The Prevalence of ADHD-Related Insomnia in the UK
Insomnia Is Common in Children With ADHD1,2
Insomnia Is Common in Children With ADHD1,2
- Attention-deficit / hyperactivity disorder (ADHD) is one of the most common neuro-developmental disorders.1 affecting 3-5% of children.2
- Of these, over 70% of children with ADHD experience insomnia.2
Significant Impact on Quality of Life of Child and Family Unit
Significant Impact on Quality of Life of Child and Family Unit
- Children with ADHD and their families already have a reduced quality of life,3 and poorly controlled sleep can be an extremely challenging complication for children and parents.4
Managing Insomnia in Children With ADHD
Managing Insomnia in Children With ADHD
- NICE’s Clinical Knowledge Summary on ADHD management indicates that melatonin may be prescribed for children and adolescents aged 6-17 years with ADHD who have insomnia, where sleep hygiene measures have been insufficient.5
A Good Night's Sleep Is Essential
for Well-Being
Statistics and Impact
Up to 73% of children with ADHD have sleep problems2
For most child psychiatrists, ADHD and sleep disorders are synonymous.3 Sleep concerns are commonly reported by parents and caregivers of children with ADHD:4
- 87% of children have difficulty settling to sleep
- 38% had difficulty staying asleep
- 32% had early morning wakening.
Other sleep issues include: difficulty with a consistent bedtime routine, resistance to bedtime and poor sleep hygiene.2 It has been suggested that ADHD may be associated with disrupted circadian rhythms.5
Up to 73% of children with ADHD have sleep problems2
For most child psychiatrists, ADHD and sleep disorders are synonymous.3 Sleep concerns are commonly reported by parents and caregivers of children with ADHD:4
- 87% of children have difficulty settling to sleep
- 38% had difficulty staying asleep
- 32% had early morning wakening.
Other sleep issues include: difficulty with a consistent bedtime routine, resistance to bedtime and poor sleep hygiene.2 It has been suggested that ADHD may be associated with disrupted circadian rhythms.5
Impact of Sleep Problems
The impact of lack of sleep among children with ADHD is extensive and can affect ability to focus, worsen ADHD symptoms, reduce attention span, affect cognitive processes and academic performance, affect social interaction and relationships with peers and impact on emotional reactivity.2,3,6-8 In a recent survey of patients and parents on the impact of ADHD and sleep, 8 out of 10 respondents reported a positive impact on ADHD behaviours or symptoms after a good night’s sleep.9
Impact of Sleep Problems
The impact of lack of sleep among children with ADHD is extensive and can affect ability to focus, worsen ADHD symptoms, reduce attention span, affect cognitive processes and academic performance, affect social interaction and relationships with peers and impact on emotional reactivity.2,3,6-8 In a recent survey of patients and parents on the impact of ADHD and sleep, 8 out of 10 respondents reported a positive impact on ADHD behaviours or symptoms after a good night’s sleep.9
Sleep Is a Persistent Issue, Though Exacerbated by Life Stage Factors10
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Please note: ADAFLEX (melatonin) is licensed for use only in children and adolescents aged 6–17 years with ADHD-related insomnia, where sleep hygiene measures have been insufficient.11
Quality of Life Impact of ADHD-Related Insomnia
Impact on Children
Impact on Children
Data show that moderate or severe sleep problems in children with ADHD were associated with poorer psychosocial quality of life and daily functioning in children.1 As an example, these children were more likely to miss or be late for school.1 Other research shows sleep issues in children with ADHD affects total quality of life and even physical health.2
Impact on Family
Impact on Family
The impact of having an ADHD child with moderate-to-severe sleep problems can have a significant effect on the family, causing poorer mental health among caregivers, compared with ADHD children without sleep issues1 and caregivers were 2.7 times more likely to be clinically depressed, stressed or anxious versus those whose child did not have sleep problems.1 It also affected everyday living, such as being late for work.1 Physicians of children with ADHD also report first-hand the significant impact of sleep problems on the family.3
Real Life Quotes About Living With ADHD
- ”It’s a noisy, destructive disorder” – HCP3
- “It weakens and can break families” – HCP3
- “It’s explosive” – HCP3
- “As a parent of a child with a sleep disorder you are awake the hours most people sleep” – Parent of child with ADHD4
- “Often she won’t sleep for over 30 hours at a time. She just can’t switch off” – Parent of child with ADHD and autism4
Managing Insomnia in Children With ADHD
The first-line option for managing ADHD-related insomnia in children and adolescents is through effective sleep hygiene measures.1 Where these have been insufficient there are limited recommended or licensed options available1
NICE guidance recommends melatonin as the ONLY pharmacological treatment option1
NICE’s Clinical Knowledge Summary on ADHD management recommends prescribing melatonin:1
- For children and adolescents aged 6-17 years with ADHD who have insomnia, where sleep hygiene measures have been insufficient.
Most prescribing is unlicensed for this patient population2-4
Many GPs are reluctant to prescribe off-label melatonin products:5
- This may increase the burden on specialists who are required to retain ongoing prescribing responsibility.
LICENSED for insomnia in children and adolescents aged 6-17 years with ADHD where sleep hygiene measures have been insufficient1,8*
Importance of Sleep Hygiene
Advising and Supporting Patients on Sleep Hygiene Measures
Sleep hygiene is the foundation of NICE’s insomnia guidance.1 Sleep hygiene focuses on the interplay of the 24-hour circadian rhythm and the homoeostatic processes that regulate sleep timing and architecture.2 It has been suggested that inadequate sleep hygiene can contribute to sleep difficulties in ADHD, therefore removing this as a contributory factor can enhance sleep.2 The amount of sleep a child needs varies by age and the following is a general guide for non-ADHD children.3
Research among healthy young adults investigating the role of consistent 8-hour bed and wake times, one of the key elements of a sleep hygiene regime, found, versus inconsistent bedtimes, that keeping regular bedtime hours moved the circadian phase 40 minutes earlier in two-thirds of subjects and pushed it back by a similar amount in the remainder.4 It also improved the alignment between sleep onset and the circadian phase in those with dim light melatonin onset of less than an hour or more than three hours before sleep onset time.4 Combining sleep hygiene with melatonin increased the number of treatment responders and improved sleep onset latency in children with neurodevelopmental disorders,5 therefore ensuring patients maintain sleep hygiene measures even while taking melatonin is essential.
