to about one-third to one-half of the usual single dose during the day, can help with falling asleep.

4.1.7. Caffeine, nicotine

As a rule, caffeine or nicotine tend to prevent sleep, since they are stimulants. However, paradoxical reactions are possible in ADHD patients, just as with stimulant drugs, so that caffeine or nicotine can have a sleep-promoting effect. This must be tested on an individual basis.120.

4.1.8. L-Theanine

L-theanine (5-N-ethyl-L-glutamine) is a glutamate antagonist. It is credited with a possible reduction in the physical and psychological stress response.121122123

According to the German Federal Institute for Risk Assessment, L-theanine has various pharmacological effects in animal studies:124

  • Blood pressure lowering
  • Influences the concentration of various neurotransmitters in the brain
  • Counteracts caffeine effects
  • Therefore possibly calming and relaxing (sedative) effect
  • Unknown,
    • Whether other effects exist
    • Whether responsiveness or attention is impaired
    • Whether possible negative effects are intensified by the additional consumption of alcohol or medication.
  • Toxicological data on L-theanine are incomplete so far
  • Therefore, it remains to be seen whether and if so, in what quantities L-theanine is safe for health when consumed daily and used in isolation.

Regarding ADHD, a randomized and placebo-controlled study in boys found a sleep-promoting effect at 400 mg/day,125 another study at 200 mg before bedtime.126
There do not appear to be any other studies. A meta-study found that the results for eszopiclone were even better than for l-theanine,127 but the sleeping pill eszopiclone was only approved in the U.S. because it was denied novelty status in the EU. Further, L-theanine is reported to improve sleep quality, but little on falling asleep time and sleep duration.128

In contrast, there are several studies showing a positive effect of L-theanine in depression.129130 131 which has been attributed to, among other things, a change in monoamine levels in the striatum, cortex, limbic system, pallidum, and thalamus.123

An anxiolytic effect and enhancement of hippocampal activity were noted in rats.132

4.1.9. Combined intake of GABA, glycine, taurine, L-theanine

A combined intake of GABA (750 mg), glycine (500 mg), taurine (500 mg), and possibly L-theanine 2 hours before bedtime may increase sleepiness (which may especially counteract the backward-shifted sleep rhythm in some ADHD sufferers) and improve sleep quality.
GABA and glycine are inhibitory neurotransmitters; taurine increases GABA.
All substances are freely available as dietary supplements. Nevertheless, they should not be taken without consulting a physician and the agents should be dosed one after the other and not all at the same time. GABA taken orally does not cross the blood-brain barrier and therefore only acts in the body. Drugs that increase GABA in the brain, on the other hand, quickly become addictive. This danger does not exist with orally taken GABA.

4.1.10. Iron

One review found strong evidence for a correlation of iron deficiency and restless legs sleep problems, as well as possible evidence for correlations with sleep problems in ADHD.133

4.1.11. Dopaminergic agents and sleep and wakefulness

D1 receptor agonists:

  • SKF38393 was able to improve excessive daytime sleepiness and restore REM sleep in animal studies.7273
  • SKF-82958 infusion effected for 2 hours:134
    • increased waking time depending on the dose
    • suppressed REM sleep and slow-wave sleep
    • slightly increased locomotion
    • slightly increased time of grooming and eating

D2 receptor agonists have different effects on sleep and wakefulness:135

  • Bromocriptine, dosed to address only the autoreceptor, increased slow-wave sleep and decreased wakefulness in rats. In healthy humans, it did not shorten sleep latency.136
  • Quinpirole134137
    • low dose: decreased wakefulness and promoted sleep in rats
    • high doses: increased wakefulness and decreased sleep
    • easily increased drinking and locomotion
    • significantly increased chewing on inedible material, a behavior associated with arousal/stress
  • RO 41-9067 increased alertness in animals in a dose-dependent manner
  • Cabergoline reduced the number of periodic leg movements in RLS during sleep
  • Pramipexole (D3 and D2 agonist)136138
    • at low doses (30 micrograms/kg), it increased slow wave sleep, REM sleep, and decreased wakefulness
    • high dose (500 micrograms/kg) increased alertness
  • Ropinirole shortened sleep latency and increased total sleep time in Parkinson’s disease, in RLS, and in healthy subjects.139136
  • Piribedil has a strong wakefulness-promoting effect. In Parkinson’s it sometimes triggered sleep attacks

D4 agonists:140

  • Ro 10-5824
    • prolonged waking time and shortened non-Rem sleep
    • delayed the onset of non rem sleep
    • amplified the theta and gamma power in the EEG.
  • A-412997
    • prolonged waking time and shortened non-Rem sleep
    • delayed the onset of non rem sleep
    • influenced onset and duration of rem.sleep
    • amplified the theta and gamma power in the EEG.

D4 antagonists:

  • L-741,741, a highly selective D4 antagonist was explored in Wistar rats141
    • 1.5 mg/kg
      • increased only the light slow wave sleep
    • 3 mg/kg
      • increased the episodes of quiet wakefulness
      • reduced and shortened the episodes of active wakefulness
    • 6 mg/kg
      • decreased episodes and increased latency of deep slow wave sleep
      • decreased episodes and duration of light slow wave sleep
      • reduced the total sleep time
      • increased the active waking state
      • erhlhte the latency of REM sleep

4.2. Sleeping pills / sleep medication NOT suitable for ADHD

4.2.1. Avoid benzodiazepines in ADHD

  • High risk of addiction to benzodiazepines (within 14 days)
    Not recommended against the background of addiction affinity in ADHD due to the strong reward delay aversion in ADHD
  • Benzodiazepines reduce the activity of the locus coeruleus and thus reduce the production and transport of norepinephrine to other parts of the brain. Therefore, they should rather be contraindicated in ADHD
  • Strong sleep effect
  • Anxiety Relief
  • Frequently used active ingredients142
    • Flurazepam
    • Nitrazepam
    • Temazepam
    • Triazolam

4.2.2. Neuroleptics not indicated in pure ADHD

Neuroleptics are not recommended for (pure) ADHD.142

Neuroleptics, like antidepressants, are not typical sleeping pills, but are used to treat mental disorders. However, due to their sedative-dampening effect, they can also help with sleep disorders, especially if these are caused by psychoses. In ADHD-HI, neuroleptics seem potentially useful only in the presence of specific comorbidities (e.g., from the autism spectrum).143

4.2.2.1. Pipamperon

Pipamperone is a low-potency neuroleptic.
Pipamperone blocked (antagonized)

  • Primarily serotonin receptors
  • Low D2 receptors
  • Low D4 receptors
  • Low alpha1-adrenoceptors

Since in ADHD there is often already a reduced sensitivity of the D4 receptor, which is partly responsible for the overreactivity of the striatum due to the omission of the inhibitory D4 receptor effect (keyword: DRD4-7R), it seems doubtful to us whether an additional impairment of the D4 receptor is really useful.

