Sleep problems, including insomnia, sleep disordered breathing, and restless legs syndrome are common in children and teenagers with attention deficit hyperactivity disorder (ADHD).
A 2016 article published in Current Psychiatry Reports outlined the current status of knowledge and appropriate management for sleep problems in children with ADHD. It reveals that between 35 and 70 percent of individuals with ADHD suffer from at least one sleep disturbance. Now that we know the facts, is there anything that can be done to improve sleep?
Why is there a link between childhood ADHD and sleep issues?
First let's understand the why. Around 55 to 87 percent of children or teenagers have at least one additional condition which is often associated with sleep problems. These include:
The disruptive behavior associated with ADHD can also make it difficult for children to fall asleep, get quality sleep, and get enough sleep.
Finally, children with ADHD are usually prescribed psychostimulant medications, which can harm sleep.
Unfortunately, when it comes to treating sleep problems in children with ADHD, existing evidence-based studies are limited by small size and short duration. More controlled trials are needed to further investigate the best treatment strategies.
With that being said, here's what we know:
How to treat insomnia in children with ADHD
Non-medical methods for treating insomnia include sleep hygiene and cognitive behavioral therapy.
Sleep hygiene involves setting consistent and appropriate behaviors towards sleep such as:
- Getting sufficient exercise during the day
- Avoiding daytime naps
- Avoiding stimulants such as caffeine close to bedtime
- Following a consistent and suitable sleep schedule
Cognitive behavioral therapy (CBT) involves a combination of stimulus control techniques, relaxation training, and cognitive restructuring.
If sleep hygiene and CBT do not improve sleep after a few weeks, it's worth investigating whether a change in ADHD medication could help.
As a very last step, sleeping pills and melatonin supplements may be considered.
How to treat sleep-disordered breathing in children with ADHD
It's thought that as many as 57 percent of children and adolescents with ADHD suffer from sleep-disordered breathing.
Sleep-disordered breathing includes a number of conditions that are characterized by abnormal breathing patterns or insufficient breathing during sleep. One such condition is obstructive sleep apnea.
Removal of the hypertrophic adenotonsillar tissues can relieve obstructive sleep apnea symptoms in more than 85 percent of children with ADHD.
How to treat restless legs syndrome in children with ADHD
Fewer than two percent of children between eight and 18 years of age suffer from restless legs syndrome (RLS). However, in children with ADHD, the prevalence rate skyrockets to between 33 and 52 percent.
Practicing good sleep hygiene can be beneficial, and iron supplements have also been shown to help relieve symptoms. In more severe cases, dopaminergic drugs may help, but more research is required to determine their effectiveness over the long-term.
Alternative medications for childhood ADHD
Decreasing dose regimens and switching to alternative formulations may be recommended by a doctor if sleep problems become an issue.
Alternative stimulants, non-stimulants, and antihistamines may be an appropriate alternative.
Martin is the creator of Insomnia Land’s free sleep training for insomnia. His online course uses CBT for insomnia techniques to help participants fall asleep and stay asleep. More than 4,000 insomniacs have completed his course and 97 percent of graduates say they would recommend it to a friend.