How do clinicians treat ADHD when someone also has chronic insomnia?

Many people worry that chronic insomnia will make stimulant treatment impossible, but sleep difficulties are not an automatic reason to avoid treating ADHD. ADHD medications can last anywhere from 8–14 hours depending on the formulation and timing, and in some cases improving daytime ADHD symptoms can actually improve sleep quality over time by reducing mental chaos and daytime fatigue that disrupts night rest. That said, chronic insomnia often exists as a separate or comorbid issue that deserves its own assessment. Insomnia may predate medication, be linked to stress or circadian shifts, or be worsened by ADHD-related arousal and difficulty shutting down at night. Addressing sleep directly is important rather than assuming it will automatically resolve with ADHD treatment. Primary approaches start with sleep hygiene and behavioural strategies: consistent sleep–wake times, limiting screens before bed, reducing caffeine later in the day, and creating a relaxing bedtime routine. The gold-standard evidence-based treatment for chronic insomnia is Cognitive Behavioural Therapy for Insomnia (CBT-I) — a structured therapy that can improve sleep habits and thoughts that interfere with sleep. CBT-I can be adapted for people with ADHD and is often more effective long-term than medications alone. In some cases, short-term use of sleep aids such as melatonin (taken 1–2 hours before bed) may be discussed with a clinician after non-pharmacologic strategies have been tried. For more tailored guidance on sleep strategies, online resources such as SleepWell Canada (e.g., https://www.sleepwellcanada.ca/) offer tips on sleep health and CBT-I.