ADHD and Sleep Problems in Children

An Intruder in the Bed
It probably comes as no surprise to parents that their ADHD children have trouble getting to sleep at night. It's hard for them to rev down and resist the impulse to play one more video game, text one more friend, post on Facebook, or start(!) their homework. But what do we really know about sleep problems and ADHD, and more importantly, what can you do about it?

What Research Tells Us

Several studies published in the past year by sleep medicine researchers have found significant differences in sleep problems between children with and without ADHD. Some of their findings include:
  • Approximately 45% of children with ADHD are reported by their parents to have moderate to severe sleep problems.  Some of the most common problems were difficulty falling asleep, resisting going to bed and tiredness on waking. According to the authors "compared with [ADHD] children without sleep problems, those with sleep problems were more likely to miss or be late for school, and their caregivers were more likely to be late for work." They contend that successful intervention to improve sleep may reduce the need for medication for some children with ADHD.
  • Children with ADHD may be chronically sleep deprived and have abnormal REM (rapid eye movement) sleep. Results show that they have a total sleep time that is significantly shorter than that of children without ADHD. The authors note that partial sleep loss on a chronic basis accumulates to become a sleep debt, which can produce significant daytime sleepiness and neurobehavioral impairment.
  • A review of 47 studies of ADHD and sleep problems in children and adolescents, suggests increased nighttime activity, reduced rapid eye movement sleep, and significant daytime drowsiness in unmedicated children with ADHD when compared to controls. Data also suggest a possible increased prevalence of periodic limb movements during sleep but little differences in sleep-disordered breathing.
An excellent, free full-text article by Judith Owens, MD, MPH, a leading sleep medicine expert, describes the diagnosis and treatment of sleep problems in children with ADHD. She notes:
The relationship between sleep problems and ADHD is hardly a straightforward one, and may present clinically in a number of different guises. For example, psychotropic medications used to treat ADHD or comorbid psychiatric conditions associated with ADHD (i.e., mood disorders, anxiety) may themselves result in sleep problems in some patients, daytime manifestations of primary sleep disorders such as obstructive sleep apnea may “mimic” ADHD symptomatology in others, comorbid sleep problems may exacerbate ADHD symptoms, and/or sleep problems may in some cases represent an “intrinsic” dysregulation of sleep and wakefulness associated with ADHD-related CNS dysfunction.
Dr. Owen also discusses the importance of screening all children with mental health problems for sleep disorders and gives clinicians suggestions for doing so.

Tips for Parents

If your ADHD child or teen has problems sleeping, don't assume there is nothing you can do about it. Consult her pediatrician about possible sleep disorders. If your child is taking stimulant medication, ask the prescribing physician whether the type or dose of medication could be affecting his sleep. Ask a child psychologist to help you develop behavioral strategies to deal with bedtime struggles. If none of this helps, you may want to take your child to a sleep specialist. You can search for an American Academy of Sleep Medicine accredited sleep center here.

Other Resources:

Sleep Tips for Children from the National Sleep Foundation

ADHD Health: Shuteye Strategies for Children | ADDitude Magazine