4.2.3. SSRIs (Selective Serotonin Reuptake Inhibitors)

Antidepressants are generally suitable for remedying depression-induced sleep problems.
However, SSRIs can exacerbate sleep problems in ADHD.95

SSRIs reduce REM sleep by 30%.144
REM sleep:145

  • Is essential to restore neurotransmitter balance in the brain (degradation of adenosine, build-up of glycogen in astrocytes; especially in non-REM)
  • Causes structural relief (serotonin raphe nuclei etc.)
  • REM sleep is particularly important in the first years of life
    • Training of sensorimotor skills
    • Training of otherwise unused behaviors
    • Newborns sleep 16 to 18 hours, of which 50 % = 8 - 9 hours REM
    • 10-year-old children still have 2 - 2.5 hours of REM sleep

4.3. More sleeping pills

We do not (yet) have specific evidence on the following sleep medications as to whether they are particularly indicated or contraindicated in ADHD.

4.3.1. Non-benzodiazepine agonists

  • Different structure than benzodiazepines

  • Act at the same receptors as benzodiazepines

  • Active ingredients, among others:

    • Zaleplon

    • Zolpidem

    • Zopiclone

      • GABA receptor agonist in the brain = risk of addiction!
        New generation sedative - Z-Drug
        Trade names: Imovane (D, CH), Optidorm (D), Somnal (A), Somnosan (D), Ximovan (D), Zopiclodura (D), Zopitin (CZ), various generics, Lunesta (USA)
  • Lower risk of dependence than benzodiazepines (unlike at least zopiclone, which may be taken for a maximum of 2 weeks due to the risk of psychological and physical addiction)
    However, there remains a risk of dependence, which is why we do not endorse non-benzodiazepine agonists as sleep aids in ADHD sufferers.

4.3.2. Barbiturates

  • Only to be used if other sleeping pills do not work
  • Strong side effects, overdose can be fatal

4.3.3. First generation antihistamines

  • Besides alleviating allergy symptoms, also sedative
  • Active ingredients, among others
    • Doxylamine
    • Meclozine
    • Promethazine

5. Sleep problems due to ADHD medication

ADHD medications can cause sleep problems as side effects. Often, but not always, these are a mere consequence of the dosage and disappear within a few weeks. Care should be taken to stop taking ADHD medication in time for it to take effect one hour before bedtime.

Sleep problems caused by ADHD medications are most commonly reported by:146

  • Mixed amphetamine salts (40-45%) (not permitted in D)
  • Dasotraline (35-45%) (new drug under investigation)
  • Lisdexamfetamine (10-19%) (Elvanse)
  • Atomoxetine (10 - 17 %)
  • Retarded methylphenidate (11%)

Several sufferers report that a small dose of stimulants (unretarded MPH, about 1/3 of a single dose taken during the day) helps them to fall asleep by relaxing them and stopping the carousel of thoughts. One sufferer commented that he could only sleep at full stimulant dosage.


  1. Lunsford-Avery, Krystal, Kollins (2016): Sleep disturbances in adolescents with ADHD: A systematic review and framework for future research. Clin Psychol Rev. 2016 Oct 23;50:159-174. doi: 10.1016/j.cpr.2016.10.004 REVIEW

  2. Andersson, Sonnesen (2018): Sleepiness, occlusion, dental arch and palatal dimensions in children attention deficit hyperactivity disorder (ADHD).Eur Arch Paediatr Dent. 2018 Mar 14. doi: 10.1007/s40368-018-0330-3.

  3. Zwennes, Loth (2019): “Moments of Failure”: Coping With Attention Deficit Hyperactivity Disorder, Sleep Deprivation, and Being Overweight: A Qualitative Hermeneutic-Phenomenological Investigation Into Participant Perspectives. J Addict Nurs. 2019 Jul/Sep;30(3):185-192. doi: 10.1097/JAN.0000000000000291.

  4. Díaz-Román, Buela-Casal (2019): Shorter REM latency in children with attention-deficit/hyperactivity disorder. Psychiatry Res. 2019 Aug;278:188-193. doi: 10.1016/j.psychres.2019.06.012.

  5. Van Dyk, Becker, Byars (2019): Rates of Mental Health Symptoms and Associations With Self-Reported Sleep Quality and Sleep Hygiene in Adolescents Presenting for Insomnia Treatment. J Clin Sleep Med. 2019 Sep 6. pii: jc-19-00057.

  6. Liu, Liu, Liu, Sun, Jia (2019): Associations of sleep problems with ADHD symptoms: Findings from the Shandong Adolescent Behavior and Health Cohort (SABHC). Sleep. 2019 Dec 2. pii: zsz294. doi: 10.1093/sleep/zsz294. n = 7.072

  7. Hvolby (2015): Associations of sleep disturbance with ADHD: implications for treatment. Atten Defic Hyperact Disord. 2015 Mar;7(1):1-18. doi: 10.1007/s12402-014-0151-0. PMID: 25127644; PMCID: PMC4340974. REVIEW

  8. Madiouni, Broc, Cindy, Bayard (2022): Attention-Deficit/Hyperactivity Disorder, Insomnia, and Sleepiness Symptoms among a Community Adult Sample: The Mediating Effect of Executive Behavioral Regulation and Metacognition Abilities. Arch Clin Neuropsychol. 2022 Feb 15:acac006. doi: 10.1093/arclin/acac006. PMID: 35175334.

  9. Bijlenga, Vollebregt, Kooij, Arns (2019): The role of the circadian system in the etiology and pathophysiology of ADHD: time to redefine ADHD? Atten Defic Hyperact Disord. 2019 Mar;11(1):5-19. doi: 10.1007/s12402-018-0271-z. REVIEW

  10. Fadeuilhe, Daigre, Richarte, Grau-López, Palma-Álvarez, Corrales, Ramos-Quiroga (2021): Insomnia Disorder in Adult Attention-Deficit/Hyperactivity Disorder Patients: Clinical, Comorbidity, and Treatment Correlates. Front Psychiatry. 2021 May 26;12:663889. doi: 10.3389/fpsyt.2021.663889. PMID: 34122179; PMCID: PMC8187558. n = 252

  11. Ruiz-Herrera, Guillén-Riquelme, Díaz-Román, Cellini, Buela-Casal (2020): Sleep among presentations of Attention-Deficit/Hyperactivity Disorder: Analysis of objective and subjective measures. Int J Clin Health Psychol. 2020 Jan-Apr;20(1):54-61. doi: 10.1016/j.ijchp.2019.08.001. PMID: 32021619; PMCID: PMC6994748.

