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Ramelteon for Insomnia Related to Attention-Deficit/Hyperactivity Disorder (ADHD)
Rachel E Fargason1, Karen Gamble1, Kristin T Avis1
1Dr. Fargason, MD, is Director of the Adult ADHD Clinic and an Associate Professor of Psychiatry & Behavioral Neurobiology. Dr. Gamble, PhD, is an Assistant Professor in the Department of Psychiatry & Behavioral Neurobiology. Dr. Avis, PhD, is an Associate Professor in Pediatrics. Ms. Besing, is a Graduate Research Assistant in the Behavioral Neuroscience program in the Psychology Department all at the University of Alabama at Birmingham School of Medicine. Dr. Cherry W. Jackson, PharmD, Professor of Pharmacy, Auburn University, Clinical Professor, Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham. Dr. Cates, PharmD, is a Professor of Pharmacy Practice at Samford University, McWhorter School of Pharmacy. Ms. May, MA, is an Assistant Professor in the Department of Psychiatry & Behavioral Neurobiology and Director of the Office of Psychiatric Clinical Research.
Ramelteon effectively advanced sleep timing in adults with ADHD and circadian rhythm sleep disorder (CRSD). However, it paradoxically increased sleep fragmentation and daytime sleepiness, requiring careful dosing considerations.
Area of Science:
- Sleep Medicine
- Neuroscience
- Pharmacology
Background:
- Adults with Attention-Deficit/Hyperactivity Disorder (ADHD) frequently experience insomnia.
- Circadian rhythm sleep disorders (CRSD), particularly delayed sleep phase type, are common comorbidities in ADHD.
- Ramelteon, a melatonin receptor agonist, is used to treat insomnia.
Purpose of the Study:
- To evaluate the efficacy of ramelteon in improving sleep patterns in adult subjects diagnosed with both ADHD and insomnia.
- To assess the impact of ramelteon on sleep timing, sleep quality, and daytime sleepiness in this specific patient population.
Main Methods:
- A randomized, double-blind, placebo-controlled crossover trial involving 36 adult subjects with ADHD and insomnia.
- Subjects received 8 mg of ramelteon nightly or a placebo for two weeks each.
- Objective sleep measures (actigraphy) and subjective measures (Epworth Sleepiness Scale, ADHD-RS) were collected.
Main Results:
- 58% of subjects met criteria for circadian rhythm sleep disorder (CRSD), delayed sleep phase type.
- Ramelteon significantly advanced mid-sleep time by approximately 45 minutes compared to placebo.
- Ramelteon also significantly increased sleep fragmentation and Epworth Sleepiness Scale scores.
Conclusions:
- Ramelteon is effective in advancing the sleep/wake cycle in adults with ADHD and CRSD.
- A paradoxical effect of increased sleep fragmentation and daytime sleepiness was observed with ramelteon use.
- Dosing and timing of ramelteon require careful consideration in patients with ADHD and comorbid circadian rhythm disorders.
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