Daridorexant for adults with attention deficit hyperactivity disorder (ADHD) and insomnia disorder: An exploratory study

Insomnia is highly prevalent in adults with Attention-Deficit/Hyperactivity Disorder (ADHD), worsening core symptoms, mood, and cognition. Despite its impact, pharmacological options remain limited. Dual orexin receptor antagonists, such as daridorexant, are a promising yet untested approach in this population. In a naturalistic one-month study, 24 adults with ADHD and comorbid insomnia disorder received daridorexant 50 mg nightly. Sleep outcomes were assessed with the Insomnia Severity Index (ISI), Sleep Condition Indicator (SCI), and actigraphy-based measures. Secondary measures included ADHD symptoms (Barkley Adult ADHD Rating Scale–IV, BAARS-IV), cognitive performance (Conners' Continuous Performance Test–3, CPT-3), and mood and anxiety (Symptoms of Depression Questionnaire, SDQ). ISI and SCI scores improved significantly (both p < .001). Actigraphy confirmed longer total sleep time, higher sleep efficiency, and shorter sleep onset latency; after correction, ISI/SCI improvement and longer total sleep time remained significant. Clinically, 62.5% achieved meaningful improvement (≥7-point ISI reduction), 25% partial-to-minimal, and 12.5% no change or worsening; nearly two-thirds reached non-clinical insomnia levels. CPT-3 revealed enhanced sustained attention and response consistency, with further gains in selective attention and reduced impulsivity among responders. BAARS-IV showed overall improvement, with the sluggish cognitive tempo subscale reaching significance. Mood and anxiety improved, and the SDQ appetite/weight subscale decreased significantly even after correction, suggesting reduced perceived appetite or weight. Daridorexant was well tolerated; two participants reported daytime sleepiness or sedation, and one discontinued due to persistent sedation. In this preliminary sample, daridorexant was associated with improvements in sleep, attention, mood and anxiety in adults with ADHD and insomnia, supporting further controlled trials. • Insomnia disorder is common in ADHD, but effective treatments remain scarce. • This is the first study testing daridorexant in adults with ADHD and insomnia disorder. • Daridorexant reduced insomnia symptoms in two-thirds of ADHD patients. • Actigraphy showed longer total sleep duration, higher efficiency, and reduced sleep onset latency. • Daridorexant also improved ADHD symptoms, cognition, mood and anxiety symptoms.