ADHD and sleep problems are interrelated. Learn how your child's ADHD may be causing sleep disruption, and how disrupted sleep can make ADHD symptoms worse for your child.
ADHD Sleep Disturbances
Children with ADHD are more likely than their peers to suffer from common sleep disorders, including insomnia, restless legs syndrome, and sleep apnea. The relationship between ADHD and sleep disorders is not completely understood.
Insomnia—the inability to fall asleep or stay asleep—is often seen in children with ADHD. Difficulty winding down and anxiousness, both common characteristics of ADHD, can fuel the fires of insomnia for ADHD kids.
Even if your ADHD child does not have problems falling asleep or staying asleep, other sleep disorders can lead to restless nights.
Restless Legs Syndrome and Involuntary Limb Movements
According to the National Institutes of Health, restless legs syndrome (RLS) is an overpowering impulse to move one's legs to alleviate discomfort. RLS usually occurs in the evening or at night when people lie down to rest. It sabotages a peaceful night's sleep and leads to daytime fatigue.
Related conditions such as periodic limb movement disorder (PLMD) can also result in poor sleep. PLMD, a frequent involuntary contraction of the leg muscles during sleep, does not usually cause people to wake up. But like RLS, PLMD can contribute to daytime sleepiness and an increase in hyperactivity for children. Per the University of Maryland Medical Center, some research indicates that ADHD and these limb movement disorders may be connected by ''a deficiency in the brain chemical dopamine.''
People with ADHD are known for having lower dopamine levels than the general population. Dopamine is a neurotransmitter involved in the brain's so-called ''pleasure center,'' the area of the brain that triggers pleasurable sensations in response to certain activities. In addition, dopamine is key to regulating attention levels.
Sleep Apnea and Sleep Breathing Disorders
The American Academy of Otolaryngology reports that sleep-disordered breathing (SDB) can cause daytime irritability, inattentiveness, and learning problems—and could contribute to attention disorders. Sleep apnea, the periodic cessation of breathing during sleep, is just one of several types of sleep breathing problems. Chronic snoring and conditions such as UARS (upper airway resistance syndrome) are other sleep breathing disorders that can affect daytime energy levels and behavior.
One study of 34 ADHD children matched against 32 non-ADHD children found that half the ADHD children had breathing problems during sleep, as opposed to only 22% of the control group. The frequency of SBD in ADHD children is roughly eight to ten times greater than for the general population.
Vicious Cycle of ADHD and Sleep Problems
A few common ADHD behaviors can cause poor quality sleep on a regular basis. In turn, these ongoing sleep problems exacerbate the ADHD symptoms.
Hyperactivity and Winding Down
Many ADHD children would experience hyperactivity even with good-quality sleep. However, sleep deprivation alone can cause hyperactivity even in children who don't have ADHD. In ADHD kids, it can make hyperactivity worse.
The ADHD mind already has problems winding down when it's time for bed. This usually results in late nights. And, of course, those late nights lead to trying mornings. Waking up on time can seem next to impossible.
Anxiety and Sleeplessness
Settling down at night is also an issue for the many ADHD children who suffer from anxiety. The disorganization that's a hallmark of ADHD can leave ADHD children with nagging fears of forgetting something critical. In addition, some stimulant medications used for ADHD may temporarily heighten anxiety. The medications can cause dry mouth or an accelerated heart rate—both of which mimic the symptoms of anxiety and panic.
The anxiety is often amplified by the slow pace of night. With their daytime distractions gone, these children have nothing to keep them from falling into hours of rumination and worry. Their unrequited apprehensions prevent them from relaxing into sleep.
The more these children spend their nights plagued by worry, the less sleep they get. And, just like the vicious cycle of sleeplessness and hyperactivity, the anxiety that keeps them up at night sets the stage for more anxiety the next night.
Sleep Deprivation Misdiagnosed as ADHD?
The Centers for Disease Control reported a 42% increase in childhood ADHD cases diagnosed between 2003 and 2011. What could cause such a sharp increase in less than a decade?
ADHD or Sleep Deprivation?
The dramatic rise in the diagnosis of childhood ADHD cases begs the question: Is chronic, partial sleep deprivation being mistakenly diagnosed as ADHD? After all, sleep deprivation can lead to irritability, lack of concentration, poor focus, and hyperactivity—for any child.
Televisions, smartphones, and other electronics have invaded not just our living rooms, but our bedrooms. As our children get older, they use more electronic devices in their bedrooms at night. Unfortunately, electronics are not conducive to sleep.
Sleep Apnea or ADHD?
Some medical professionals are now theorizing that children with sleep apnea may be getting misdiagnosed with ADHD, since both conditions can lead to hyperactivity and impulsive behaviors. Sleep specialist Dr. Steven Park suggests that sleep apnea should be ruled out when ADHD is suspected. The percentage of children with obstructive sleep apnea (2 - 4%) is similar to the percentage of children believed to have ADHD. While it's possible the two can coexist, sleep apnea may be causing ADHD symptoms where true ADHD is not present.
Does Your Child Have ADHD or Just a Sleep Disorder?
People with ADHD have a higher incidence of sleep disorders. Finding cases of sleep-deprived hyperactivity misdiagnosed as ADHD can prove difficult.
A sleep specialist, working with an ADHD specialist, can help to pinpoint the correct diagnoses for your child. One way to clarify the ADHD diagnosis is to identify and treat your child's sleep issues. Your child's pediatrician may recommend a sleep study. The sleep study will determine if your child has breathing issues or involuntary limb movement while sleeping. It can also track your child's heart rate and sleep phases.
How Much Sleep Does Your Child Need?
The National Sleep Foundation (NSF) recommends 9 to 11 hours of sleep for children 6 to 13 years old. Teenagers (14 to 17 years old) need about 8 to 10 hours of sleep every night. Of course, every child is different, which is why the NSF includes recommended maximum and minimum hours of sleep along with their general guidelines.
With ADHD in the mix, your child's sleep may be disrupted several times a night. Once any sleep problems have been diagnosed and treated to the extent possible, work with your child to figure out how many hours of sleep are optimal.
Better Sleep for Your ADHD Child
Even if your child has not been diagnosed with a problem such as sleep apnea or restless legs syndrome, certain changes to their nighttime routine might still improve both sleep quality and ADHD symptoms. Consider making adjustments in these areas:
Lifestyle Factors & Environment
Limit caffeine and processed sugars throughout the day. Keep the bedroom environment cool, calm, and free from clutter. Develop an evening wind-down routine to make preparing for sleep easier.
Give your child's electronics, including tablets or smartphones, a strict bedtime—and keep them out of your child's bedroom. Although handheld electronic devices are ubiquitous these days, they are notorious for delaying and disrupting sleep. Your ADHD child does not need additional mental stimulation at bedtime.
Work with your child's pediatrician to keep ADHD medications from working overtime. ADHD expert Dr. William Pelham of Florida International University's Center for Children and Families notes that newer stimulant medications for ADHD have a twelve-hour duration—two to three times longer than the stimulant medications used just a few decades ago. Some children may be stimulated by ADHD medications for a few hours longer than intended. Your child's doctor can help you tweak dosages and medication timing so that your child is not overstimulated at night.
Sleep problems and ADHD have a complex relationship. Work with your child's doctors to identify all the issues that may be causing sleep disruption. By encouraging good sleep hygiene, you can improve your child's sleep quality. Better sleep at night will mean better daytime functioning for your ADHD child.