How Common Are Sleep Disorders and Sleep Medication Use in People with ADHD?

What you need to know

• People with ADHD have significantly higher rates of diagnosed sleep disorders and sleep medication prescriptions compared to those without ADHD, from childhood through older adulthood.
• 7.5% of people with ADHD had a diagnosed sleep disorder, compared to 1.5% of those without ADHD.
• 47.5% of people with ADHD were prescribed sleep medication, compared to 12% of those without ADHD.
• The rates of sleep disorders and medication use in people with ADHD were highest in middle-aged and older adults, but the relative risk compared to those without ADHD was highest in children and adolescents.

Understanding ADHD and sleep problems

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental condition characterized by persistent inattention and/or hyperactivity-impulsivity that interferes with daily functioning and development. ADHD affects about 5% of children and 2.5% of adults worldwide.

People with ADHD often experience difficulties with sleep, which can further impact their health, mood, and cognitive performance. Previous studies have found associations between ADHD and various sleep problems, but most research has focused on children and adolescents or used small clinical samples. This large nationwide study aimed to examine the rates of diagnosed sleep disorders and sleep medication prescriptions in people with ADHD across the lifespan.

Study design and findings

The researchers used Swedish national registers to identify over 6.4 million people born between 1945-2008, including 145,490 people diagnosed with ADHD. They looked at diagnoses of sleep disorders and prescriptions for sleep medications across different age groups from childhood to older adulthood.

Higher rates of sleep disorders in ADHD

The study found that people with ADHD had significantly higher rates of diagnosed sleep disorders compared to those without ADHD:

• 7.5% of people with ADHD had a sleep disorder diagnosis, compared to 1.5% of those without ADHD
• This corresponds to an 8-fold increased risk of having a sleep disorder diagnosis for people with ADHD

The most common sleep disorder diagnoses in people with ADHD were:

1. Unspecified sleep disorders (3.8%)
2. Insomnia (1.7%)
3. Sleep apnea (1.3%)

Much higher rates of sleep medication use

The disparity was even greater for sleep medication prescriptions:

• 47.5% of people with ADHD were prescribed sleep medication, compared to 12% of those without ADHD
• This represents a 14-fold increased risk of being prescribed sleep medication for people with ADHD

The most commonly prescribed sleep medications for people with ADHD were:

1. Melatonin (24.4%)
2. Propiomazine (21.7%)
3. Zopiclone (20.6%)

Differences across age groups

While the overall rates of sleep disorders and medication use were higher in people with ADHD across all age groups, some interesting patterns emerged:

• The prevalence of diagnosed sleep disorders in people with ADHD was highest in middle-aged (31-45 years) and older adults (46-60 years)
• However, the relative risk compared to people without ADHD was highest in children (5-11 years) and adolescents (12-17 years)
• Children with ADHD had the highest relative risk of being prescribed sleep medication - 129 times higher than children without ADHD

Sex differences

The study also found some differences between males and females with ADHD:

• Females with ADHD had both higher absolute rates and relative risk of sleep disorder diagnoses compared to males with ADHD
• Females also had higher rates of sleep medication prescriptions, but the relative risk compared to those without ADHD was similar across sexes

Implications of the findings

The results of this study highlight several important points about sleep problems in people with ADHD:

Underdiagnosis of sleep disorders

The much lower rates of diagnosed sleep disorders (7.5%) compared to sleep medication prescriptions (47.5%) in people with ADHD suggest that sleep disorders may be significantly underdiagnosed in this population. This could be due to:

• Sleep problems being viewed as symptoms of ADHD rather than separate disorders
• Lack of systematic sleep assessments in ADHD care
• Limited training on sleep disorders for many healthcare providers

Need for improved assessment and treatment

The findings emphasize the importance of thoroughly evaluating and addressing sleep problems in people with ADHD across the lifespan. This may include:

• Implementing routine sleep disorder screenings as part of ADHD care
• Providing additional training on sleep disorders for clinicians who work with ADHD patients
• Developing targeted interventions to prevent and treat sleep problems in people with ADHD

Lifespan perspective

While much previous research has focused on sleep problems in children with ADHD, this study shows that sleep disorders remain a significant issue into adulthood. The higher absolute rates in older adults with ADHD highlight the need for continued attention to sleep health throughout the lifespan.

Medication considerations

The high rates of sleep medication use in people with ADHD, particularly in children, raise questions about current treatment practices. While medications can be helpful for managing sleep problems, it’s important to ensure their use is based on proper diagnosis and that non-medication options are also considered.

Conclusions

• People with ADHD have significantly higher rates of diagnosed sleep disorders and sleep medication use compared to those without ADHD, from childhood through older adulthood.
• Sleep disorders appear to be underdiagnosed in people with ADHD, given the much higher rates of medication prescriptions compared to formal diagnoses.
• There is a need for improved assessment, diagnosis, and treatment of sleep problems in ADHD care across all age groups.
• Further research is needed to better understand the relationship between ADHD and sleep problems and to develop targeted interventions.