If Adderall makes me sleepy, do I need a higher dose?

In this article:

• Why does Adderall make me tired?
• If Adderall makes me sleepy, do I need a higher dose?
• When to see a doctor
• Tips for managing Adderall-induced sleepiness

In this article

• Why does Adderall make me tired?
• If Adderall makes me sleepy, do I need a higher dose?
• When to see a doctor
• Tips for managing Adderall-induced sleepiness

Adderall is a central nervous system stimulant prescribed to treat attention deficit disorder (ADHD or ADD) in adults and children. Healthcare providers also prescribe the FDA-approved drug to patients with narcolepsy, a condition that causes excessive daytime sleepiness. Although Adderall is a stimulant, some patients taking it may feel sleepy at times. In some cases, the dosage or timing of Adderall may contribute to sleepiness, but other factors could also be at play behind the fatigue.

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Why does Adderall make me tired?

Patients who continually struggle with sleepiness while taking Adderall should talk to their healthcare providers about whether their current dosage is sufficient, says Sayanti Bhattacharya, MD, a psychiatrist and founder of Verve Psychiatry in Chapel Hill, N.C. 

“It’s possible that you are not taking an adequate dose if you’re continuing to struggle with sleepiness on the medication,” she says. “It’s also important to rule out other possible causes of sleepiness, including whether you’re getting enough sleep in general or if you have other sleep challenges, which can be common in people with ADHD.”

Adderall dosages vary. Doses for adults and children often begin at 5 to 10 mg and are adjusted based on age, the condition that’s being treated, how well the drug is working, and any side effects. Adderall is made from an amphetamine and dextroamphetamine combination, and is available in an extended-release capsule and tablet form. It is only available through a prescription. 

“If tiredness is getting in the way of your life or continuing for more than a few days, you should talk to your doctor,” Dr. Bhattacharya said. Healthcare providers may conclude that another factor could be causing fatigue, including some of these reasons below.

Medication side effects

Tiredness is a reported side effect of Adderall, occurring in 2% of children and 6% of adults – consistently higher than placebo in randomized controlled trials, says Amir Miodovnik, MD, a developmental-behavioral pediatrician with Pediatric Developmental Solutions outside Washington, D.C.

Rebound fatigue

“Some people experience rebound fatigue – sometimes called the Adderall crash – as the medication wears off,” Dr. Miodovnik says. “Adderall increases levels of dopamine and norepinephrine in the brain to help with focus and alertness. When the medicine wears off, those levels can drop suddenly, leaving the brain temporarily below baseline levels.”

Dopamine and norepinephrine are neurotransmitters that play important roles in cognitive function, including alertness and attention. When their levels drop, a patient may experience fatigue. “During this period – and for about one to two hours after the dose has worn off – people may feel low energy, emotionally flat, irritable, sad, or hungry,” Dr. Miodovnik says. 

Skipping meals

Forgetting to eat may compound the effects of an Adderall crash, Dr. Miodovnik says. “Some may also hyperfocus or skip meals while the medicine is active, which can leave them drained once it fades,” he says. “Adding a small, short-acting booster dose later in the day can help smooth the transition.”

Poor sleep

About 17% of children and 27% of adults in Adderall XR clinical trials reported trouble falling or staying asleep. “Even when the medicine is taken in the morning, it can still make it harder for the brain to wind down at night,” Dr. Miodovnik says.

Less sleep or lighter sleep can add up to daytime fatigue, he says. “Research also shows that stimulant medications can reduce sleep quality. These effects are usually strongest in the first few weeks after starting or changing the dose, and may improve as the body adjusts.”

Co-occurring conditions

Co-occurring conditions like anxiety, depression, or thyroid disorders can influence energy levels as well, says John Abroon, MD, a primary care physician in New York City.

“Clinical observations consistently report that fatigue can result from timing, metabolism, and individual neurochemistry,” he says. “Because of these multiple factors, increasing the dose independently is not recommended and could worsen side effects and impair sleep.”

