Adults with attention-deficit/hyperactivity disorder (ADHD) consistently score lower on happiness and quality of life assessments, but it might not be the condition that's fueling this. New research suggests that one factor, insomnia severity, could also be making all other ADHD symptoms worse. This is the first time scientists have demonstrated that insomnia severity, rather than sleep quality or circadian rhythm shifts, directly impacts ADHD traits and quality of life in middle-aged and older adults.
Researchers out of the University of Southampton and the Netherlands Institute for Neuroscience looked at data from 1,364 participants (mean age 52 years) in the Netherlands Sleep Registry who had provided answers to questions regarding ADHD traits, sleep disturbances, bedtime/sleep patterns, depression and quality of life.
The team found a strong link between ADHD traits and disrupted sleep patterns – especially severe insomnia, poor sleep quality and a tendency toward later sleep schedules. Among those with ADHD traits, insomnia severity was the only sleep factor that significantly explained their lower quality of life.
“Our findings show a link between ADHD traits, insomnia severity, and reduced life satisfaction,” said study senior author Sarah L. Chellappa, an associate professor at the University of Southampton. “We know that sleep disruption can impact neurobehavioral and cognitive systems, including attention and emotional regulation. At the same time, sleep disruption may arise from ADHD-related impulsivity and hyperactivity, suggesting a reinforcing cycle between sleep disorders and ADHD.”
So if insomnia drives more debilitating ADHD symptoms, and sleep disorders are a common problem for adults with ADHD, it presents a bit of a chicken-and-egg conundrum. However, the good news is that sleep disorders are easier to treat than altering the clock on the circadian rhythm's chronotype, which is predominantly genetic.
"At least 25% of adults with ADHD self-report sleep disorders, including delayed sleep–wake phase syndrome, restless legs syndrome, daytime sleepiness and insomnia," the researchers noted. "The latter is the most common sleep disorder affecting the general population, with estimates of 43-83% among ADHD."
In a 2017 paper, which delivered that 43-83% number, the researchers found that this high occurrence of insomnia was present regardless of pharmacological treatment for ADHD. Essentially, medication for ADHD – like stimulants – were not to blame for poor sleep outcomes, nor were the drugs doing anything to really help.
The University of Southhampton team highlight the need to better address insomnia and quality of life measures when it comes to older adults with ADHD, in particular providing behavior-based treatments, like the fairly recent breakthrough of cognitive behavioral therapy for insomnia (CBT-I).
“Adults with ADHD traits may be more likely to have low sleep quality, insomnia complaints, and low mood levels, all of which lead to reduced life satisfaction,” said study co-author Samuele Cortese, a professor at the University of Southampton.
As well as being the first to link specific sleep problems to quality of life in ADHD adults, this study also shifts the conversation away from children. This research, centered on a cohort of older adults, adds to a severely understudied population in ADHD science. Poor sleep in midlife and beyond has been linked to chronic disease, so treating insomnia could have broader health benefits.
The research also draws attention to the late-diagnosis ADHD population, which has (until the last five years or so) been largely overlooked and left to self-manage symptoms.
“There needs to be more research to understand this complex interplay," Cortese added. "By improving our understanding, we could uncover treatment options that improve the quality of life of people with ADHD. For instance, targeting insomnia complaints in individuals with higher ADHD traits, with cognitive behavioral therapy for insomnia (CBT-I) or sleep restriction therapy may help improve their quality of life.”
The research was published in the journal BMJ Mental Health.
Source: University of Southampton via EurekAlert!