METHYLPHENIDATE AND SLEEP IN ADULTS WITH ADHD - A NARRATIVE REVIEW

Marta Kaczorek; Bożena Kiełbasa; Olga Kowalczyk; Katarzyna Pagacz; Julia Gatniewska; Aleksandra Stadnik; Wiktoria Kolasa; Maria Jędryka; Dominik Zając; Urszula Jarzęcka; Monika Lis

doi:10.31435/ijitss.3(51).2026.6190

Authors

Marta Kaczorek Institute of Psychiatry and Neurology, Warsaw, Poland https://orcid.org/0009-0007-1406-2076
Bożena Kiełbasa Tytus Chałubiński District Hospital in Zakopane, Zakopane, Poland https://orcid.org/0009-0002-1667-124X
Olga Kowalczyk Rev. J. Glowatzki County Hospital, Strzelce Opolskie, Poland https://orcid.org/0009-0008-5105-3301
Katarzyna Pagacz The Lower Silesian Centre for Oncology, Pulmonology and Haematology, Wrocław, Poland https://orcid.org/0009-0000-1973-8433
Julia Gatniewska Regional Hospital in Poznań, Poznań, Poland https://orcid.org/0009-0001-1463-7497
Aleksandra Stadnik Wrocław University Hospital, Wrocław, Poland https://orcid.org/0009-0005-4764-3980
Wiktoria Kolasa Wrocław University Hospital, Wrocław, Poland https://orcid.org/0009-0005-4809-7053
Maria Jędryka Public health care institution in Oława, Oława, Poland https://orcid.org/0009-0000-9052-8914
Dominik Zając Central Clinical Hospital of UCC WUM, Warsaw, Poland https://orcid.org/0009-0004-0415-5322
Urszula Jarzęcka Medical Centre for Postgraduate Education, Proffesor W. Orlowski Memorial Hospital, Warsaw, Poland https://orcid.org/0009-0009-1160-8541
Monika Lis Mazovian "Bródnowski" Hospital, Warsaw, Poland https://orcid.org/0000-0003-4021-919X

DOI:

https://doi.org/10.31435/ijitss.3(51).2026.6190

Keywords:

ADHD, Attention-Deficit/Hyperactivity Disorder, Adults, Methylphenidate, Stimulants, Sleep Architecture, Sleep Quality, Sleep Onset, ADHD Pharmacotherapy

Abstract

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental condition that is highly prevalent among children. However, the persistence of symptoms of this condition into the adulthood should not be dismissed. The worldwide prevalence of adult ADHD is estimated to affect about 2.5% to 3.4% of the adult population and is associated with severe behavioural, emotional and social disfuncions. Chronic sleep disturbances, most frequently insomnia and deleyed sleep-wake phase disorder, are among the most commonly reported symptoms in adult clinical presentation of ADHD.

In this paper we combined scientific evidence form most recent studies and research papers published between January 2016 and June 2026 concerning the effects of short- and long-acting methylphenidate formulations on sleep quality and sleep-onset latency in adults with ADHD. We searched across PubMed and Google Scholar databases in accordance with predefined methodological inclusion criteria to investigate the connection between stimuland-based pharmacotherapy and sleep efficiency.

Although stimulant pharmacotherapy may prolong sleep-onset latency by approximately 10 to 20 minutes in a subset of patients, clinical findings indicate that overall sleep duration and sleep efficiency generally remains unimpaired. Polysomnographic records further suggest that optimized methylphenidate dosing does not significantly disrupt the microstructure of physiological sleep architecture, including deep sleep (N3) and rapid eye movement (REM) stages. Moreover, modern modified release formulations demonstrate potential benefits in stabilizing circadian regulation, reducing nocturnal racing thoughts and mitigating the evening rebound of ADHD symptoms.

Ultimately, methylphenidate appears to have a promising safety profile regarding the sleep quality and architecture in adult population. Maintaining treatment adherence and improving patients' quality of life require the appropriate use of long-acting formulations, individualized dosage schedules, and consideration of patients' baseline chronotype.