  12. Scarpelli, Gorgoni, D’Atri, Reda, De Gennaro (2019): Advances in Understanding the Relationship between Sleep and Attention Deficit-Hyperactivity Disorder (ADHD). J Clin Med. 2019 Oct 19;8(10). pii: E1737. doi: 10.3390/jcm8101737.

  13. Vaidyanathan, Shah, Gayal (2016): Sleep Disturbances in Children with Attention – Deficit/Hyperactivity Disorder (ADHD): Comparative Study with Healthy Siblings.J Can Acad Child Adolesc Psychiatry. 2016 Fall;25(3):145-151.

  14. Gomes-Tiago, de S. Costa, Alvim-Soares, Malloy-Diniz, de Miranda (2016): Sleep duration and intensity of ADHD symptoms; Revista Brasileira de Psiquiatria; ISSN 1516-4446; ISSN 1809-452X; Rev. Bras. Psiquiatr. vol.38 no.4 São Paulo Oct./Dec. 2016; http://dx.doi.org/10.1590/1516-4446-2015-1847

  15. Cohen, Dan, Asraf, Haimov (2019): The Sleepiness Curve of Young Men With and Without Attention-Deficit Hyperactivity Disorder (ADHD). Behav Sleep Med. 2019 Feb 26:1-13. doi: 10.1080/15402002.2019.1583564.

  16. Yıldız Miniksar, Özdemir (2021): Sleep quality in children and adolescents with attention-deficit and hyperactivity disorder. Arch Pediatr. 2021 Oct 20:S0929-693X(21)00173-1. doi: 10.1016/j.arcped.2021.09.017. PMID: 34688509 n = 222

  17. Bjorvatn, Brevik, Lundervold, Halmøy, Posserud, Instanes, Haavik (2017): Adults with Attention Deficit Hyperactivity Disorder Report High Symptom Levels of Troubled Sleep, Restless Legs, and Cataplexy. Front Psychol. 2017 Sep 20;8:1621. doi: 10.3389/fpsyg.2017.01621. eCollection 2017.

  18. so Gomes-Tiago, de S. Costa, Alvim-Soares, Malloy-Diniz, de Miranda (2016): Sleep duration and intensity of ADHD symptoms; Revista Brasileira de Psiquiatria; ISSN 1516-4446; ISSN 1809-452X; Rev. Bras. Psiquiatr. vol.38 no.4 São Paulo Oct./Dec. 2016; http://dx.doi.org/10.1590/1516-4446-2015-1847

  19. Ruiz-Herrera, Guillén-Riquelme, Díaz-Román, Cellini, Buela-Casal (2020): Sleep among presentations of Attention-Deficit/Hyperactivity Disorder: Analysis of objective and subjective measures. Int J Clin Health Psychol. 2020 Jan-Apr;20(1):54-61. doi: 10.1016/j.ijchp.2019.08.001. PMID: 32021619; PMCID: PMC6994748. n = 92

  20. Becker, Cusick, Sidol, Epstein, Tamm (2018): The Impact of Comorbid Mental Health Symptoms and Sex on Sleep Functioning in Children with ADHD; Eur Child Adolesc Psychiatry. 2018 Mar; 27(3): 353–365. doi: 10.1007/s00787-017-1055-2; PMCID: PMC5854508, NIHMSID: NIHMS911130, PMID: 28983772; n = 181

  21. Gagnon, Labrosse, Gingras, Godbout (2021): Sleep Instability Correlates with Attentional Impairment in Boys with Attention Deficit Hyperactivity Disorder. Brain Sci. 2021 Oct 27;11(11):1425. doi: 10.3390/brainsci11111425. PMID: 34827422; PMCID: PMC8615536. n = 27

  22. Mimouni-Bloch, Offek, Engel-Yeger, Rosenblum, Posener, Silman, Tauman (2021): Association between sensory modulation and sleep difficulties in children with Attention Deficit Hyperactivity Disorder (ADHD). Sleep Med. 2021 Jun 1;84:107-113. doi: 10.1016/j.sleep.2021.05.027. PMID: 34144449. n = 76

  23. Steiger (2002): Sleep and the hypothalamo-pituitary-adrenocortical system. Sleep Med Rev. 2002 Apr;6(2):125-38.

  24. Aubry, Jermann, Gex-Fabry, Bockhorn, Van der Linden, Gervasoni, Bertschy, Rossier, Bondolfi (2010): The cortisol awakening response in patients remitted from depression; journal of Psychiatric Research, December 2010, Volume 44, Issue 16, Pages 1199–1204; DOI: http://dx.doi.org/10.1016/j.jpsychires.2010.04.015

  25. Minkel, Moreta, Muto, Htaik, Jones, Basner, Dinges (2014): Sleep deprivation potentiates HPA axis stress reactivity in healthy adults. Health Psychol. 2014 Nov;33(11):1430-4. doi: 10.1037/a0034219.

  26. Cusick, Isaacson, Langberg, Becker (2018): Last night’s sleep in relation to academic achievement and neurocognitive testing performance in adolescents with and without ADHD. Sleep Med. 2018 Aug 21;52:75-79. doi: 10.1016/j.sleep.2018.07.014. n = 300

  27. Ranum, Wichstrøm, Pallesen, Falch-Madsen, Halse, Steinsbekk (2019): Association Between Objectively Measured Sleep Duration and Symptoms of Psychiatric Disorders in Middle Childhood. JAMA Netw Open. 2019 Dec 2;2(12):e1918281. doi: 10.1001/jamanetworkopen.2019.18281.

  28. Vriend, Davidson, Corkum, Rusak, Chambers, McLaughlin (2013): Manipulating sleep duration alters emotional functioning and cognitive performance in children. J Pediatr Psychol. 2013 Nov;38(10):1058-69. doi: 10.1093/jpepsy/jst033.

  29. Sadeh, Gruber, Raviv (2003): The effects of sleep restriction and extension on school-age children: what a difference an hour makes. Child Dev. 2003 Mar-Apr;74(2):444-55.

  30. Beebe (2011): Cognitive, behavioral, and functional consequences of inadequate sleep in children and adolescents. Pediatr Clin North Am. 2011 Jun;58(3):649-65. doi: 10.1016/j.pcl.2011.03.002.

