Adult Attention-Deficit/Hyperactivity Disorder (ADHD) and Insomnia: an Update of the Literature

Abstract

Three cross-sectional, clinical, and population studies report a prevalence of insomnia in ADHD adults ranging from 43 to 80%. Longitudinal evidence for a link between childhood-onset ADHD and insomnia at later age is mixed, with one study confirming and another study not supporting such a longitudinal association. In randomized, placebo-controlled trials, insomnia is reported significantly more often in the treatment arm than in the placebo arm. In varying percentages of trial participants, insomnia is a treatment-emergent adverse effect in triple-bead mixed amphetamine salts (40-45%), dasotraline (35-45%), lisdexamfetamine (10-19%), and extended-release methylphenidate (11%). Ten to seventeen percent of subjects in placebo-controlled trials of atomoxetine report insomnia, possibly related to poor metabolizer status. The mechanisms explaining the relationship between ADHD and sleep problems are incompletely understood, but both genetic and non-shared environmental influences may be involved. Adults with ADHD should be assessed for insomnia, which is frequently comorbid, and both conditions should be treated.

Recognizing Poor Sleep Quality Factors During Oral Health Evaluations

“…5,6 Obstructive Sleep Apnea Airway collapses during the sleep cycle, preventing normal breathing, causing lack of oxygen to the brain, preventing the individual from reaching deep sleep along with body and brain repair. 1,5,6,13,14 Poor memory processing, poor emotion processing [2][3][4][5][6]9,12,37 out of the deep stages of sleep, they are prevented from obtaining rejuvenation of the body and brain needed to achieve or maintain optimal health. 1,2 Sleep arousals can be caused by poor sleep hygiene, restricted airway, systemic health issues, or cognitive health issues.…”

“…1,2 Sleep arousals can be caused by poor sleep hygiene, restricted airway, systemic health issues, or cognitive health issues. [1][2][3][4]…”

“…Behavioral manifestations such as irritability, impatience, yawning, falling asleep during the appointment, slow body movements, and lack of interest or focus in conversation may all be indicators a patient might be experiencing chronic sleep quality issues. 3,4,24 Chronic poor sleep quality and/or quantity situations can affect facial feature appearance, the formation of oral structures, and the development of oral disease. 8,24,25,[38][39][40] Health History Assessment of a patient's health history includes information such as demographics, social history, medical history, and dental history.…”

“…1,2 Often, manifestations of poor sleep are misinterpreted as behavioral issues, cognitive dysfunction, and/or systemic health concerns that may present differently in children and adults. 1,3,4 The National Sleep Foundation estimates that 50 to 70 million Americans are affected by chronic sleep disorders or sleep disruptions that can significantly affect health and safety. 5 The Centers for Disease Control and Prevention (CDC) has declared sleep deprivation a public health crisis.…”

“…5,6 Poor sleep quality can be a multifactorial situation and/or condition(s) that can be affected by a person's sleep environment, physiological features related to systemic health, oral myofunctional disorders, restricted airway, and/ or chemical and electrical imbalances related to melatonin or circadian rhythm. 1,3,7,8,11,16,24,25 Sleep deprivation, including OSA, does not discriminate according to age, gender, or body composition. OSA is not often identified in childhood, because the severity of signs and symptoms tend to increase through developmental growth into adulthood.…”