Adhd And Sleep In Children And Adolescents
Its also common for children with ADHD to experience sleep issues. However, diagnosis can be even more complicated for kids because symptoms of ADHD and sleep disorders are often similar. Symptoms of ADHD are exaggerated when kids are tired, and some kids with sleep issues may even show behaviors that mimic ADHD even if they dont have it. This is why its so important for a doctor to thoroughly diagnose ADHD. Many doctors will use a combination of medical, developmental, and educational assessments to truly understand if ADHD or something else is at play.
The sleep disorders associated with ADHD in children and adolescents can keep them from getting their recommended amount of sleep each night.
Symptoms Of Delayed Sleep
The most common sign of delayed sleep-wake phase syndrome is being unable to fall asleep at a socially normal bedtime. This late bedtime makes waking up early difficult, and the lack of a full night of sleep can trigger many symptoms:
- Excessive Sleepiness: You may struggle to stay awake during the day or even find yourself nodding off.
- Difficulty Concentrating: Without enough sleep, you may struggle to stay focused or think clearly. You might also struggle to remember content.
- Difficulty Doing Usual Tasks: A lack of sleep can impair your judgment and ability to make choices.
- Abuse of Alcohol or Drugs: People with DSPD are at risk for misusing sleep aids, stimulants, or alcohol to fall asleep or stay awake.
These symptoms may worsen if you frequently change your sleep schedule, such as traveling across time zones.
Eat Meals On A Schedule
I eat dinner at a certain time so Iâm not hungry before bed and end up ruining my sleep with a stomach full of sugar and alcohol. If youâre impulsive like me, having snacks in plain sight can be enough temptation.
ð¡Pro-Tip! Put snacks out-of-reach. Youâll probably forget about them and realize you didnât need them in the first place. Alternatively, give the temptation to a friend – you canât grab a glass of wine if thereâs no wine in the house!
Iâve never been successful trying to make changes all at once. When I heard about these ideas to improve sleep hygiene, I did one of them. Just one. Itâs easier to succeed this way because thereâs less pressure – which makes me want to keep doing it.
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Time To Redefine Adhd
In line with our hypothesis, we propose an additional diagnostic presentation category referred to as ADHD-SOM . In this group, the ADHD symptoms are the result of chronic sleep disorders, that may have a large genetic component, and almost always lead to poor sleep quality and/or quantity, and suboptimal development or functioning of the dopaminergic system.
In summary, our plea for a redefinition of ADHD symptoms as the result of a chronic sleep disorder, is based on the following pieces of evidence that have been discussed throughout this manuscript:
Medication And Supplements To Aid Sleep
- Stimulants: Studies show that the use of stimulants for treating ADHD can help with sleep by targeting ADHD symptoms that often trigger sleep problems. Depending on the individual, the time the dose is taken can sometimes impact sleep .
- Melatonin: This hormone is naturally produced in the brain and helps signal to the brain that its sleep time. Talk to your doctor about melatonin and whether taking a supplement may be appropriate and helpful.
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Helpful Resources For People Living With Adhd
If youre having trouble sleeping and you have ADHD, there are resources that might help.
The ADHD Coaches Organization directory can connect you with an ADHD coach whos right for you. You can even choose the speciality for the type of coach you need.
If you want to connect with other adults living with ADHD, try the CHADD online community. Sometimes finding someone having similar experiences can give you ideas that will work for you, too.
ADDitude Magazine has Mobile Apps for Better Sleep, which may help you get a more restful sleep.
Wearing A Wrist Tracking Device
Your doctor may have you wear a wrist tracking device, also known as actigraphy. Similar to creating a sleep log, this will help to discover your current sleep schedule. These devices use what is known as an accelerometer to record motion. Knowing your current sleep schedule is important to help determine how your schedule needs to be shifted, and what the proper course of action is.
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Tips To Improve Sleep
Improving sleep hygiene has been shown to improve sleep health, especially in individuals with ADHD. Sleep hygiene is a set of health considerations that can help people get to sleep and remain asleep each night. Sleepers can make several lifestyle changes with their sleep hygiene in mind.
- Maintain a consistent schedule: Sticking to the same schedule, including a consistent bedtime routine, can help you optimize your sleep health. Aim to wake up and go to sleep at the same time, even on weekends.
- Limit blue light exposure at night: Exposure to screens too close to bedtime can make it more difficult to fall asleep and may negatively affect your ability to remain asleep. Devices like computers, tablets, and phones emit blue light, which can have a significant impact on getting restful sleep.
- Establish a comfortable bedroom environment: A cozy, quiet room with relaxing elements and a cool temperature can improve your sleep hygiene.
- Increase exercise: Working out during the day can improve your ability to fall asleep at night.
- Avoid certain substances before bedtime: Caffeine and alcohol can affect our ability to fall and remain asleep. Avoid these substances near bedtime for better sleep.
How Do I Know If I Have Delayed Sleep Phase Syndrome
You may have DSPS if the sleep disorder is also causing impairment in social, occupational or other areas of your life. The prevalence of DSPS among adolescents and young adults is approximately seven to 16 percent.
