ADHD really a sleep problem?
September 4, 2017
European College of Neuropsychopharmacology
75 percent of children and adults with attention deficit hyperactivity disorder
(ADHD) also have sleep problems, but until now these have been thought to be
separate issues. Now a in a pulling together of the latest research, Scientists
are proposing of a new theory which says that much of ADHD may in fact be a
problem associated with lack of regular circadian sleep.
Around 75% of children
and adults with Attention Deficit Hyperactivity Disorder (ADHD) also have sleep
problems, but until now these have been thought to be separate issues. Now a in
a pulling together of the latest research, Scientists are proposing of a new
theory which says that much of ADHD may in fact be a problem associated with
lack of regular circadian sleep.
Presenting the proposal
at the ECNP Conference in Paris, Professor Sandra Kooij (Associate Professor of
Psychiatry at VU University Medical Centre, Amsterdam and founder and chair of
the European Network Adult ADHD) said:
“There is extensive
research showing that people with ADHD also tend to exhibit sleep problems.
What we are doing here is taking this association to the next logical step:
pulling all the work together leads us to say that, based on existing evidence,
it looks very much like ADHD and circadian problems are intertwined in the
majority of patients.
We believe this because
the day and night rhythm is disturbed, the timing of several physical processes
is disturbed, not only of sleep, but also of temperature, movement patterns,
timing of meals, and so on.
If you review the
evidence, it looks more and more like ADHD and sleeplessness are 2 sides of the
same physiological and mental coin.”
Professor Kooij laid out
the links which have led to the synthesis:
In 75% of ADHD patients, the physiological
sleep phase — where people show the physiological signs associated with sleep,
such as changes in the level of the sleep hormone melatonin, and changes in
sleep-related movement — is delayed by 1.5 hours.
Core body temperature changes associated
with sleep are also delayed (reflecting melatonin changes)
Many sleep-related disorders are associated
with ADHD, including restless-leg syndrome, sleep apnea, and the circadian
rhythm disturbance, the delayed sleep phase syndrome
ADHD people often show greater alertness in
the evening, which is the opposite of what is found in the general population
Many sufferers benefit from taking
melatonin in the evening or bright light therapy in the morning, which can help
reset the circadian rhythm
Recent work has shown that around 70% of
adult ADHD sufferers show an oversensitivity of the eyes to light, leading many
to wear sunglasses for long periods during the day — which may reinforce the
problems associated with a ‘circadian shift’.
Chronic late sleep leads to a chronic sleep
debt, associated with obesity, diabetes, cardiovascular disease and cancer.
This cascade of negative health consequences may in part be preventable by
resetting the sleep rhythm.
“We are working to
confirm this physical-mental relationship by finding biomarkers, such as
Vitamin D levels, blood glucose, cortisol levels, 24 hour blood pressure, heart
rate variability, and so on. If the connection is confirmed, it raises the
intriguing question: does ADHD cause sleeplessness, or does sleeplessness cause
ADHD? If the latter, then we may be able to treat some ADHD by
non-pharmacological methods, such as changing light or sleep patterns, and
prevent the negative impact of chronic sleep loss on health.”
“We don’t say that
all ADHD problems are associated with these circadian patterns, but it looks
increasingly likely that this is an important element.”
Andreas Reif (University Hospital, Frankfurt, and leader of the EU CoCA project
on ADHD ), who was not involved in the research, said “A disturbance of
the circadian system may indeed be a core mechanism in ADHD, which could also
link ADHD to other mental illnesses such as depression or bipolar disorder. But
also beyond these pathophysiological considerations, sleep problems and
abnormalities of circadian rhythms are a huge problem for many patients,
heavily impacting on their social life” He continued “More research
into the interconnections between ADHD and the “inner clock” is thus
very relevant to improve patients’ lives and to shed light on the disease
mechanism of ADHD.”
Note: Attention deficit
hyperactivity disorder (ADHD) is a group of behavioural symptoms with a
neurobiological background, that include inattentiveness, hyperactivity, mood
swings and impulsiveness. ADHD is highly heritable, and several differences in
brain volume and function have been shown compared to controls. Symptoms of
ADHD tend to be noticed at an early age and may become more noticeable when a
child’s circumstances change, such as when they start school. Most cases are
diagnosed when children are 6 to 12 years old, but ADHD is also increasingly
recognised in adults and older people, as ADHD can persist during the lifespan.
People with ADHD often have additional problems, such as sleep, mood- and
anxiety disorders. Between 2 and 5 % of children, adults and older people
suffer from ADHD.