Sleep Disturbances and Rebound Effect

Question: Can sleep disturbances be caused by the “rebound effect” of stimulants?
Answer: Rebound means worse than if you hadn’t taken the medication. What’s worse? Symptoms that are helped by the medication may be worse right after it wears off. This is especially true of tablets, less with XR form of Adderall and Concerta. An example of rebound is number of math problems worked correctly in the classroom study on 5mg of Adderall tablets vs. placebo at 6 hours.
Clinically I have found that adjusting the last dose of medication – sometimes earlier and sometimes later – frequently helps with trouble falling asleep.
I have not found any formal studies relating to rebound insomnia. There is a reference in the current edition of Goodman & Gillman’s textbook, Pharmacology that after taking amphetamines for a long time, especially in higher doses it may take 2 months for sleep to get back to normal.
Support for the idea of rebound insomnia comes mainly from 2 sources – theoretical scientific principles and clinical experience. People with ADHD have problems falling asleep when they’re not on medication – especially those who have mental or physical hyperactivity. Studies show that physical hyperactivity continues while they are asleep and is generally helped by stimulants. There are occasionally patients who actually sleep better taking a stimulant at bedtime.
People don’t sleep best when they are not paying attention to anything – that invites random ideas and images to pop into their mind – frequently related to hassles of the day or anticipated problems of the next day. We fall asleep best when we lightly focus on something not too stimulating like soft music or reading something not too exciting.

FAQs: ADHD