Sleep Disorders and ADHD: Why Psychiatrists Should Screen for Excessive Daytime Sleepiness

Psychiatrists should routinely assess sleep issues in attention-deficit/hyperactivity disorder (ADHD) to improve treatment decisions and reduce risk, Eric Konofal, MD, PhD, told Psychiatric Times at the American Society of Clinical Psychopharmacology (ASCP) Annual Meeting.

Konofal, a French neurologist and sleep specialist who has studied ADHD, narcolepsy, and alertness disorders for roughly 2 decades, said that clinicians may be missing a critical biologic component that influences symptoms, treatment response, and patient risk.

Why Sleep and ADHD Symptoms Often Overlap

According to Konofal, many psychiatric and neurologic symptoms intersect through disturbances in sleep-wake regulation. In clinical practice, that overlap can complicate diagnosis and treatment decisions.

“For patients, sometimes we have an overlap between psychiatric symptoms and neurological symptoms,” Konofal told Psychiatric Times. “And inside psychiatry and neurology is sleep.”

He emphasized that sleep disruption may represent a shared pathway across disorders rather than a separate or secondary issue.

“Why a patient with psychiatric disorder or neurological disorder have a common part of symptomatology [is] probably linked to the sleep disorders,” he said.

Konofal’s work particularly focuses on ADHD and narcolepsy, conditions he described as closely tied to alertness and sleep-wake functioning.

Excessive Daytime Sleepiness May Influence ADHD Treatment Response

In considering treatment strategies, Konofal emphasized the need to assess excessive daytime sleepiness alongside core ADHD symptoms. He suggested clinicians should leverage standardized scales for such assessments, noting that patients with severe ADHD symptoms and substantial daytime sleepiness may respond differently to stimulant versus nonstimulant approaches.

“If you use a non-stimulant treatment, you have no benefit on excessive daytime sleepiness,” Konofal explained.

According to Konofal, untreated daytime sleepiness may contribute to additional medication use, including potentially problematic combinations of drugs.

“Patient on non-stimulant treatment use other drugs and mix,” he said.

He also suggested that untreated ADHD combined with excessive daytime sleepiness may increase patient vulnerability and risk.

Objective Sleep Testing Could Change ADHD Care

Konofal repeatedly emphasized the need for more objective assessment tools in psychiatry, particularly for ADHD.

“If you are a psychiatrist, you check only symptoms, list of symptoms, checklist,” he said. “But it’s not objective.”

He advocated for incorporating sleep-focused testing into ADHD protocols when feasible, including polysomnography and the Multiple Sleep Latency Test (MSLT), which objectively measures somnolence. “In Paris, we have a protocol for patients with ADHD,” Konofal explained. “Patients with ADHD have a polysomnography and MSLT.”

He believes objective sleep measures could improve clinical awareness and potentially refine treatment strategies for complex ADHD presentations.

Practical Sleep Screening Steps for Psychiatrists

While acknowledging that formal sleep testing can be expensive and inaccessible, Konofal stressed that psychiatrists can still begin incorporating sleep assessment into routine practice using simple symptom measures.

“The first step is to check the symptoms of ADHD and check symptoms of sleepiness,” he said.

He specifically encouraged combining ADHD rating scales with assessments of excessive daytime sleepiness to better identify patients who may require closer evaluation.

“You can just see if the patient has excessive daytime sleepiness,” Konofal said, noting that many psychiatrists are not currently considering this initial level of sleep screening.

Sleep Problems Extend Beyond ADHD Across Psychiatry

Although much of the discussion centered on ADHD, Konofal emphasized that sleep disturbances cut across nearly all psychiatric conditions.

“Whole psychiatric disorders have a problem of sleep,” he said, pointing to depressive and anxiety disorders as examples where sleep disruption is deeply intertwined with symptom burden.

Ultimately, he called for closer collaboration among psychiatrists, neurologists, and sleep specialists to improve care for patients whose symptoms may straddle traditional disciplinary boundaries.

“My position is today the field [should join together] sleep specialists, neurologists, and psychiatrists,” he said. “Because if you want to treat correctly and objectively patient with ADHD, it is very important to increase the measurements.”

Dr Konofal is a senior medical consultant at the Paediatric Sleep Disorders Center and clinical investigator at Clinical Pharmacology & Pharmacogenetic Department of Robert Debré Hospital. He is an internationally recognized as a sleep disorder researcher, scientist, and medical investigator in ADHD, RLS, and alertness and wake-deficit spectrum disorders.

Reference

1. Konofal E. Mazindol IR/SR: A 50-Year Legacy Repositioned as a First-In-Class Orexin–Monoamine Modulator for ADHD and Arousal-Related Disorders. Poster presented at the 2026 ASCP Annual Meeting; May 26-29, 2026; Miami, FL.