References

Adamis, D., Tiernan, J., Coada, I., Langan, N., Gavin, B., & McNicholas, F. (2026). Prevalence of sleep disorders in adults with attention deficit hyperactivity disorder (ADHD): The impact of comorbidity and ADHD subtype. SN Comprehensive Clinical Medicine, 8, Article 6. https://doi.org/10.1007/s42399-025-02243-1

Adamis, D., Tiernan, J., Langan, N., Gavin, B., & McNicholas, F. (2026). Effects of medications on sleep quality, insomnia, and circadian rhythm in adults with ADHD: A pragmatic longitudinal study. Sleep Medicine, 138, Article 108721. https://doi.org/10.1016/j.sleep.2025.108721

Ahlberg, R., Garcia-Argibay, M., Taylor, M., Lichtenstein, P., D'Onofrio, B. M., Butwicka, A., Beach, P., Larsson, H., & Chang, Z. (2023). Prevalence of sleep disorder diagnoses and sleep medication prescriptions in individuals with ADHD across the lifespan: A Swedish nationwide register-based study. BMJ Mental Health, 26(1), e300809. https://doi.org/10.1136/bmjment-2023-300809

Cândido, R. C. F., Menezes de Padua, C. A., Golder, S., & Junqueira, D. R. (2021). Immediate‐release methylphenidate for attention deficit hyperactivity disorder (ADHD) in adults. Cochrane Database of Systematic Reviews, 2021(1), CD013011. https://doi.org/10.1002/14651858.CD013011.pub2

Cataldo, M., Donnelly, G., Cutler, A. J., Silk, J., Reiz, J. L., & Childress, A. (2022). Analysis of daily sleep diary measures from multilayer extended-release methylphenidate (PRC-063) studies in children and adults with ADHD. Journal of Attention Disorders, 26(14), 1870–1881. https://doi.org/10.1177/10870547221106238

Coogan, A. N., Schenk, M., Palm, D., Bierbaum, L., Otterbach, B. L., Schloesser, A., & Thome, J. (2019). Impact of adult attention deficit hyperactivity disorder and medication status on sleep/wake behavior and molecular circadian rhythms. Neuropsychopharmacology, 44(7), 1198–1206. https://doi.org/10.1038/s41386-019-0327-6

Cueto, C., Gonzales, M. R., Tejada, A. N., Guerrero Leon, K., Mora, A., Cabrera, A., & Amodeo, L. R. (2026). Methylphenidate leads to disruptions in rest/wake patterns after discontinuation. Psychopharmacology, 243(3), 535–552. https://doi.org/10.1007/s00213-025-06859-y

Díaz-Román, A., Mitchell, R., & Cortese, S. (2018). Sleep in adults with ADHD: Systematic review and meta-analysis of subjective and objective studies. Neuroscience & Biobehavioral Reviews, 89, 61–71. https://doi.org/10.1016/j.neubiorev.2018.02.014

Fayyad, J., De Graaf, R., Kessler, R., Alonso, J., Angermeyer, M., Demyttenaere, K., De Girolamo, G., Haro, J. M., Karam, E. G., Lara, C., et al. (2007). Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder. Br. J. Psychiatry: J. Ment. Sci., 190, 402–409.

Fredriksen, M., Golparian, N., Beiske, K., & Stavem, K. (2021). Impact of methylphenidate on sleep problems in adults with ADHD: A pilot polysomnography study. Nordic Journal of Psychiatry, 75(3), 234–238. https://doi.org/10.1080/08039488.2020.1833984

Goodman, D. W., Starr, H. L., Ma, Y. W., Rostain, A. L., Ascher, S., & Armstrong, R. B. (2017). Randomized, 6-week, placebo-controlled study of treatment for adult attention-deficit/hyperactivity disorder: Individualized dosing of osmotic-release oral system (OROS) methylphenidate with a goal of symptom remission. The Journal of Clinical Psychiatry, 78(1), 105–114. https://doi.org/10.4088/JCP.15m10348

Gosling, C. J., Garcia-Argibay, M., De Prisco, M., Arrondo, G., Ayrolles, A., Antoun, S., Caparos, S., Catalán, A., Ellul, P., Dobrosavljevic, M., Farhat, L. C., Fico, G., Eudave, L., Groenman, A. P., Højlund, M., Jurek, L., Nourredine, M., Oliva, V., Parlatini, V., ... Cortese, S. (2025). Benefits and harms of ADHD interventions: Umbrella review and platform for shared decision making. BMJ, 391, e085875. https://doi.org/10.1136/bmj-2025-085875