Although sleep hygiene is the term used by healthcare professionals (HCPs), some HCPs prefer terms such as core sleep routines, habits and behaviours as some parents/patients associate the word hygiene with physical cleanliness before bedtime. Asking patients/parents/caregivers about their sleep habits, routines and behaviours, alongside determining their DLMO, and identifying zeitgebers, such as eating, drinking, work and exercise,6 can help create a personalised and optimised sleep management programme.
Amount of Sleep Needed by Age
10-12 hours for children aged 3-6 years
10-11 hours for children aged 7-12 years
8-9 hours for teenagers
Sleep Hygiene Tips
A Regular Sleep Schedule
- Wake up and get out of bed at the same time every morning, even at weekends and after a poor night’s sleep.1,7,8
- Get up in the morning and get as much exposure to bright light as possible.1,8
- Exercise early in the day and avoid exercising 4 hours before bedtime.1
The Bedroom Environment
- Aim for a temperature that is neither too cold or too hot.1
- Keep the bedroom dark and quiet.1,7
- No televisions, computers, phones or tablets should be in the bedroom1,8 (see blue light section) – instead create a sleep-only room.1
Avoid Blue Light
- No use of televisions, computers, phones or tablets in the 2 hours before bedtime – these suppress melatonin production.1 Using time-out or blocking usage via the settings and control section can help with regulating use.
- If using no devices is not possible, recommend dimming the screen or using a night-mode.9
- Specialty glasses, such as blue-light blocking or amber glasses, can counter the melatonin-suppressing effects of blue light.9
Things to Avoid
- Eating large meals 2 hours before bedtime.1
- Alcohol for 2 hours before bedtime.1
- Caffeine drinks after mid-day.1
- Napping in the day time.1,7
Things to Try
- Relaxation and mindfulness exercises in the early evening.1
- Warm, milky drinks before bedtime – milk contains calcium, which contains tryptophan that is synthesised to make melatonin.10
- A bath before bedtime.1
Patient Case Studies
These are hypothetical patient case studies for illustrative purposes only.
“I am a part time sales assistant in retail, but I’m also a part-time caregiver to Dillan, so only work 12 hours a week.
He was so active as a kid, he would not go to sleep, he used to have a loud voice, he used to shout, to scream, he got kicked out of nurseries, and he was always active. I had a few places that wouldn’t look after him because of it, and I was getting stuck for childcare needing to work. It was very stressful, because I had two jobs at the time.
I found out about the local centre myself first, then went to ask the GP for a referral there. Getting the diagnosis was a relief, because I also struggled with lots of things as a kid, and went to CAMHS. My mum didn’t want me to get the diagnosis at the time, but at least I had meetings. Otherwise everyone thought I was just naughty. I get how he’s feeling.”
– Single parent to an 11-year old boy with ADHD1
“I was diagnosed around 9 or 10 with ADHD, after ongoing struggles at school paying attention and staying awake. My parents pushed for me to have adjustments made. I was lucky that I was bright and good at some subjects, and with my ADHD I would get really into some things.
I always had trouble getting to sleep but initially we thought it was just me being energetic and related to the sleep issues Mum has.”
– Patient, aged 16, with ADHD1
“I have a 16 year old daughter who was diagnosed at 5 with ADHD. I would cut off my arm right now if there was a way to cure her, but I know we’ll never cure it - just find a way to manage it and live something closer to a more ordinary life.
Often she won’t sleep for over 30 hours at a time. She just can’t switch off, so we’ll go to bed and then she’ll still be up the next morning. We’ve tried everything, but its complicated with her other medication and needs.”
– Parent of a 16-year old daughter with ADHD1
Economic Impact of ADHD-Related Insomnia
ADHD Exerts a Significant Economic Burden on Society
An analysis in 2013 concluded that the annual healthcare costs for an ADHD patient aged 6-17 years were £1,290, more than four times that of a non-ADHD patient.2
Long-term costs
At an individual basis, it is estimated that the total annual cost of illness projected for an individual with ADHD born in 2013 is estimated to be £102,135.89 over the course of 50 years.3 The healthcare costs form only a small proportion of the total costs of ADHD (the average annual estimated cost was £920.37 in 2012/2013), with employment (average annual income loss of £2,650.28) and education (average annual cost of £3,839.79) exerting a greater economic burden.3
Based on a 2022 estimate that there are 2.6 million people in the UK with ADHD, the long-term total cost to society over 50 years is an estimated £260 billion.3,4
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Figure 1: Breakdown of annual health service costs for patients with ADHD (Cases) following diagnosis.4
Given that lack of sleep can worsen ADHD symptoms5 and that up to 73% of children with ADHD experience insomnia,6 sleep problems are likely to be a key contributing factor in the economic impact of ADHD. Data on chronic insomnia in adults alone suggest that the UK loses 1.3% of its estimated annual GDP per annum due to insomnia-induced lack of workplace productivity, around £33.33 billion.7
UK healthcare costs for ADHD patients aged 6-17 years are FOUR TIMES that of non-ADHD patients of the same age2
UK-AGB-ADA-0018 | Date of preparation: January 2024
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