Expert: Dr Billy Levin - 5/19/2011

Question
Dr Levin,
My 8 year old son has been on Ritalin LA, 20 mg once a day for the past 3 months. He takes it after breakfast every morning and is doing very well with this dosage. My only problem is that he has suffered from insomnia ever since he is on the Ritalin LA, 20mg.  He goes to bed at 7:30, and falls asleep quite easily but then wakes up between 12:00 and 2:00 in the morning and will sometimes stay awake for 2 - 3 hours before falling asleep again.  We've tried putting him to bed later than normal but he still wakes up.  I know that insomnia is one of the side effects of the medication but I would just like to know if there is not something I can do to help him to get more sleep at night?  He has a twin brother that he also wakes up in the early hours of the morning - so it is not only affecting him but the rest of the family as well?  Thank you for any advice?

Answer
It is difficult to comment on a treatment I feel is wrong and you have misinformation . Please accept my good intensions. ADHD is a full time condition ,not a part time one. Ritalin LA even if the dose is optimal, only lasts 8 hours at most. When it fades in the afternoon the rebound of ADHD is often worse than before.This can cause insomnia. It is essential to also use a short acting optimal dose of Ritalin at 3pm which will fade by 7pm so as not to affect sleep.Next,Ritalin LA,  as if fades at about 3pm  it cannot affect the sleep at 7.30pm.
Four things may cause insomnia.
1 the condition ADHD itself
2  stress and sibling rivalry
3  Ritalin given tooooo late
4   nightmares, common in ADHD
The fact that he falls asleep clearly must sugges it is not Ritalin or the condition. Ask you doctor about Melatonin given before bedtime could help. Serenace could help both stress, sleeping and nightmares. Either or but at optimal doses.