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

Abstract

Objective: This systematic review assessed current evidence on sleep medication for attention-deficit/hyperactivity disorder (ADHD) patients, to establish appropriate guidance for clinicians faced with prescribing such medications. Methods: Five articles (based on four pharmacological compounds) out of a total 337 were identified as evidence to guide pharmacological treatment of ADHD-related sleep disorders. Data regarding participant characteristics, measures of ADHD diagnosis, measures of sleep, and outcome data were extracted. Results: Zolpidem and L-theanine both displayed a poor response in reducing sleep latency and increasing total sleep time, however L-theanine did produce an increase in sleep efficiency. Zolpidem produced high levels of side effects, leading to the largest dropout rate of all five studies. Clonidine reduced insomnia; and melatonin also exhibited a positive response, with reduced sleep latency, higher total sleep time, and higher sleep efficiency. Conclusions: There is a relative paucity of evidence for the pharmacological treatment of ADHD-related sleep disorders; therefore, further research should be conducted to replicate these findings and obtain reliable results.

Clonidine Use in Psychiatry: Panacea or Panache?

“…Moreover, clonidine seems to be an attractive option targeting insomnia in ADHD [10] and remain a good remedy for paediatric insomnia in general [10] , and a case series has also reported that clonidine seems to be beneficial and fairly well tolerated in intractable sleep disorders in children and young adults with neurodevelopmental disorders [11] .…”

Melatonin for sleep problems in children with neurodevelopmental disorders

“…use of electronic gadgets before bedtime), the child's difficulty slowing thoughts and settling for sleep, difficulty for parents setting limits and managing behaviour, psychiatric and medical comorbidities and unwanted effects of stimulant medication may contribute to sleep problems in children with ADHD 12,20…”

“…Other sleep problems may include resistance in going to bed, night awakenings, difficulty with morning awakenings, daytime sleepiness and restless legs syndrome 9,20. Sleep deprivation potentially worsens ADHD symptoms and intensifies disruptive behaviours 20.…”

Safety, Tolerability and Efficacy of Drugs for Treating Behavioural Insomnia in Children with Attention-Deficit/Hyperactivity Disorder: A Systematic Review with Methodological Quality Assessment

“…The sleep problems reported in children with ADHD include disturbances in sleep quality or quantity, restless leg syndrome (RLS), periodic limb movement (PLM) and sleep disordered breathing (SDB) 4 . Among these the most common problems include difficulty initiating sleep, maintaining sleep (recurrent waking or restless sleep) and early morning awakening with inability to return to sleep [4][5][6][7] . There is a relationship between sleep and ADHD symptoms, which seem to overlap with very little separation.…”

“…However there are no approved treatments, either prescribed or over-the-counter preparations for managing sleep disturbances such as behavioural insomnia in these children, as compared to those in general paediatric populations 4,26,27 . Despite the widespread use of these unapproved agents to aid sleep in children with ADHD, few data exist on their safety, tolerability and efficacy.…”