Does Your Baby Want a Sleep Physician: ADHD and Sleep Problems
Sleep disorders are very common in children with rates between 25-40%. Unfortunately, the vast majority go undetected and untreated, although there are good treatment options for most pediatric sleep disorders. ADHD symptoms and symptoms of sleep disorders in children can also overlap, reinforce each other, or lead to misdiagnosis.
Children suffer from many of the same sleep disorders as adults:
- Obstructive sleep apnea
- Restless Leg Syndrome
- Periodic limb movement disorder
- insomnia
Any of these sleep disorders can and usually do lead to chronic sleep deprivation.
Sleep disorders in children (especially ADHD children) are often overlooked
Sleepy children do not act like sleepy adults. In fact, sleep-deprived children are more likely to show Hyperactivity and inattention as hypersomnia (sleepiness).
When “sleep disorders” are detected, I often recommend a sleep specialist evaluation, even if the only symptom of the sleep disorder is a behavioral, learning, or psychiatric problem. This does not necessarily mean the child needs a sleep test, but only a trained sleep specialist can determine which of these children needs further sleep diagnostics. Clear indications for a further sleep assessment are:
- snoring
- Difficult or very light breathing at night
- Sweating in sleep
- Sleeping in strange positions (especially with the head thrown back and the neck hyperextended)
- Complain of nocturnal restlessness or a strange feeling in the legs or arms
- Inability to fall asleep or stay asleep
- Resist going to bed
- I often wake up in the middle of the night and need parents’ attention
- Napping after the age of 5-6
- Bed-wetting (especially if the child has had a dry spell, but then bed-wetting again)
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Is It ADHD Or A Sleep Disorder?
Sleep deprivation can mimic ADHD because it causes the same signs and symptoms as ADHD. This can lead to misdiagnosis. In one study, nearly half of children diagnosed with ADHD did not meet diagnostic criteria a year later after having an adenotonsillectomy to treat obstructive sleep apnea. While this group of patients is typically considered to consider sleep disorders after all else has failed, I believe it is crucial that pediatricians, psychiatrists, and psychologists screen for sleep disorders all children suspected of having behavioral, learning, or psychiatric disorders . Sleep should be one of the first considerations, not the last.
Of course, for many children, insomnia and ADHD are not mutually exclusive. Because these syndromes often overlap, optimal treatment for each disease makes it easier to treat the other. On the other hand, the lack of a sleep disorder in children with ADHD makes it difficult to treat ADHD.
If your child has insomnia, here are some tips for a better night’s sleep in addition to a sleep consultation from a sleep specialist:
Sleeping tips for children
- Make sure you get enough sleep. Children need a lot more sleep than adults. School-age children take 10-12 hours a night, while teenagers usually take 9-9 ½ to feel good.
- No screens for 1 hour before bed.
- Keep a routine. This is essential. A typical routine involves bathing / showering, brushing teeth, combing hair, and then reading / listening to a story. Bedtime should not be longer than 30 minutes.
- Make sure you have fairly solid sleep and wake times. Children can stay up 1 hour longer on weekends or special occasions, but it is best not to vary any more, especially if the child is having trouble sleeping.
- No heavy meals, especially no sugar / simple carbohydrates 2 hours before bed.
- The room should be cool, dark and calm. If a night light is required, move it far from the bed and get one that does not emit blue wavelength.
- As a general rule, do not play roughly or exercise vigorously 1-2 hours before bed. However, some children with ADHD sleep better if they play a little hard about 1 hour before bed. Experiment with it.
- Do not help the child fall asleep, which you do not want to and cannot repeat several times during the night.
- After you’ve covered the child and kissed them goodnight, keep them sleepy (hopefully) but still awake so they can get used to falling asleep in bed alone (or at least without their parents).
- Pay careful attention to drug dosage times, as many drugs for depression, anxiety, allergies, and asthma can affect the sleep-wake cycle. The obvious concern is that stimulant drugs used to treat ADHD can cause insomnia.
Remember, if a child is chronically sleep deprived, whether due to reduced sleep quantity or poor quality sleep, then their ADHD symptoms get worse and are more difficult to manage with pharmaceutical or behavioral treatments.
To find a qualified sleep specialist near you, visit the American Academy of Sleep Medicine website, www.aasmnet.org.
References
- Chervin RD et al. Inattention, hyperactivity, and symptoms of sleep-related breathing disorder. Pediatrics 2002; 109 (3): 449-56
- Chervin RD et al. Breathing, behavior, and cognition disorders in children before and after an adenotonsillectomy. Pediatrics 2006; 117 (4): e769-78.
- O’Brien LM. The Neurocognitive Effects of Sleep Disorders in Children and Adolescents in Sleep, Memory, and Learning, Stickgold R, ed. Otherwise 2011.
