A study found lower reported sleepiness in medicated than unmedicated young men with ADHD during prolonged wakefulness. Because only four medicated participants took amphetamine, the pooled result cannot establish an amphetamine-specific effect.
The study included 59 men aged 18–35: 39 with combined-type ADHD and 20 controls. Sleep was monitored with actigraphy before a 25-hour continuous-wakefulness protocol. Participants rated sleepiness hourly on the Karolinska Sleepiness Scale.
Seventeen participants with ADHD took their regular stimulant doses at 8 a.m. and again at midnight; 13 received methylphenidate and four amphetamine. Another 22 participants with ADHD remained unmedicated. Treatment groups were not a blinded, randomized comparison of amphetamine with placebo.
The unmedicated ADHD group reported greater sleepiness, especially overnight and early in the morning. At the end of wakefulness, its ratings exceeded those of controls and the medicated ADHD group. The medicated group did not differ significantly from controls.
That nonsignificant comparison does not prove equivalence or normal functioning in every participant. More importantly, the endpoint was subjective sleepiness. A lower score is not direct proof of unimpaired driving, preserved complex judgment or absence of microsleeps.
Most treated participants received methylphenidate, and the small amphetamine subgroup does not allow reliable separation of drug effects. Existing treatment history and clinical selection can also differ between medicated and unmedicated participants.
The findings apply to young men with a specified ADHD presentation under an unusual wakefulness schedule. They do not establish that stimulants can safely replace sleep or that the same pattern occurs in women, older adults or other ADHD presentations. No concentration–impairment cutoff was validated.
Read our analysis of a separate randomized hypersomnia treatment comparison.
The effects of stimulant medications on the sleepiness curve of young men with Attention-Deficit Hyperactivity Disorder (ADHD). doi:10.1186/s12888-026-08011-2.