Haimov, I., Dan, O., Eisenstein, S., & Shorer, Z. (2026). The effects of stimulant medications on the sleepiness curve of young men with attention-deficit hyperactivity disorder (ADHD). BMC Psychiatry, 26, Article 361. https://doi.org/10.1186/s12888-026-08011-2

Jaeschke, R. R., & Sułkowska, J. Z. (2025). Methylphenidate, sleep, and the “stimulant paradox” in adult ADHD: A conceptual framework for integrating chronopharmacotherapy and coaching. Journal of Clinical Medicine, 14(23), Article 8494. https://doi.org/10.3390/jcm14238494

Low, A. M., Vangkilde, S., le Sommer, J., Fagerlund, B., Glenthøj, B., Jepsen, J. R. M., & Habekost, T. (2023). Effects of methylphenidate on subjective sleep parameters in adults with ADHD: A prospective, non-randomized, non-blinded 6-week trial. Nordic Journal of Psychiatry, 77(1), 102–107. https://doi.org/10.1080/08039488.2022.2080253

Ni, H.-C., Lin, Y.-J., Gau, S. S.-F., Huang, H.-C., & Yang, L.-K. (2017). An open-label, randomized trial of methylphenidate and atomoxetine treatment in adults with ADHD. Journal of Attention Disorders, 21(1), 27–39. https://doi.org/10.1177/1087054713476549

Stein, M. A., Zulauf-McCurdy, C., & DelRosso, L. M. (2022). Attention deficit hyperactivity disorder medications and sleep. Child and Adolescent Psychiatric Clinics of North America, 31(3), 499–514. https://doi.org/10.1016/j.chc.2022.03.006

Surman, C. B. H., & Walsh, D. M. (2021). Managing sleep in adults with ADHD: From science to pragmatic approaches. Brain Sciences, 11(10), Article 1361. https://doi.org/10.3390/brainsci11101361

Surman, C. B. H., & Walsh, D. M. (2022). Understanding the impact of stimulants on sleep in ADHD: Evidence from systematic assessment of sleep in adults. CNS Drugs, 36(3), 253–260. https://doi.org/10.1007/s40263-022-00905-5

Weibel, S., Menard, O., Ionita, A., Boumendjel, M., Cabelguen, C., Kraemer, C., Micoulaud-Franchi, J. A., Bioulac, S., Perroud, N., Sauvaget, A., Carton, L., Gachet, M., & Lopez, R. (2020). Practical considerations for the evaluation and management of attention deficit hyperactivity disorder (ADHD) in adults. Encephale, 46(1), 30–40. https://doi.org/10.1016/j.encep.2019.06.005

Weiss, M. D., Surman, C., Khullar, A., He, E., Cataldo, M., & Donnelly, G. (2021). Effect of a multi-layer, extended-release methylphenidate formulation (PRC-063) on sleep in adults with ADHD: A randomized, double-blind, forced-dose, placebo-controlled trial followed by a 6-month open-label extension. CNS Drugs, 35(6), 667–679. https://doi.org/10.1007/s40263-021-00814-z

Wigal, S. B., Wigal, T., Childress, A., Donnelly, G. A. E., & Reiz, J. L. (2020). The time course of effect of multilayer-release methylphenidate hydrochloride capsules: A randomized, double-blind study of adults with ADHD in a simulated adult workplace environment. Journal of Attention Disorders, 24(3), 373–383. https://doi.org/10.1177/1087054716672335

Wynchank, D., Bijlenga, D., Beekman, A. T., Kooij, J. J. S., & Penninx, B. W. (2017). Adult attention-deficit/hyperactivity disorder (ADHD) and insomnia: An update of the literature. Current Psychiatry Reports, 19(12), Article 98. https://doi.org/10.1007/s11920-017-0860-0

Zhu, S., Wang, T., Wang, J., Yang, S., Yu, Z., Gao, H., & Chen, G. (2023). Efficacy and safety of PRC-063 for attention-deficit/hyperactivity disorder: A systematic review and meta-analysis from randomized controlled trials. Journal of Attention Disorders, 27(5), 470–487. https://doi.org/10.1177/10870547231153941