  31. Dan, Cohen, Asraf, Saveliev, Haimov (2020): The Impact of Sleep Deprivation on Continuous Performance Task Among Young Men With ADHD. J Atten Disord. 2020 Jan 9:1087054719897811. doi: 10.1177/1087054719897811. n = 34

  32. Cohen, Asraf, Saveliev, Dan, Haimov (2021): The effects of sleep deprivation on the processing of emotional facial expressions in young adults with and without ADHD. Sci Rep. 2021 Jul 9;11(1):14241. doi: 10.1038/s41598-021-93641-7. PMID: 34244583. n = 35

  33. Cremone-Caira, Buirkle, Gilbert, Nayudu, Faja (2019): Relations between caregiver-report of sleep and executive function problems in children with autism spectrum disorder and attention-deficit/hyperactivity disorder. Res Dev Disabil. 2019 Aug 31;94:103464. doi: 10.1016/j.ridd.2019.103464.

  34. Belli, Breda, Di Maggio, Esposito, Marcucci, Bruni (2022): Children with neurodevelopmental disorders: how do they sleep? Curr Opin Psychiatry. 2022 Feb 14. doi: 10.1097/YCO.0000000000000790. PMID: 35165244.

  35. Keshavarzi, Bajoghli, Mohamadi, Salmanian, Kirov, Gerber, Holsboer-Trachsler, Brand (2014): In a randomized case-control trial with 10-years olds suffering from attention deficit/hyperactivity disorder (ADHD) sleep and psychological functioning improved during a 12-week sleep-training program. World J Biol Psychiatry. 2014 Dec;15(8):609-19. doi: 10.3109/15622975.2014.922698.

  36. Peppers, Eisbach, Atkins, Poole, Derouin (2016): An Intervention to Promote Sleep and Reduce ADHD Symptoms.J Pediatr Health Care. 2016 Nov – Dec;30(6):e43-e48. doi: 10.1016/j.pedhc.2016.07.008.

  37. Langberg, Breaux, Cusick, Green, Smith, Molitor, Becker (2019): Intraindividual variability of sleep/wake patterns in adolescents with and without attention-deficit/hyperactivity disorder. J Child Psychol Psychiatry. 2019 Jun 24. doi: 10.1111/jcpp.13082.

  38. Lorton, Lubahn, Estus, Millar, Carter, Wood, Bellinger (2006): Bidirectional Communication between the Brain and the Immune System: Implications for Physiological Sleep and Disorders with Disrupted Sleep, Neuroimmunomodulation 2006;13:357–374, https://doi.org/10.1159/000104864

  39. Suarez (2008): Self-reported symptoms of sleep disturbance and inflammation, coagulation, insulin resistance and psychosocial distress: evidence for gender disparity. Brain Behav Immun. 2008 Aug;22(6):960-8. doi: 10.1016/j.bbi.2008.01.011.

  40. Meier-Ewert, Ridker, Rifai, Regan, Price, Dinges, Mullington (2004) Effect of sleep loss on C-reactive protein, an inflammatory marker of cardiovascular risk. J Am Coll Cardiol. 2004 Feb 18;43(4):678-83. n = 20

  41. Vgontzas, Papanicolaou, Bixler, Lotsikas, Zachman, Kales, Prolo, Wong, Licinio, Gold, Hermida, Mastorakos, Chrousos (1999): Circadian interleukin-6 secretion and quantity and depth of sleep. J Clin Endocrinol Metab. 1999 Aug;84(8):2603-7.

  42. Vgontzas, Zoumakis, Bixler, Lin, Follett, Kales, Chrousos (2004): Adverse effects of modest sleep restriction on sleepiness, performance, and inflammatory cytokines. J Clin Endocrinol Metab. 2004 May;89(5):2119-26.

  43. Motivala, Sarfatti, Olmos, Irwin (2005): Inflammatory markers and sleep disturbance in major depression. Psychosom Med. 2005 Mar-Apr;67(2):187-94.

  44. Chrousos (2009): Stress and disorders of the stress system. Nat Rev Endocrinol. 2009 Jul;5(7):374-81. doi: 10.1038/nrendo.2009.106. PMID: 19488073. REVIEW

  45. Martin, Papadopoulos, Rinehart, Sciberras (2019): Associations Between Child Sleep Problems and Maternal Mental Health in Children with ADHD. Behav Sleep Med. 2019 Nov 25:1-14. doi: 10.1080/15402002.2019.1696346.

  46. Kiehn, Faltraco, Palm, Thome, Oster (2019): Circadian Clocks in the Regulation of Neurotransmitter Systems. Pharmacopsychiatry. 2019 Oct 30. doi: 10.1055/a-1027-7055.

  47. Salehinejad, Majidinezhad, Ghanavati, Kouestanian, Vicario, Nitsche, Nejati (2020): Negative impact of COVID-19 pandemic on sleep quantitative parameters, quality, and circadian alignment: Implications for health and psychological well-being. EXCLI J. 2020 Sep 11;19:1297-1308. doi: 10.17179/excli2020-2831. PMID: 33192213; PMCID: PMC7658458. n= 160

  48. Yuksel, McKee, Perrin, Alzueta, Caffarra, Ramos-Usuga, Arango-Lasprilla, Baker (2021): Sleeping when the world locks down: Correlates of sleep health during the COVID-19 pandemic across 59 countries. Sleep Health. 2021 Apr;7(2):134-142. doi: 10.1016/j.sleh.2020.12.008. PMID: 33509687; PMCID: PMC7835079. n = 6.882

  49. Palm, Uzoni, Simon, Fischer, Coogan, Tucha, Thome, Faltraco (2021): Evolutionary conservations, changes of circadian rhythms and their effect on circadian disturbances and therapeutic approaches. Neurosci Biobehav Rev. 2021 Jun 5;128:21-34. doi: 10.1016/j.neubiorev.2021.06.007. PMID: 34102148. REVIEW

  50. Simonneaux, Ribelayga (2003): Generation of the melatonin endocrine message in mammals: a review of the complex regulation of melatonin synthesis by norepinephrine, peptides, and other pineal transmitters. Pharmacol Rev. 2003 Jun;55(2):325-95. doi: 10.1124/pr.55.2.2. PMID: 12773631. REVIEW

  51. Bioulac, Taillard, Philip, Sagaspe (2020): Excessive Daytime Sleepiness Measurements in Children With Attention Deficit Hyperactivity Disorder. Front Psychiatry. 2020 Feb 26;11:3. doi: 10.3389/fpsyt.2020.00003. PMID: 32174847; PMCID: PMC7055535. REVIEW

  52. Becker (2019): ADHD and sleep: recent advances and future directions. Curr Opin Psychol. 2019 Sep 20;34:50-56. doi: 10.1016/j.copsyc.2019.09.006.

  53. Korman, Levy, Maaravi-Hesseg, Eshed-Mantel, Karni (2019): Subclinical Scores in Self-Report Based Screening Tools for Attention Deficits Correlate With Cognitive Traits in Typical Evening-Type Adults Tested in the Morning. Front Psychol. 2019 Jun 18;10:1397. doi: 10.3389/fpsyg.2019.01397. eCollection 2019.