DSPS may develop in early childhood but most commonly it emerges or worsens during adolescence. Some adolescents delay their sleep schedules for social reasons and may not have underlying abnormalities in their circadian rhythm . For those, sleep schedules normalize in early adulthood. Learn more about circadian sleep disorders.
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Why Do People With Adhd Have Problems Sleeping
There are several theories about the causes of sleep disturbance in people with ADHD, with a telling range of viewpoints. Physicians base their responses to their patients complaints of sleep problems on how they interpret the cause of the disturbances. A physician who looks first for disturbances resulting from disorganized life patterns will treat problems in a different way than a physician who thinks of them as a manifestation of ADHD.
Thomas Brown, Ph.D., longtime researcher in ADHD and developer of the Brown Scales, was one of the first to give serious attention to the problem of sleep in children and adolescents with ADHD. He sees sleep disturbances as indicative of problems of arousal and alertness in ADHD itself. Two of the five symptom clusters that emerge from the Brown Scales involve activation and arousal:
- Organizing and activating to begin work activities.
- Sustaining alertness, energy, and effort.
Brown views problems with sleep as a developmentally-based impairment of management functions of the brain particularly, an impairment of the ability to sustain and regulate arousal and alertness. Interestingly, he does not recommend treatments common to ADHD, but rather recommends a two-pronged approach that stresses better sleep hygiene and the suppression of unwanted and inconvenient arousal states by using medications with sedative properties.
How To Get To Sleep With Add
No matter how a doctor explains sleep problems, the remedy usually involves something called sleep hygiene, which considers all the things that foster the initiation and maintenance of sleep. This set of conditions is highly individualized. Some people need absolute silence. Others need white noise, such as a fan or radio, to mask disturbances to sleep. Some people need a snack before bed, while others cant eat anything right before bedtime. A few rules of sleep hygiene are universal:
- Use the bed only for sleep or sex, not as a place to confront problems or argue.
- Have a set bedtime and a bedtime routine and stick to it rigorously.
- Avoid naps during the day.
Two more elements of good sleep hygiene seem obvious, but they should be stressed for people with ADHD.
- Get in bed to go to sleep. Many people with ADHD are at their best at night. They are most energetic, thinking clearest, and most stable after the sun goes down. The house is quiet and distractions are low. This is their most productive time. Unfortunately, they have jobs and families to which they must attend the next morning, tasks made harder by inadequate sleep.
- Avoid caffeine late at night. Caffeine can cause a racing ADHD brain to grow more excitable and alert. Caffeine is also a diuretic, although not as potent as experts once thought, and may cause sleep disruptions brought on by needing to go to the bathroom. It is a good strategy to avoid consuming any liquids shortly before bedtime.
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No Sleep Problems If Allowed To Maintain Desired Schedule
Some people may be unaware they have Delayed Sleep Phase Syndrome because they are still able to maintain societal and work expectations, despite being constantly tired. Most people with DSPS have no trouble sleeping if allowed to sleep on their desired schedule . Those with DSPS will likely sleep well on weekends or breaks, and use that time to catch up on the sleep they missed during the rest of the week.
Assess Current Sleep Habits
Begin by faithfully keeping a sleep diary that tracks:
- Actual hours slept each night, including times . The National Sleep Foundation recommends 7 to 9 hours of sleep for adults, 8 to 10 hours for teens, and 9 to 11 hours for 6 to 13 year olds. The more sleep that is done when the sun is down, the better.
- Weekday and weekend sleeping hours. There shouldnt be too much variation between the two.
- Sleep locations
- Environment
- Awakenings/nightmares
- Naps during the day
- If and how sleep habits affect others in the household
Consider signing up for a sleep study, a test that studies brain waves, oxygen levels in the blood, breathing, and more to see if any sleep disorders are present. If diagnosed with sleep apnea, a CPAP machine helps with breathing.
Anatomical issues, like a deviated septum, can also lend themselves to obstructed breathing and other sleeping problems. A septoplasty and other procedures can correct the issue.
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Are You A Night Owl About Adhd And Late Sleep
by APSARD Blogger | Nov 7, 2016
PsyQ, psycho-medical programs, Expertise center adult ADHD, the Hague, The Netherlands
ADHD is related to several sleep problems, but the most frequent seems the delayed sleep phase syndrome, a disturbance of the circadian rhythm. Research of children and adults with ADHD shows that the majority of these individuals has a late sleep onset that is associated with a late onset of the sleep hormone melatonin . Melatonin is produced by the pineal gland in the brain when it is getting dark in the evening, and we wake up by light in the morning. The onset of the melatonin production helps to fall asleep. For most adults the onset of melatonin is around 9.30 pm in ADHD children compared to controls this occurs at least 45 minutes later, and in adults with ADHD even 90 minutes . After melatonin onset, it normally takes 2 hours to fall asleep, but in adults with ADHD it takes at least 3 hours . So it does make sense that so many people with ADHD have difficulty falling asleep on time. This late onset of melatonin is driven by genes that regulate the biological clock, and those genes have been linked psychiatric disorders like ADHD and bipolar disorder . What the exact relationship is between this late sleep pattern and ADHD is still unknown.
