ADHD And Sleep Disorders: Lack Of Sleep May Be The Real Cause
Inability to pay attention, forgetfulness and poor impulse control can all be signs of ADHD, but recent research has suggested that lack of restorative sleep may be the root of the problem. A large percentage of children diagnosed with ADHD experience poor sleep, but untangling the two conditions can be difficult. Parents often observe that children with ADHD have a history of sleep difficulties, and many observe that ADHD symptoms subside when their child gets even one night of uninterrupted sleep. Does that suggest their child may have been misdiagnosed in the first place?
According to many researchers, sleep disorders are rare in children and therefore it is plausible that not may will have sleep disorders misdiagnosed as ADHD, or a combination of ADHD and a sleep disorder. One thing that is certain however, is that ADHD symptoms can be made far worse when a child is not getting enough sleep. Resolving sleep issues can alleviate many of the common symptoms.
ADHD can be caused by many other factors, including depressions, anxiety, and trauma, which can lead to pronounced sleep disorders, or just a general inability to fall asleep (sleep induction). To properly identify the root cause, symptoms like distractibility, lack of attention, and hyperactivity must be considered.
If a child diagnosed with ADHD is experiencing night terrors for example, or even sleep apnea, or asthma related symptoms, sleep disorders may follow, but addressing the sleep issue first might be a good tactic. an estimated 6-10% of the American population has ADHD, which typically makes it self apparent in early childhood. Only a psychologist or a psychiatrist trained in sleep disorders and ADHD will really be able to distinguish whether or lack of sleep is a cause, though there are plenty of symptoms to look out for, including:
Trouble falling or staying asleep
Difficulty waking up and getting out of bed in the morning
Suddenly awakening and screaming or experiencing a panic attack
Coughing upon awakening
Sleep apnea related symptoms, like pauses in breathing or struggling while breathing
Irritability and lack of calm
Difficulty concentrating and diminished attention to task skills
Excessive amount of energy and physical activity
Tendency to interrupt conversations, blurting things out
Forgetfulness, tendency to lose things
To determine if your child might have a sleep disorder which may be enhancing ADHD symptoms, one guideline researchers watch is how much sleep children are getting at a typical age group, with emphasis placed on young children, even before they may develop ADHD symptoms. Even moderate amounts of sleep deficit can contribute to enhanced ADHD issues.
Though there are guidelines for how much sleep kids should be getting at every age, individual children vary in how much they need, so sleeping less than is typical is not an instant indication that something is wrong. However, less sleep than the average child of that age should be cause for further investigation. And lack of sleep can be impacting a child’s behavior even if it doesn’t reach the level of a full-blown disorder.
Sleep Guidelines For Children And Teens
Babies 4-11 months 12-15 hours
Toddlers 1-2 years 11-14 hours
Preschoolers 3-5 years 10-13 hours
Elementary Age 6-13 years 9-11 hours
Teens 13-18 years 8-10 hours
Teasing Out ADHD And Sleep Disorders
Sleep and ADHD are a lot like the chicken and egg scenario. Children with ADHD typically have a much higher energy level than other kids, so settling in for the night and falling to sleep in a relatively short amount of time is often difficult. Parents may also lose sleep time, spending hours assisting restless children who have poor sleep induction or poor sleep hygiene.
Further, medications used to treat ADHD are often stimulants, which can have a caffeine buzz kind of effect on children at night. So it’s very possible that lack of sleep, short of a diagnosable sleep disorder, could be making a child’s ADHD symptoms far worse.
How To Deal With ADHD And Sleep Issues
If a child taking stimulant medication such as Adderal, (amphetamine salts), is having trouble sleeping, you should consult your doctor, who might adjust the timing of dosage of the meds it’s not in effect at bedtime. It’s mission critical to make sure your child has a mattress that is inviting, not excessively firm, and offers a cradling and nurturing environment. A natural latex mattress is typically our recommendation for children with ADHD as it is hypo-allergenic as well, and does not off gas or produce petroleum distillate fumes that can further compound the problem, especially if your child has sleep apnea, sensitivity to fragrances or fumes, mold, or mildew (natural latex is anti-microbial and anti-fungal).
If lack of sleep without any obvious medical issue appears to be causing proiblems, then a visit to a health practitioner is the logical next step. You can get them to help create a sleep hygiene behavioral plan with the parent which will increase the amount of productive sleep time.This might include following a more consistent bedtime routine, reducing screen time right before bed, and other strategies to help improve sleep hygiene. Obviously, you want to rule out sleep apnea or other medical issues as well.
This site offers a resource page on sleep hygiene, which can help you create the perfect sleep sanctuary for your child.
Attention deficit/hyperactivity disorder (ADHD) is a term used to describe hyperactivity, inattentiveness, and impulsive behavior. It is a fairly common condition that begins in childhood and may persist well into adulthood. Children with ADHD typically have trouble remaining still, staying focused, and possibly controlling their outward behavior and emotions, which can lead to poorer social skills, isolation, lack of independence, and poor performance in school. Children with severe ADHD often require enhanced attention from parents, teachers, school systems, and healthcare professionals in order to perform on level and to succeed.