  54. Wynchank, Bijlenga, Penninx, Lamers, Beekman, Kooij, Verhoeven (2019): Delayed sleep-onset and biological age: late sleep-onset is associated with shorter telomere length. Sleep. 2019 Jul 4. pii: zsz139. doi: 10.1093/sleep/zsz139. n = 2.936

  55. Türkoğlu, Çetin (2019): The relationship between chronotype and obesity in children and adolescent with attention deficit hyperactivity disorder. Chronobiol Int. 2019 Aug;36(8):1138-1147. doi: 10.1080/07420528.2019.1622131.

  56. Becker, Kapadia, Fershtman, Sciberras (2019): Evening circadian preference is associated with sleep problems and daytime sleepiness in adolescents with ADHD. J Sleep Res. 2019 Oct 25:e12936. doi: 10.1111/jsr.12936.

  57. Walch, Cochran, Forger (2016): A global quantification of “normal” sleep schedules using smartphone data. Sci Adv. 2016 May 6;2(5):e1501705. doi: 10.1126/sciadv.1501705. PMID: 27386531; PMCID: PMC4928979.

  58. Van der Heijden, Smits, Van Someren, Gunning (2005): Idiopathic chronic sleep onset insomnia in attention-deficit/hyperactivity disorder: a circadian rhythm sleep disorder. Chronobiol Int. 2005;22(3):559-70. n = 87

  59. Lee, Kim, Lee (2019): Association between sleep duration and attention-deficit hyperactivity disorder: A systematic review and meta-analysis of observational studies. J Affect Disord. 2019 May 28;256:62-69. doi: 10.1016/j.jad.2019.05.071. REVIEW

  60. Cremone-Caira, Root, Harvey, McDermott, Spencer (2019): Effects of Sleep Extension on Inhibitory Control in Children With ADHD: A Pilot Study. J Atten Disord. 2019 May 29:1087054719851575. doi: 10.1177/1087054719851575.

  61. Iglowstein, Jenni, Molinari, Largo (2003): Sleep Duration From Infancy to Adolescence: Reference Values and Generational Trends; Pediatrics, 111, 302-307.

  62. Dollman, Ridley, Olds, Lowe (2007): Trends in the duration of school‐day sleep among 10‐ to 15‐year‐old South Australians between 1985 and 2004. https://doi.org/10.1111/j.1651-2227.2007.00278.x

  63. Matricciani, Olds, Petkov (2012): In search of lost sleep: Secular trends in the sleep time of school-aged children and adolescents, Sleep Medicine Reviews, Volume 16, Issue 3, 2012, Pages 203-211, ISSN 1087-0792, https://doi.org/10.1016/j.smrv.2011.03.005. REVIEW

  64. Magee, Hale (2012): Longitudinal associations between sleep duration and subsequent weight gain: A systematic review, Sleep Medicine Reviews, Volume 16, Issue 3, 2012, Pages 231-241, ISSN 1087-0792, https://doi.org/10.1016/j.smrv.2011.05.005. REVIEW

  65. Türkoğlu, Tahsin Somuk, Sapmaz, Bilgiç (2019): Effect of adenotonsillectomy on sleep problems, attention deficit hyperactivity disorder symptoms, and quality of life of children with adenotonsillar hypertrophy and sleep-disordered breathing. Int J Psychiatry Med. 2019 Mar 1:91217419829988. doi: 10.1177/0091217419829988.

  66. Tomkies, Johnson, Shah, Caraballo, Evans, Mitchell (2019): Obstructive Sleep Apnea in Children With Autism. J Clin Sleep Med. 2019 Sep 4. pii: jc-18-00732.

  67. Hesselbacher, Aiyer, Surani, Suleman, Varon (2019): A Study to Assess the Relationship between Attention Deficit Hyperactivity Disorder and Obstructive Sleep Apnea in Adults. Cureus. 2019 Oct 24;11(10):e5979. doi: 10.7759/cureus.5979.

  68. Miano, Castelnovo, Bruni, Manconi (2021): Sleep microstructure in attention deficit hyperactivity disorder according to the underlying sleep phenotypes. J Sleep Res. 2021 Jun 24:e13426. doi: 10.1111/jsr.13426. PMID: 34169594.

  69. Bioulac, Micoulaud-Franchi, Philip (2015): Excessive daytime sleepiness in patients with ADHD–diagnostic and management strategies. Curr Psychiatry Rep. 2015 Aug;17(8):608. doi: 10.1007/s11920-015-0608-7.

  70. Helfer, Bozhilova, Cooper, Douzenis, Maltezos, Asherson (2020): The key role of daytime sleepiness in cognitive functioning of adults with attention deficit hyperactivity disorder. Eur Psychiatry. 2020 Mar 5;63(1):e31. doi: 10.1192/j.eurpsy.2020.28. PMID: 32131909; PMCID: PMC7315868.

  71. Willie, Renthal, Chemelli, Miller, Scammell, Yanagisawa, Sinton (2005): Modafinil more effectively induces wakefulness in orexin-null mice than in wild-type littermates. Neuroscience. 2005;130(4):983-95.

  72. Wen, Chen, Rong, Jing, Chen, Ma (2013):. The regulation of SKF38393 on the dopamine and D1 receptor expression in hippocampus during chronic REM sleep restriction. CNS Neurosci Ther. 2013 Sep;19(9):730-3. doi: 10.1111/cns.12140. PMID: 23827052; PMCID: PMC6493419.

  73. Hyacinthe, Barraud, Tison, Bezard, Ghorayeb (2014): D1 receptor agonist improves sleep-wake parameters in experimental parkinsonism. Neurobiol Dis. 2014 Mar;63:20-4. doi: 10.1016/j.nbd.2013.10.029. PMID: 24211719.

  74. Gorgoni, Scarpelli, Reda, De Gennaro (2019): Sleep EEG oscillations in neurodevelopmental disorders without intellectual disabilities. Sleep Med Rev. 2019 Oct 30;49:101224. doi: 10.1016/j.smrv.2019.101224.

  75. Bestmann, Conzelmann, Baving, Prehn-Kristensen (2019): Associations between cognitive performance and sigma power during sleep in children with attention-deficit/hyperactivity disorder, healthy children, and healthy adults. PLoS One. 2019 Oct 24;14(10):e0224166. doi: 10.1371/journal.pone.0224166. eCollection 2019. n = 56

  76. Ueda, Takeichi, Kaga, Oguri, Saito, Nakagawa, Maegaki, Inagaki (2019): Atypical gamma functional connectivity pattern during light sleep in children with attention deficit hyperactivity disorder. Brain Dev. 2019 Nov 21. pii: S0387-7604(19)30510-8. doi: 10.1016/j.braindev.2019.11.001.

