The circadian rhythm in adult attention-deficit/hyperactivity disorder: current state of affairs

Abstract

Adults with ADHD often have sleep problems that are caused by a delay of their internal circadian rhythm system. Such individuals are often typified as ‘evening’ or ‘night’ persons. This review focuses on the link between ADHD symptoms and the evening typology through multiple pathways. Etiology of the internal circadian rhythm system, the genetic basis for evening typology, overlap between ADHD symptoms and evening preference and risk factors for various chronic health conditions, including metabolic syndrome and cancer, are discussed. The treatment perspectives to reset the delayed rhythm in adults with ADHD involve psychoeducation on sleep hygiene, melatonin in the afternoon or evening and bright light therapy in the morning.

Keywords::

• ADHD
• bright light therapy
• cancer risk
• chronotype
• circadian rhythm
• chronic conditions
• delayed sleep phase syndrome
• melatonin
• metabolic syndrome
• sleep hygiene
• sleep-onset insomnia

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • The majority of adult attention-deficit/hyperactivity disorder (ADHD) patients have sleep difficulties during their lifetime, many of which are related to a delayed sleep onset and offset, or delayed sleep phase syndrome.

• • This genetically driven sleep pattern or ‘evening chronotype’ leads to a chronic short sleep duration that has been associated with several physical conditions like obesity, diabetes, high blood pressure, cardiovascular disease and cancer.

• • The importance of sufficient hours of sleep in adults with ADHD thus not only pertains to their daily functioning without sleepiness, but also to several serious health risks in the long term.

• • Treatment of late sleep with higher or low doses of melatonin at different times, and light therapy in the morning may reset the rhythm.

• • Whether this indeed increases sleep duration and prevents the development of chronic diseases is subject to further study. Not only the adult ADHD population’s health, but the health condition of the Western population in general may benefit, because sleep short and the daily use of light late at night are widespread nowadays.

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