ADHD and Sleep Problems: Diagnosis and Treatment Options
Any parent of a child with ADHD will tell you that ADHD doesn’t end at bedtime; trouble getting your child into bed, difficulties falling asleep and restless sleep throughout the night all can go hand in hand with ADHD.
The Research on ADHD and Sleep Disorders
A study completed in 2009 showed that children with ADHD sleep less during the night and have less REM sleep than those without ADHD. This study measured the amount of sleep in both children with and without ADHD. According to the results, children with ADHD had 33 minutes less sleep time each night. Children with ADHD had 16 minutes less of REM sleep; between 25 percent and 50 percent of all children with ADHD have sleep problems. The lead author of the study believes that lack of sleep isn’t the cause of ADHD symptoms, however it may contribute to the severity of the symptoms.
Another study showed that 45 percent of children with ADHD had moderate to severe sleep problems including resisting going to bed, difficulty falling asleep and feeling tired when waking – indicating less than restful sleep. The children with sleep problems were more apt to miss or be late for school and their caregivers were more likely to be late to work.
Studies also show that children with ADHD are more active during sleep, have reduced REM sleep and suffer from daytime drowsiness.
Diagnosing Sleep Disorders
According to Dr. Judith Owens, diagnosing sleep problems in children with ADHD is sometimes difficult because there are several different possible reasons for sleep disturbances, including the use of stimulant medications, poor sleeping habits or coexisting conditions such as mood disorders or anxiety. The ADHD itself may cause sleep problems by causing a deregulation of sleep and wakefulness cycles. In addition, sleep disorders, such as sleep apnea or bruxism, may cause symptoms similar to ADHD and may be misdiagnosed. Dr. Owens suggests that all children who are diagnosed with ADHD or other mental illnesses should be screened, and, if necessary treated, for sleep disturbances.
Treating Sleep Disturbances
Deciding on the best treatment for your child’s sleep problems begins with finding the cause. While we explained that this can be difficult, it is important to begin with a complete evaluation with your family doctor. Based on the severity of the problem, he may suggest sleep studies to be completed by a specialist.
Treatment should be specific to your child’s needs. Some ways common sleep disturbances are treated are:
Sleep Walking – taking safety precautions such as providing the child with a first floor bedroom or waking the child periodically through the night.
Bedwetting – addressing any emotional distress that may be causing the bedwetting, medication, using bedwetting alarms, bladder control conditioning
Anxiety or mood disorders – using calming bedtime routines, cognitive behavioral therapy and medication if necessary and only where appropriate
Sleep Apnea – removal of tonsils and adenoids or a procedure called nasal continuous positive airway pressure
Narcolepsy – scheduled naps throughout the day, medication
Delayed sleep – phase syndrome (when sleep rhythms are delayed, such as in teenagers who don’t fall asleep until 2:00 AM and then have trouble waking up) - light therapy, gradually changing sleep schedule, using medication short-term to adjust the sleep schedule
At-Home Care for Children with ADHD
While an underlying sleep disorder should be treated in conjunction with your doctor, there are some ways parents of children with ADHD can make bedtime easier and help your child get to and stay asleep:
- Create a relaxing and calming bedtime routine and stick with it every night
- Have your child go to bed and wake up at the same time every day
- Remove stimulating activities, such as video games, several hours prior to bedtime
- Create a token economy with rewards for going to bed without resistance
- If your child gets up from bed, calmly return him to bed
- Use white noise to help your child calm his hyperactive mind
- Monitor nap schedules to make sure your child isn’t sleeping too much during the day
If you institute changes to try to help your child get to sleep and still find he can’t fall asleep or wakes up through the night, talk with your doctor.
“A Clinical Overview of Sleep and Attention-Deficit/Hyperactivity Disorder in Children and Adolescents,” 2009, Judith A. Owens, M.D., Journal of the Canadian Academy of Child and Adolescent Psychiatry 18:2
“Sleep and Sleep Disorders in Children and Adolescents: Information for Parents, Date Unknown, Peg Dawson, Ed.C. NASP Resources
“Sleep Problems Linked to ADHD in Children, 2009, March 2, Rick Nauert, PsychCentral.com
“The Link Between ADHD and Sleep Problems, 2012, April 25, Michael Craig Miller, M.D., Intelihealth.com