Attention-Deficit/Hyperactivity Disorder and Delayed Sleep Phase Syndrome in Adults: A Randomized Clinical Trial on the Effects of Chronotherapy on Sleep.
Study Goal
The researchers aimed to determine whether melatonin (with or without bright light therapy) advanced sleep times and improved sleep quality in adults with ADHD and delayed sleep phase syndrome (DSPS), potentially explaining the reduction in ADHD symptoms.
Results Summary
Melatonin advanced the dim-light melatonin onset (DLMO) but did not advance sleep times or improve sleep quality. Combining melatonin with bright light therapy further advanced DLMO but also did not affect ADHD symptoms or sleep timing.
Population
Adults (18-55 years) with ADHD and delayed sleep phase syndrome (DSPS).
Effective Dosage
0.5 mg/day melatonin, with or without 30 minutes of bright light therapy (BLT) between 0700 and 0800 h.
Duration
3 weeks of treatment, with follow-up 2 weeks post-treatment.
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
chronotherapy with melatonin | increase | dim-light melatonin onset (DLMO) | adults with attention-deficit/hyperactivity disorder (ADHD) and delayed sleep phase syndrome (DSPS) | 1.5 h | effectively advanced | #1 |
chronotherapy with melatonin | decrease | ADHD symptoms | adults with attention-deficit/hyperactivity disorder (ADHD) and delayed sleep phase syndrome (DSPS) | 14% | reduced | #2 |
Melatonin combined with bright light therapy (BLT) | increase | DLMO | adults with attention-deficit/hyperactivity disorder (ADHD) and delayed sleep phase syndrome (DSPS) | 2 h | advanced | #3 |
Melatonin combined with bright light therapy (BLT) | no change | ADHD symptoms | adults with attention-deficit/hyperactivity disorder (ADHD) and delayed sleep phase syndrome (DSPS) | no significant change | did not affect | #4 |
Melatonin with or without BLT | no change | sleep times | 49 adults (18-55 years) with ADHD and DSPS | - | did not advance | #5 |
Melatonin with or without BLT | no change | sleep in general | 49 adults (18-55 years) with ADHD and DSPS | - | did not improve | #6 |
Melatonin with or without BLT | no change | wake-activity rhythms | 49 adults (18-55 years) with ADHD and DSPS | - | did not strengthen | #7 |
Delayed sleep phase syndrome (DSPS) is the most common sleep disturbance in adults with attention-deficit/hyperactivity disorder (ADHD). We previously showed that chronotherapy with melatonin effectively advanced the dim-light melatonin onset (DLMO), a biomarker for the internal circadian rhythm, by 1.5 h and reduced ADHD symptoms by 14%. Melatonin combined with bright light therapy (BLT) advanced the DLMO by 2 h, but did not affect ADHD symptoms. This article explores whether sleep times advanced along with DLMO, leading to longer sleep duration and better sleep in general, which might explain the working mechanism behind the reduction in ADHD symptoms after treatment with melatonin. This article presents exploratory secondary analysis on objective and self-reported sleep characteristics from a three-armed double-blind randomized placebo-controlled clinical trial (RCT), which included 49 adults (18-55 years) with ADHD and DSPS. Participants were randomized to receive sleep education and 3 weeks of (1) 0.5 mg/day placebo, (2) 0.5 mg/day melatonin, or (3) 0.5 mg/day melatonin plus 30 min of bright light therapy (BLT) between 0700 and 0800 h. Sleep was assessed at baseline, directly after treatment, and 2 weeks after the end of treatment. Objective measures were obtained by actigraphy, self-reported measures by various sleep questionnaires and a sleep diary. Melatonin with or without BLT did not advance sleep times, improve sleep in general, or strengthen wake-activity rhythms. So even though the DLMO had advanced, sleep timing did not follow. Adding extensive behavioral coaching to chronotherapy is necessary for advancing sleep times along with DLMO and to further alleviate ADHD symptoms.