ADHD is associated with a variety of sleep problems, including daytime drowsiness, breathing patterns consistent with sleep apnea, restless leg syndrome, and and periodic leg movement syndrome.
Sleep deprivation is a pernicious and serious problem among children in America. The National Sleep Foundation’s 2004 Sleep in America poll showed that more than two-thirds of children experience sleep problems at least a few nights a week. For children with ADHD, poor sleep patterns may profoundly impact ADHD symptoms. Fortunately, one prominent study found that treating sleep problems in a child with a hard diagnosis of ADHD may be enough to eliminate attention and hyperactivity issues for some children.
Children and adults behave differently because of sleep deprivation. Adults usually become drowsy and sluggish, while kids tend to overcompensate and engage in high energy behavior. This is the core reason why sleep deprivation is sometimes confused with ADHD in children. Children may also be subject to mood swings, emotionally explosive, and aggressive because of sleep deprivation. In a study that involved 2,463 children from ages 6-15, kids with sleep issues were more likely to be aggressive, defy authority figures, and display outbursts and other inappropriate behaviors.
Sleep problems are also quite common in adults with ADHD. In one study, researchers compared adults with narcolepsy and idiopathic hypersomnia (too much sleep), and found a high percentage of symptom overlap, suggesting the possibility that ADHD is commonly misdiagnosed among adults.
The CDC has reported that the prevalence of ADHD is about 4-5% in the general population. They also noted that ADHD occurs more frequently in boys than girls, but the prevalence among adult men and women is about the same. The cause of ADHD is not precisely known, but research suggests that it may be related to anatomic abnormalities in the brain, exposure to smoking by pregnant mothers, toxic materials, and/or genetic factors.
ADHD is associated with emotional problems, increased rates of drug and alcohol abuse, and failure to perform on level in academic and workplace environments. Further, sleep problems are associated with mood disorders and intellectual impairment. Treating sleep problems in children and adults with ADHD can drastically improve symptoms and quality of life.
The Link Between Sleep and Mood
You probably know firsthand that lack of sleep has strong effects on your mood. After a sleepless night, you may be more irritable, short-tempered, and responsive to stress. Once you get a good night’s sleep, however, your mood quickly returns to normal.
Studies have shown that even partial sleep deprivation has a huge effect on mood. University of Pennsylvania researchers found that individuals who were limited to only 4.5 hours of sleep a night for seven days reported feeling more stressed, angry, lonely, depressed, and mentally exhausted. When the subjects started a normal sleep, they reported a spike in mood and felt exhilarated in many cases.
Not only does sleep affect mood, but certain mental states can also affect sleep. Anxiety increases agitation and uneasiness, which make it hard to sleep. Stress also affects sleep by making the body aroused, awake, and hyperaware of our surroundings. People who are under constant stress or who have experienced PTSD inducing events tend to have sleep problems.
Insomnia and Psychological Problems
“There’s a big relationship between psychiatric and psychological problems and sleep. So people who are depressed or have anxiety often have trouble with sleep as part of those disorders,” says Dr. Lawrence Epstein, Medical Director of Sleep Health Centers and an instructor at Harvard Medical School.
Difficulty sleeping is sometimes the first symptom of depression. Studies have found that 15 to 20 percent of people diagnosed with insomnia will develop major depression. While sleep research is still exploring the relationship between depression and sleep, studies have shown that depressed people may have abnormal sleep patterns.
Sleep problems may, in turn, contribute to psychological problems. For example, chronic insomnia may increase an individual’s risk of developing a mood disorder, such as depression or anxiety. In one major study of 10,000 adults, people with insomnia were five times more likely to develop depression. Lack of sleep can be an even greater risk factor for anxiety. In the same study, people with insomnia were 20 times more likely to develop panic disorder (a type of anxiety disorder). Another study showed that insomnia is a reliable predictor of depression and many other psychiatric disorders, including all types of anxiety disorders.
Addressing Sleep Problems Makes a Difference
If you sleep poorly and feel depressed, anxious, or less emotionally responsive, there are many treatments that can help. First, look at your sleep habits and see if there are steps that you can take on your own to improve the quantity and quality of your sleep. If problems persist, you may wish to see a medical provider and ask about an evaluation for sleep problems and mental health concerns. After an evaluation and diagnosis, your provider can advise you on the best course of treatment. Options may include behavioral or other forms of therapy and/or medications.
Even if you do not have underlying sleep problems, taking steps to ensure adequate sleep will lead to improved mood and well-being. Sheila, a Boston district attorney and mother, became sleep deprived due to the conflicting demands of a full-time job and caring for her young children. She began to feel cranky, irritable, and uncharacteristically depressed. When she got both of her children on a consistent sleep schedule, she herself started sleeping an average of seven to eight hours a night and her mood improved considerably.