by Dr. Astrid Chong

Do you know of any children who lack concentration, are restless, fidgety and easily distracted?  Do you know a child who is inappropriately impulsive, makes careless mistakes, is physically overactive, has unsuitable social skills, experiences difficulty organizing things, talks excessively and has the inability to listen and follow instruction? Some of these activities are natural for children, provided they only last for a short period of time. However, for the children who behave this way on a regular basis, there may be a problem. These symptoms can potentially be due to a disorder called Attention Deficit Hyperactivity Disorder (more commonly known as ADHD).  Since many children can show any one of these different symptoms at any given time, it is no wonder that it is so difficult to separate a true ADHD child from an overzealous, rambunctious child.  ADHD is becoming a popular word, particularly in the younger population.  Characterized by the numerous symptoms listed above, ADHD presents itself in many different forms, varies between individuals and can range in degree from mild, medium to severe.  It is more common in boys (three times more likely than girls) and can even exist in adults. 

The interesting thing is that sleep problems are very common among people who have ADHD. In fact, many experts believe that as many as 70 to 80% of all patients with ADHD have difficulty sleeping, particularly in falling asleep. One study showed that it could take up to 2 to 3 hours for a patient with ADHD to fall asleep compared to less than 40 minutes for those without ADHD.  It’s not only falling asleep that is the problem with ADHD as other studies confirm that many people with ADHD also suffer from sleep disorders such as sleep apnea, insomnia or restless legs syndrome. 

Do you remember the last time you lacked sleep?  Perhaps you noticed the next day that it became difficult to learn and focus.  You may even have been inattentive and had difficulty controlling impulsive, emotional reactions to situations.  These sleep-deprived symptoms are very similar to those experienced by someone with ADHD.  Knowing that sleep can have such a strong impact on our behaviour begs the question — are sleep problems only secondary to having ADHD or are sleep disorders the real cause of ADHD?

Sleep Connection: Up all Day and Night
The National Sleep Foundation estimates that 30 to 40 million Americans have sleep disorders that affect their health and daily functioning. The research on sleep disorders in children is still in its early stages. However, research has shown that some people may be misdiagnosed with ADHD when the real problem is chronic sleep deprivation, either from a sleep disorder or from poor sleeping habits. There are many studies that support the theory that sleep is the culprit of hyperactive symptoms. For example, one study revealed that 11 and 12 year olds who got less than 6.5 hours of sleep every night had attention and behavior problems similar to patients who had ADHD. These kids were often irritated and defiant and had additional problems at school.  Also, another study showed that people who have both ADHD and a sleep disorder significantly improve in their symptoms of ADHD and decrease need for medication after the sleep problem is treated.

Looking at the human body, what is the connection? It has been largely established in the medical world that sleep deprivation impacts brain function.  ADHD is a neurological/brain disorder that happens because the chemical messengers in our brain are not working properly. There is substantial evidence that the pathology to ADHD and the sleep-wake cycle of our brain share common chemical messengers and mechanisms.

Sleep Apnea and ADHD
One sleep disorder that is closely associated with ADHD is obstructive sleep apnea.   In general, sleep apnea is commonly associated with snoring (most nights). In obstructive sleep apnea, there is a tendency for breathing to stop in between snoring. This decreases the amount of oxygen to the brain and therefore affects the sleep cycle. One study found that boys 8 years of age or younger who were habitual snorers were 4.3 times more likely to have ADHD than boys who did not snore.  Another study used a snoring score and found that the increase in snoring was associated with higher levels of inattention and hyperactivity.  This condition is related to other diseases in adults and children including problems with brain function such as impairments in verbal and non-verbal intelligence, memory, sustained attention, concentration and psychosocial functioning. Interestingly, theses impairments result in symptoms similar to ADHD.

What to Do?
Feeling moody, restless or unable to concentrate is no way to go through life. Neither is having sleepless nights.  While the answer still remains unclear until further research is done, let’s do all that we can to help children get a good night’s sleeps regardless if ADHD or sleep deprivation came first.  If you are a parent with a rambuctious inattentive child,  you may want to assess your child’s sleep patterns (regular snoring, snoring with long breaks in between, sleep walking, etc.). Consult your healthcare practitioner about these symptoms right away.  They will be able to screen for sleep disorders, diagnose the problem and assist in the treatment.  In the meantime, if sleep appears to be an issue with your child and you think it could be affecting his/her behaviour, start developing good sleep habits and regular routines (establish bedtime) and avoid stimulants and high levels of activity after a certain hour. Teach your child with ADHD how to calm down and fall asleep.  Hug them, give them lots of love and seek help as there are many solutions to help ADHD and sleep disorders in children.

Dr. Astrid Chong is a doctor of naturopathic medicine currently living and studying in England.