Interactions with Adderall

Taking Adderall and other drugs together can cause unintended interactions. Antibiotics like linezolid, multiple sclerosis drugs like ozanimod, and potent monoamine oxidase inhibitors (MAOIs) – which are used to treat depression – are among the meds that can interact with Adderall. 

Sedatives like Xanax can also affect nerve communications in the central nervous system. By slowing brain activity, the drug causes a person to feel sleepy. However, because Adderall is designed to provide the opposite effect, combining these two drugs can lead to unpredictable reactions.

Because Adderall releases neurotransmitters like serotonin in the brain, it’s important to inform a healthcare provider if you also take an antidepressant. Selective serotonin reuptake inhibitors (SSRIs), such as Prozac and Lexapro, and serotonin and norepinephrine reuptake inhibitors (SNRIs), including Cymbalta and Effexor XR, also increase serotonin levels. This can lead to a potentially serious condition known as serotonin syndrome. Insomnia, restlessness, and agitation can be a part of serotonin syndrome. 

If Adderall makes me sleepy, do I need a higher dose?

Not necessarily. If Adderall makes you sleepy, it’s important to consult with a healthcare provider first to determine what other factors may be causing your fatigue, Dr. Abroon says.

“If you experience persistent fatigue, you should always consult your healthcare provider, who will be able to assess timing, formulation, dosage, potential interactions, as well as any underlying medical issues,” he says. “Like with any other medication, you should have a direct line of open communication with your healthcare provider.”

However, patients may need a dose adjustment or a different treatment plan if they experience sleepiness soon after taking the medication. At the same time, it is still active in their system, Dr. Bhattacharya says.

When to talk to your healthcare provider

With any new medication, your body often needs time to adjust as it adapts to the changes the drug introduces. However, certain signs and symptoms shouldn’t be ignored and may warrant a conversation or visit with a healthcare provider.

“You should see a doctor right away if you experience agitation, shakiness, palpitations, worsening anxiety, extreme sleep changes, irritability, or dizziness,” Dr. Bhattacharya says. 

However, some appetite suppression, finding it harder to fall asleep if the medication is taken too late, and feeling very awake and a “bit wired” can happen in many people, she says.

“This is a very effective medication but needs to be carefully monitored,” Dr. Bhattacharya says. “Dose changes should be made only after consulting your doctor. Some serious side effects are possible, so it’s important to communicate with your doctor if you are noticing any unexpected changes upon starting the medication.”

Dr. Abroon also advises prompt medical attention if you experience lethargy, mood swings, sudden behavioral changes, or chest discomfort. “Mild effects such as dry mouth, temporary insomnia, or reduced appetite are considered normal, but ongoing or extreme fatigue is not,” he says.

Tips for managing Adderall-induced sleepiness

If you find yourself feeling sleepy while taking Adderall, there are several strategies you can try to manage the drowsiness and stay alert throughout the day.

• Take Adderall earlier in the day to avoid disrupting nighttime sleep, Dr. Abroon says. Good and consistent sleep habits can help prevent daytime tiredness. 
• Eat balanced meals, Dr. Abroon says. Eating a healthy diet can help prevent energy crashes.
• Don’t skip meals. Dr. Miodovnik says that inconsistent eating can leave a person feeling more drained once the medication wears off.
• Engage in light to moderate exercise, he adds. Exercise improves alertness and can counteract Adderall-induced sleepiness.
• Talk to your doctor. While a dose adjustment may be needed, Dr. Bhattacharya says that if sleepiness occurs when the medication is wearing off, a healthcare provider may consider other changes, such as adjusting when the drug is taken. 
• Carefully track symptoms. It’s easy to forget symptoms when speaking with a healthcare provider, especially ones that aren’t consistent. Tracking symptoms helps identify patterns and possible triggers, Dr. Abroon says.