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

Question: I have trouble falling asleep when I take Adderall or Concerta. What can I do about it?
Answer: In evaluating any presumed side effect of medication it is important to ask how the side effect (e.g. insomnia) relates to the last dose of medication. Adderall tablets reach peak blood level in 3 hours. Methylphenidate (Ritalin) tablets peak in 1 1/2 hours. Adderall XR and Concerta peak in 6 hours. After the blood level peaks, it starts down. If the last dose of Adderall XR or Concerta is at 4:00 pm and the sleep problem is at 10:00 pm, it’s probably due to peak blood (i.e. a direct side effect). But if the last dose of medication is at noon and the sleep problem is at 11:00 pm, it’s more likely rebound. In the first case the medication needs to be taken earlier. In the second case it could be taken earlier or later.
Some people need to be fairly high functioning well into the evening but also need to get to bed by 10:00 or 11:00 to get adequate sleep. Fortunately we have safe, effective sleep medications that provide normal sleep and wear off by morning (Ambien, Lunesta, Sonata).

FAQs: ADHD

Question: How is Desoxyn different from Adderall and Dexedrine?
Answer: There is a lot of literature to support the fact that abuse liability is related to reuptake blockade and/or increased release of dopamine in the nucleus accumbens. The best resource is ADD Treatment with Stimulants, by Solanto, et al, 2001.
Recent reports by 5 different agencies (including DEA and OIG) that monitor substance abuse have found that Methamphetamine (Desoxyn) is by far the most abused stimulant. All this data is available through the Freedom of Information Act at each agency.
I have been prescribing Desoxyn for over 30 years. It has been available since 1941. It is clearly the most likely to be abused. Clinically it is sometimes the best tolerated. The most likely explanation for this is a reduced relative effect on Norepinephrine.