  77. Furrer, Jaramillo, Volk, Ringli, Aellen, Wehrle, Pugin, Kurth, Brandeis, Schmid, Jenni, Huber (2019): Sleep EEG slow-wave activity in medicated and unmedicated children and adolescents with attention-deficit/hyperactivity disorder. Transl Psychiatry. 2019 Nov 28;9(1):324. doi: 10.1038/s41398-019-0659-3. n = 136

  78. Mishra, Pullum, Thayer, Plummer, Conkright, Morris, O’Hara, Demas, Ashley (2020): Chemical sympathectomy reduces peripheral inflammatory responses to acute and chronic sleep fragmentation. Am J Physiol Regul Integr Comp Physiol. 2020 Mar 4. doi: 10.1152/ajpregu.00358.2019. PMID: 32130024.

  79. Nikles, Mitchell, de Miranda Araújo, Harris, Heussler, Punja, Vohra (2020): Senior HEJ. A systematic review of the effectiveness of sleep hygiene in children with ADHD. Psychol Health Med. 2020 Apr;25(4):497-518. doi: 10.1080/13548506.2020.1732431. PMID: 32204604. n = 1.469 METASTUDIE

  80. Wolf, Calabrese (2020): Stressmedizin & Stresspsychologie; Seite 206

  81. Fargason, Fobian, Hablitz, Paul, White, Cropsey, Gamble (2017): Correcting delayed circadian phase with bright light therapy predicts improvement in ADHD symptoms: A pilot study. J Psychiatr Res. 2017 Aug;91:105-110. doi: 10.1016/j.jpsychires.2017.03.004.. PMID: 28327443.

  82. Rybak, McNeely, Mackenzie, Jain, Levitan (2006): An open trial of light therapy in adult attention-deficit/hyperactivity disorder. J Clin Psychiatry. 2006 Oct;67(10):1527-35. doi: 10.4088/jcp.v67n1006. PMID: 17107243.

  83. Winkler (2007): ADHS und Schlaf : Probleme beim Einschlafen und Aufwachen bei ADHS / ADS / HKS

  84. Hoedlmoser, Pecherstorfer, Gruber, Anderer, Doppelmayr, Klimesch, Schabus (2008): Instrumental conditioning of human sensorimotor rhythm (12-15 Hz) and its impact on sleep as well as declarative learning. Sleep. 2008 Oct;31(10):1401-8. PMID: 18853937; PMCID: PMC2572745.

  85. Sterman, Howe, Macdonald (1970): Facilitation of spindle-burst sleep by conditioning of electroencephalographic activity while awake. Science. 1970 Feb 20;167(3921):1146-8. doi: 10.1126/science.167.3921.1146. PMID: 5411633.

  86. Cortoos, De Valck, Arns, Breteler, Cluydts (2010): An exploratory study on the effects of tele-neurofeedback and tele-biofeedback on objective and subjective sleep in patients with primary insomnia. Appl Psychophysiol Biofeedback. 2010 Jun;35(2):125-34. doi: 10.1007/s10484-009-9116-z. PMID: 19826944.

  87. Viola, James, SchlangenDijk (2008): Blue-enriched white light in the workplace improves self-reported alertness, performance and sleep quality; Scandinavian Journal of Work, Environment & Health; Vol. 34, No. 4 (August 2008), pp. 297-306; Stable URL: http://www.jstor.org/stable/40967721

  88. Landers, Tamblyn, Perriam (2009): Effect of a blue-light-blocking intraocular lens on the quality of sleep; Journal of Cataract & Refractive Surgery; Volume 35, Issue 1, January 2009, Pages 83–88; n = 49

  89. Hammer, Holzer (2012): Leben hinter Glas – Zusammenhang von Lichtmangelerscheinungen und Aufenthalt in Innenräumen; S. 26 ff in: Stephan (Hrsg.): Siebentes Syposium. Licht und Gesundheit. 15. und 16. März 2012: eine Sondertagung der TU Berlin und der DAfP, DGP und LiTG4. April 2012; Quelle: Google Books; fachlich hochwertige Darstellung der Auswirkung von Tageslicht auf chronobiologische Wirkungen

  90. http://www.wirsindheller.de/Beleuchtungsstaerke-Lux.65.0.html

  91. http://www.drweil.com/videos-features/videos/breathing-exercises-4-7-8-breath/

  92. Wenzel (2012): Koffein-haltige Lebensmittel; Eine Zusammenstellung zur Geschichte, Verwendung und Wirkung von coffeinhaltigen Lebensmitteln; Hochschule Weihenstephan

  93. Kaplan, McNicol, Conte, Moghadam (1989): Dietary Replacement in Preschool-Aged Hyperactive Boys; Pediatrics 1989;83;7

  94. Mosetter, Mosetter (2004): Ausgebrannte Zellen – Die Neurobiochemie des Burnout, Trauma – Zeitschrift für Psychotraumatologie und ihre Anwendungen 12 Jg. (2014) Heft 2, S. 52-61

  95. Krause, Krause (2014): ADHS im Erwachsenenalter; Symptome – Differentialdiagnose – Therapie, Seite 289

  96. Griese, Schulz (2009): Schlafstörungen – Spürsinn und Sensibilität zeigen; Pharmazeutische Zeitung Online 7/2009

  97. Eugene (2020): Association of sleep among 30 antidepressants: a population-wide adverse drug reaction study, 2004-2019. PeerJ. 2020 Mar 11;8:e8748. doi: 10.7717/peerj.8748. PMID: 32201646; PMCID: PMC7071824. n = 69,196 Fälle von Schafproblemen bei n = 7,366,864 medikamentierten Fällen

  98. Smith, Gozal, Hunter, Kheirandish-Gozal (2017): Parent-Reported Behavioral and Psychiatric Problems Mediate the Relationship between Sleep-Disordered Breathing and Cognitive Deficits in School-Aged Children. Front Neurol. 2017 Aug 11;8:410. doi: 10.3389/fneur.2017.00410. eCollection 2017.

  99. Steinhausen, Rothenberger, Döpfner (2010): Handbuch ADHS, Seite 87: Verweis auf Kapitel 15

  100. Ricketts, Sturm, McMakin, McGuire, Tan, Smalberg, McCracken, Colwell, Piacentini (2018): Changes in Sleep Problems Across Attention-Deficit/Hyperactivity Disorder Treatment: Findings from the Multimodal Treatment of Attention-Deficit/Hyperactivity Disorder Study. J Child Adolesc Psychopharmacol. 2018 Nov 2. doi: 10.1089/cap.2018.0038. n = 576

  101. Donovan (2019): How To Trick Your Brain Into Falling Asleep; TEDxYoungstown

  102. Hiscock, Mulraney, Heussler, Rinehart, Schuster, Grobler, Gold, Bohingamu Mudiyanselage, Hayes, Sciberras (2019): Impact of a behavioral intervention, delivered by pediatricians or psychologists, on sleep problems in children with ADHD: a cluster-randomized, translational trial. J Child Psychol Psychiatry. 2019 Jun 11. doi: 10.1111/jcpp.13083.

