How do specialists approach ADHD when someone also has insomnia long-term?

Long-term insomnia is not a contraindication to managing ADHD symptoms with stimulant medication. ADHD medications typically last in the system anywhere from 8–14 hours, and in some cases an improvement in daytime ADHD symptoms can actually improve sleep quality over time by reducing mental chaos and daytime fatigue that disrupts night rest. Insomnia is often likely to be a separate entity that may warrant assessment by itself. 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. The only reason to discontinue a particular ADHD medication in the context of managing sleep patterns is if it directly causes a worsening of sleep pattern, whether someone had pre-existing insomnia or not.