Treating the sleep problem may improve the ADHD
STUDY: Grassi G et al, Comprehensive Psychiatry 2026;148:152700
STUDY TYPE: Naturalistic observational study
FUNDING: Idorsia Pharmaceuticals Ltd.
Background
Daridorexant (Quviviq) is an orexin antagonist, a new breed of sleep medicines that improve next day functioning. Over half of people with ADHD have insomnia, and this is the first report of an orexin antagonist there. It is not a true test; no randomization, no control group.
The Study
- 24 adults with ADHD and comorbid insomnia disorder
- Daridorexant 50 mg nightly for one month
- Primary outcomes were subjective insomnia severity (Insomnia scale (ISI), Sleep Condition Indicator (SCI)) and actigraphy-based sleep measures. Secondary outcomes included ADHD symptoms, attention testing, and mood.
Sleep improved substantially. Insomnia ISI scores dropped from a median of 16 to 8, and 63% of patients achieved a clinically meaningful response (7-point reduction). Nearly two-thirds crossed below the clinical threshold for insomnia disorder. Actigraphy confirmed longer total sleep time, better sleep efficiency, and shorter sleep onset latency. Sustained attention and response consistency on cognitive testing also improved. ADHD symptom scores trended down, with the sluggish cognitive tempo subscale reaching significance. Anxiety improved as well.
Limitations: no control group, only 24 patients, one month of follow-up, industry bias.
Practice Implications
- This is a preliminary signal, not a practice-changer.
- For sleep in ADHD, CBT-insomnia is first-line.
- Look for these conditions which are common in ADHD: Sleep apnea (20-30%), restless leg syndrome (20-30%), and night owls (70-80%).
- Night owls improve with low-dose melatonin (1-3 mg) or blue-light blocking glasses and dawn simulators.
- Some ADHD meds, like clonidine and guanfacine, improve sleep.
— Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