  103. Sciberras, Mulraney, Heussler, Rinehart, Schuster, Gold, Hayes, Hiscock (2017): Does a brief, behavioural intervention, delivered by paediatricians or psychologists improve sleep problems for children with ADHD? Protocol for a cluster-randomised, translational trial. BMJ Open. 2017 Apr 4;7(4):e014158. doi: 10.1136/bmjopen-2016-014158.

  104. Mindell, Owen (2010): A clinical guide to pediatric sleep: diagnosis and management of sleep problems in children and adolescents.

  105. Kimura, Aso, Yabuuchi, Matsubara (2020): Association between objectively measured walking steps and sleep in community-dwelling older adults: A prospective cohort study. PLoS One. 2020 Dec 14;15(12):e0243910. doi: 10.1371/journal.pone.0243910. PMID: 33315927. n = 855

  106. Hvolby, Bilenberg (2011): Use of Ball Blanket in attention-deficit/hyperactivity disorder sleeping problems. Nord J Psychiatry. 2011 Apr;65(2):89-94. doi: 10.3109/08039488.2010.501868. PMID: 20662681. n = 42

  107. Ekholm, Spulber, Adler (2020): A randomized controlled study of weighted chain blankets for insomnia in psychiatric disorders. J Clin Sleep Med. 2020 Sep 15;16(9):1567-1577. doi: 10.5664/jcsm.8636. PMID: 32536366; PMCID: PMC7970589. RCT

  108. Eron, Kohnert, Watters, Logan, Weisner-Rose, Mehler (2020); Weighted Blanket Use: A Systematic Review. Am J Occup Ther. 2020 Mar/Apr;74(2):7402205010p1-7402205010p14. doi: 10.5014/ajot.2020.037358. PMID: 32204779. METASTUDIE

  109. Becklund, Rapp-McCall, Nudo (2021): Using weighted blankets in an inpatient mental health hospital to decrease anxiety. J Integr Med. 2021 Mar;19(2):129-134. doi: 10.1016/j.joim.2020.11.004. PMID: 33317955.

  110. Wade, Crawford, Ford, McConnachie, Nir, Laudon, Zisapel (2011:) Prolonged release melatonin in the treatment of primary insomnia: evaluation of the age cut-off for short- and long-term response. Curr Med Res Opin. 2011 Jan;27(1):87-98. doi: 10.1185/03007995.2010.537317. n = 791 sowie dieselben Autoren (2010) aus der selben Studie: Nightly treatment of primary insomnia with prolonged release melatonin for 6 months: a randomized placebo controlled trial on age and endogenous melatonin as predictors of efficacy and safety; BMC Medicine20108:51; DOI: 10.1186/1741-7015-8-51© Wade et al; licensee BioMed Central Ltd. 2010; n = 791

  111. Luthringer, Muzet, Zisapel, Staner (2009): Int Clin Psychopharmacol. 2009 Sep;24(5):239-49. doi: 10.1097/YIC.0b013e32832e9b08. The effect of prolonged-release melatonin on sleep measures and psychomotor performance in elderly patients with insomnia. n = 40

  112. Lemoine, Nir, Laudon, Zisapel (2007): Prolonged-release melatonin improves sleep quality and morning alertness in insomnia patients aged 55 years and older and has no withdrawal effects. J Sleep Res. 2007 Dec;16(4):372-80. n = 170

  113. Wade, Crawford, Ford, McConnachie, Nir, Laudon, Zisapel (2011:) Prolonged release melatonin in the treatment of primary insomnia: evaluation of the age cut-off for short- and long-term response. Curr Med Res Opin. 2011 Jan;27(1):87-98. doi: 10.1185/03007995.2010.537317. n = 791 sowie dieselben Autoren (2010) aus der selben Studie: Nightly treatment of primary insomnia with prolonged release melatonin for 6 months: a randomized placebo controlled trial on age and endogenous melatonin as predictors of efficacy and safety; BMC Medicine20108:51; DOI: 10.1186/1741-7015-8-51© Wade et al; licensee BioMed Central Ltd. 2010; n = 791

  114. Salardini, Zeinoddini, Kohi, Mohammadi, Mohammadinejad, Khiabany, Shahriari, Akhondzadeh (2016): Agomelatine as a Treatment for Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: A Double-Blind, Randomized Clinical Trial. J Child Adolesc Psychopharmacol. 2016 Jun 10., n = 54

  115. https://psychiatrietogo.de/2014/09/16/andersartiges-antidepressivum-agomelatin-valdoxan/#comment-8442

  116. www.schlafgestoert.de: Welche Schlafmittel gibt es?

  117. Krause, Krause (2014): ADHS im Erwachsenenalter: Symptome – Differenzialdiagnose – Therapie, Seite 289

  118. Adler, Reingold, Morrill, Wilens (2006): Combination pharmacotherapy for adult ADHD. Curr Psychiatry Rep. 2006 Oct;8(5):409-15. doi: 10.1007/s11920-006-0044-9. PMID: 16968624. n = 16

  119. Ruigt, Kemp, Groenhout, Kamphuisen (1990): Effect of the antidepressant Org 3770 on human sleep. Eur J Clin Pharmacol. 1990;38(6):551-4. doi: 10.1007/BF00278580. PMID: 2373128. n = 6

  120. Krause, Krause (2014): ADHS im Erwachsenenalter; Symptome – Differentialdiagnose – Therapie, Seite 211 unten

  121. Kimura, Ozeki, Juneja, Ohira (2007): L-Theanine reduces psychological and physiological stress responses. Biol Psychol. 2007 Jan;74(1):39-45. n = 12

  122. White, de Klerk, Woods, Gondalia, Noonan, Scholey (2016): Anti-Stress, Behavioural and Magnetoencephalography Effects of an L-Theanine-Based Nutrient Drink: A Randomised, Double-Blind, Placebo-Controlled, Crossover Trial. Nutrients. 2016 Jan 19;8(1). pii: E53. doi: 10.3390/nu8010053.

  123. Shen, Yang, Wu, Zhang, Wu, Wang, Tang, Chen (2019): L-theanine ameliorate depressive-like behavior in a chronic unpredictable mild stress rat model via modulating the monoamine levels in limbic-cortical-striatal-pallidal-thalamic-circuit related brain regions. Phytother Res. 2019 Feb;33(2):412-421. doi: 10.1002/ptr.6237.

