1. ADHD and Sleep Roberto Olivardia, Ph.D. Harvard Medical School Roberto_olivardia@hms.harvard.edu

2. Common Sleep Issues/Disorders Difficulty falling asleep (even as an infant) Unwilling to nap even when exhausted Feel more alert/energized after dark (10PM) Go to bed late (2AM) Difficulty awakening (regardless of ample sleep) Difficulty in maintaining alertness during day (borderline narcolepsy) “Primary Disorder of Vigilance” Sleep talking, sleepwalking, bruxism, bedwetting

3. Sleep Disorders Obstructive Sleep Apnea Obstructive Sleep Apnea Narcolepsy Narcolepsy Restless Leg Syndrome Restless Leg Syndrome Night Terrors Night Terrors Sleep Walking Sleep Walking

4. How Sleep Issues Affect ADHD Increased hyperactivity Increased hyperactivity Increased inattentiveness Increased inattentiveness Moodiness, Irritability Moodiness, Irritability 1 hour of sleep loss, 3 nights in a row impacts vigilance on Continuous Performance Test 1 hour of sleep loss, 3 nights in a row impacts vigilance on Continuous Performance Test Lower metabolism, Increased appetite. Lead to obesity Lower metabolism, Increased appetite. Lead to obesity

5. Studies looking at sleep in ADHD populations Cortese et al meta-analysis: 722 kids with ADHD and 638 Controls: Cortese et al meta-analysis: 722 kids with ADHD and 638 Controls: ADHD had significantly higher bedtime resistance, more sleep onset difficulties, night awakenings, difficulties with morning awakenings, sleep disordered breathing, and daytime sleepiness compared with controls. Apnea-hypopnea index sig higher in ADHD children than controls. Lower sleep efficiency, true sleep time

6. Theories: ADHD and Sleep Biological/Neurological Biological/Neurological Behavioral Behavioral Genetic Genetic

7. Treatment GET SLEEP STUDY GET SLEEP STUDY Melatonin Melatonin Modafinil (Provigil) Modafinil (Provigil) Stimulants Stimulants SSRI’s (if depression/anxiety is comorbid) SSRI’s (if depression/anxiety is comorbid) Caffeine? Caffeine? Surgical Procedures: Tonsillectomy, Septoplasty Surgical Procedures: Tonsillectomy, Septoplasty CPAP (noncompliance common) CPAP (noncompliance common) No naps No naps Work on getting to bed early 20 minute intervals earlier Work on getting to bed early 20 minute intervals earlier

8. Treatment Introduce stimulating sensory to daytime sleepiness Introduce stimulating sensory to daytime sleepiness Relaxation exercises/Deep breathing Relaxation exercises/Deep breathing Warm bath Warm bath UNPLUG UNPLUG Change in pajamas Change in pajamas Dim lights Dim lights Climate control Climate control Sound machines Sound machines Light music on repeat Light music on repeat Eye masks/dark rooms Eye masks/dark rooms Singing to child, co-sleeping Singing to child, co-sleeping Assess patient’s motivation to change sleep pattern Assess patient’s motivation to change sleep pattern

9. ADHD and Sleep Roberto Olivardia, Ph.D. Harvard Medical School Roberto_olivardia@hms.harvard.edu