Around 75 percent of children and adults with attention deficit hyperactivity disorder (ADHD) also have sleep problems.

These have been thought to be separate issues… until now.

In pulling together of the latest research, scientists are proposing that much of ADHD may in fact be a problem associated with lack of regular circadian sleep.

“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,” said Professor Sandra Kooij, Associate Professor of Psychiatry at VU University Medical Centre, Amsterdam.

Professor Kooij, founder and chair of the European Network Adult ADHD, was speaking at the ECNP Conference in Paris.

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“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 two sides of the same physiological and mental coin.”

Links between sleep and ADHD

ADHD people often show greater alertness in the evening, which is the opposite of what is found in the general population

Professor Kooij laid out the links which have led to the synthesis:

  • In 75% of ADHD patients, the physiological sleep phase 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 apnoea, 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
  • 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.

There is hope

Many ADHD sufferers benefit from taking melatonin in the evening or bright light therapy in the morning, which can help reset the circadian 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,” said Professor Kooij.

“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.”

Many ADHD sufferers benefit from taking melatonin in the evening or bright light therapy in the morning, which can help reset the circadian rhythm

What is ADHD?

Attention deficit hyperactivity disorder (ADHD) is a group of behavioural symptoms with a neurobiological background including 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 between six and 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 two and five percent of children, adults and older people suffer from ADHD.

Source: European College of Neuropsychopharmacology via www.sciencedaily.com

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