A Case Report On Delayed Sleep Phase Disorder In An Adolescent: Misdiagnosisand Symptom Overlap With Mood Disorder And Attention Deficit Hyperactivedisorder
Andleeb Rasheed, Myra Ahmed, Samira Naim, Shakeel Raza , Shahram Sarrafi, Annam Zaidi, Rizwana Sabeeh and Saira Mushtaq
DOI
Andleeb Rasheed*, Myra Ahmed, Samira Naim, Shakeel Raza , Shahram Sarrafi, Annam Zaidi, Rizwana Sabeeh and Saira Mushtaq
Rush University Medical Center, USA
- *Corresponding Author:
- Rush University Medical Center, USA Tel: +7082896330 E-mail:
Received date: May 03, 2016 Accepted date: June 21, 2016 June 26, 2016
Citation: Rasheed A, Ahmed M, Naim S, et al. A Case Report on Delayed Sleep Phase Disorder in an Adolescent: Misdiagnosis and Symptom Overlap with Mood Disorder and Attention Deficit Hyperactive Disorder. Med Case Rep. 2016, 2:3. doi:10.21767/2471-8041.100028
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Treatment Of Delayed Sleep
The goal of delayed sleep-wake phase disorder treatment is to align your circadian rhythm to meet target sleep and wake times. Treatment typically begins with improving sleep hygiene, and you may need to reset your sleep routine. Qualities of good sleep hygiene include:
- Going to bed and waking up at the same time each day
- Keeping the bedroom cool, quiet, and dark
- Getting enough exercise and light exposure during the day
- Developing a relaxing bedtime routine, such as reading or taking a bath
- Avoiding all devices with light in the hours before bedtime
- Getting out of bed if you cannot fall asleep after 20 minutes
The elimination of blue light devices before bedtime is key in improving DSPD symptoms. The blue light can suppress the sleep hormone melatonin and therefore disrupt your sleep cycle.
In addition to improving sleep hygiene, bright light therapy is a viable treatment option. Research shows that bright light exposure in the first one or two hours of the morning advances your circadian rhythm. With your circadian rhythm advanced, you should fall asleep earlier and wake up earlier.
You might also consider a melatonin supplement in the hours before your bedtime. At this time, a consensus on exact timing and dosage of melatonin has not been established. Consult your doctor to determine how much to take and when to take it.
Whats The Connection Between Adhd And Sleep
Beginning around puberty, people with ADHD are more likely to experience shorter sleep time, problems falling asleep and staying asleep, and a higher risk of developing a sleep disorder. Nightmares are also common in children with ADHD, especially those with insomnia. Sleep problems in ADHD tend to increase with age, though sleep problems in early childhood are a risk factor for future occurrence of ADHD symptoms.
Even those who are rarely hyperactive during the day may experience racing thoughts and a burst of energy at night that interfere with sleeping. For some, nighttime presents the perfect opportunity to hyperfocus on a project, as there are less distractions. Unfortunately, this makes it difficult to settle down for sleep and it can lead to a disrupted sleep-wake schedule. Over time, insomnia may worsen as people start to develop feelings of stress related to bedtime.
Many people with ADHD experience daytime sleepiness and difficulty waking up as a result of poor sleep. Others experience restless, non-refreshing sleep with multiple nighttime awakenings.
Sleep problems in ADHD appear to differ depending on the type of ADHD. Individuals with predominantly inattentive symptoms are more likely to have a later bedtime, while those predominantly hyperactive-impulsive symptoms are more likely to suffer from insomnia. Those with combined hyperactive-impulsive and inattentive ADHD experience both poor sleep quality and a later bedtime.
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Adaptation To Late Sleeping Times
Working the evening or night shift, or working at home, makes DSPD less of an obstacle for some. Many of these people do not describe their pattern as a “disorder”. Some DSPD individuals nap, even taking 45 hours of sleep in the morning and 45 in the evening. DSPD-friendly careers can include security work, the entertainment industry, hospitality work in restaurants, theaters, hotels or bars, call center work, manufacturing, healthcare or emergency medicine, commercial cleaning, taxi or truck driving, the media, and freelance writing, translation, IT work, or medical transcription. Some other careers that have an emphasis on early morning work hours, such as bakers, coffee baristas, pilots and flight crews, teachers, mail carriers, waste collection, and farming, can be particularly difficult for people who naturally sleep later than is typical. Some careers, such as over-the-road truck drivers, firefighters, law enforcement, nursing, can be suitable for both people with delayed sleep phase syndrome and people with the opposite condition, advanced sleep phase disorder, as these workers are needed both very early in the morning and also late at night.
Some people with the disorder are unable to adapt to earlier sleeping times, even after many years of treatment. Sleep researchers Dagan and Abadi have proposed that the existence of untreatable cases of DSPD be formally recognized as a “sleep-wake schedule disorder disability”, an invisible disability.