  124. Bundesinstitut für Risikobewertung (2001, aktualisiert 2003): Getränke mit isoliertem L-Theanin

  125. Lyon, Kapoor, Juneja (2011): The effects of L-theanine (Suntheanine®) on objective sleep quality in boys with attention deficit hyperactivity disorder (ADHD): a randomized, double-blind, placebo-controlled clinical trial. Altern Med Rev. 2011 Dec;16(4):348-54. n = 98

  126. Rao, Ozeki, Juneja (2015): In Search of a Safe Natural Sleep Aid. J Am Coll Nutr. 2015;34(5):436-47. doi: 10.1080/07315724.2014.926153.

  127. Anand, Tong, Besag, Chan, Cortese, Wong (2017): Safety, Tolerability and Efficacy of Drugs for Treating Behavioural Insomnia in Children with Attention-Deficit/Hyperactivity Disorder: A Systematic Review with Methodological Quality Assessment. Paediatr Drugs. 2017 Jun;19(3):235-250. doi: 10.1007/s40272-017-0224-6. REVIEW

  128. Barrett, Tracy, Giaroli (2013): To sleep or not to sleep: a systematic review of the literature of pharmacological treatments of insomnia in children and adolescents with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol. 2013 Dec;23(10):640-7. doi: 10.1089/cap.2013.0059. REVIEW

  129. Hidese, Ota, Wakabayashi, Noda, Ozawa, Okubo, Kunugi (2016): Effects of chronic l-theanine administration in patients with major depressive disorder: an open-label study. Acta Neuropsychiatr. 2017 Apr;29(2):72-79. doi: 10.1017/neu.2016.33.

  130. Rothenberg, Zhang (2019): Mechanisms Underlying the Anti-Depressive Effects of Regular Tea Consumption. Nutrients. 2019 Jun 17;11(6). pii: E1361. doi: 10.3390/nu11061361.

  131. Cicero, Bove, Colletti, Rizzo, Fogacci, Giovannini, Borghi (2017): Short-Term Impact of a Combined Nutraceutical on Cognitive Function, Perceived Stress and Depression in Young Elderly with Cognitive Impairment: A Pilot, Double-Blind, Randomized Clinical Trial. J Prev Alzheimers Dis. 2017;4(1):12-15. doi: 10.14283/jpad.2016.10.

  132. Ogawa, Ota, Ogura, Kato, Kunugi (2018): Effects of L-theanine on anxiety-like behavior, cerebrospinal fluid amino acid profile, and hippocampal activity in Wistar Kyoto rats. Psychopharmacology (Berl). 2018 Jan;235(1):37-45. doi: 10.1007/s00213-017-4743-1.

  133. Leung, Singh, McWilliams, Stockler, Ipsiroglu (2020): Iron deficiency and sleep – A scoping review. Sleep Med Rev. 2020 Jun;51:101274. doi: 10.1016/j.smrv.2020.101274. PMID: 32224451. REVIEW

  134. Isaac, Berridge (2003): Wake-promoting actions of dopamine D1 and D2 receptor stimulation. J Pharmacol Exp Ther. 2003 Oct;307(1):386-94. doi: 10.1124/jpet.103.053918. PMID: 12944496.

  135. Herrera-Solís, Arias-Carrión, Sarro-Ramírez, Salas-Crisóstomo, Murillo-Rodríguez (2016): The Effects of Dopamine Receptor Agonists on the Sleep-Wake Cycle. In: Monti, Pandi-Perumal, Chokroverty (Herausgeber) (2016): Dopamine and Sleep: Molecular, Functional, and Clinical Aspects, 38-44; 42

  136. Micallef, Rey, Eusebio, Audebert, Rouby, Jouve, Tardieu, Blin (2009): Antiparkinsonian drug-induced sleepiness: a double-blind placebo-controlled study of L-dopa, bromocriptine and pramipexole in healthy subjects. Br J Clin Pharmacol. 2009 Mar;67(3):333-40. doi: 10.1111/j.1365-2125.2008.03310.x. PMID: 19220275; PMCID: PMC2675044.

  137. Monti, Jantos, Fernández (1989): Effects of the selective dopamine D-2 receptor agonist, quinpirole on sleep and wakefulness in the rat. Eur J Pharmacol. 1989 Oct 4;169(1):61-6. doi: 10.1016/0014-2999(89)90817-0. PMID: 2574689.

  138. Lagos, Scorza, Monti, Jantos, Reyes-Parada, Silveira, Ponzoni (1998): Effects of the D3 preferring dopamine agonist pramipexole on sleep and waking, locomotor activity and striatal dopamine release in rats. Eur Neuropsychopharmacol. 1998 May;8(2):113-20. doi: 10.1016/s0924-977x(97)00054-0. PMID: 9619689.

  139. Ferreira, Galitzky, Thalamas, Tiberge, MontastrucL, Sampaio, Rascol (2002): Effect of ropinirole on sleep onset: a randomized, placebo-controlled study in healthy volunteers. Neurology. 2002 Feb 12;58(3):460-2. doi: 10.1212/wnl.58.3.460. PMID: 11839850.

  140. Nakazawa, Nakamichi, Imai, Ichihara (2015):Effect of dopamine D4 receptor agonists on sleep architecture in rats. Prog Neuropsychopharmacol Biol Psychiatry. 2015 Dec 3;63:6-13. doi: 10.1016/j.pnpbp.2015.05.006. PMID: 25985889.

  141. Cavas, Navarro (2006): Effects of selective dopamine D4 receptor antagonist, L-741,741, on sleep and wakefulness in the rat. Prog Neuropsychopharmacol Biol Psychiatry. 2006 Jun;30(4):668-78. doi: 10.1016/j.pnpbp.2005.11.039. PMID: 16457926.

  142. http://www.gesundheit.de/krankheiten/gehirn-und-nerven/schlafstoerungen/schlafmittel

  143. Reiersen, Todd (2008): Co-occurrence of ADHD and autism spectrum disorders: phenomenology and treatment; Expert Rev Neurother. 2008 Apr;8(4):657-69. doi: 10.1586/14737175.8.4.657.

  144. Studentenskript zur Vorlesung NEUROPSYCHOLOGIE Zimmer WS 2011/12 Uni Köln

  145. Studentenskript zur Vorlesung NEUROPSYCHOLOGIE Zimmer WS 2011/12 Uni Köln

  146. Wynchank, Bijlenga, Beekman, Kooij, Penninx (2017): Adult Attention-Deficit/Hyperactivity Disorder (ADHD) and Insomnia: an Update of the Literature. Curr Psychiatry Rep. 2017 Oct 30;19(12):98. doi: 10.1007/s11920-017-0860-0. PMID: 29086065.