My son Jeremiah is 4 years old and has had sleeping difficulties from the day I became his adoptive mother at the age of 1 year. Last April he and I spent the night at Oregon Health and Sciences University to have a Sleep Study done. The results have been interesting and the next step will be a Tonsillectomy in order to correct obstructive sleep apnea. Our hope is to avoid a diagnosis and the treatment that goes along with ADHD.
The National Sleep Foundation estimates 30-40 million Americans have sleep disorders affecting health and daily functioning. This may be another one of those Chicken or Egg situations because sleep problems are often symptoms of other disorder including ADHD, Depression, Anxiety Disorders. Sleep disorders can also be a side effect of medications, such as stimulants, caffeine, alcohol, and obesity. Or a primary sleep disorder such as an obstructed airway or obstructive sleep apnea..
The question is, does obstructive sleep apnea, cause ADHD and Learning Disorders?
Snoring is the major symptom with obstructive sleep apnea. When a child snores there may be a cessation of breathing between snoring which reduces the oxygen to the brain and disrupts the sleep cycle. Adults with this condition are at an increased risk for heart disease, hypertension, depression, and brain damage. My own step-brother died at the age of 33 years old due to sleep apnea.
Until recently most parents didn’t worry too much when they had a child who snored. However, evidence indicates that Obstructive Sleep Apnea Syndrome may effect respiration, physical growth, and development. Research is indicating children with Sleep-related Obstructive Breathing Disorders may also suffer neurocognitive deficits. Neurocognitive deficits include impairments in verbal and non-verbal intelligence, memory, psychomotor efficiency, sustained attention, concentration and psychosocial functioning. In addition, many children show symptoms of hyperactivity, impulsivity, and distractibility, similar to Attention Deficit Hyperactivity Disorder (ADHD).
Current research shows some children may be misdiagnosed with ADHD when the actual problem may be sleep deprivation. Some recent studies show many children being treated with ADHD also suffer from sleep disorders such as sleep apnea, insomnia or restless legs syndrome. The encouraging news is that children who have both ADHD and a sleep disorder have shown dramatic improvement with their ADHD symptoms once the sleep disorder has been treated.
When a child shows symptoms of ADHD a sleep assessment should be consider and included as part of the diagnosis. Parents may want to keep a sleep diary for several weeks and discuss the following observations with the doctor:
Do you notice any of the following in your child?
- Snoring, gasping for breath, or pauses in breathing during sleep?
- Restless sleep?
- Difficulty falling or staying asleep?
- Does your child have difficulty waking in the morning?
In addition before treating your child for ADHD you may want to discuss any other know issues your child may have such as:
- A known sleep disorder, such as insomnia, sleep apnea, restless legs syndrome.
- Circadian rhythm disorder.
- Medical conditions that may interfere with sleep, including upper airway obstruction, pain, neurological or psychiatric conditions.
- Medications that may disrupt sleep.
- Child Obesity.
Other things to note about your child during the daytime include:
- Sleepiness.
- Declining performance in school and other activities.
- Difficulty paying attention.
- Mood or personality changes.
- Memory problems.
- Physical complaints especially headaches.
Whether a sleep disorder is the cause of the problem or not, talking with your child’s doctor about your child’s sleep patterns, problems or issues is important because any ADHD treatment needs to include good sleeping habits.
The most common cause of Sleep-related Obstructive Breathing Disorder for children is upper airway obstruction. There are three grades of severity:
- Primary snoring, which is snoring without blood gas abnormality.
- Upper airway resistance syndrome, which is snoring with increased work of breathing and nocturnal arousal but normal blood gas profile
- Obstructive Sleep Apnea Syndrome, which includes disturbed sleep and snoring associated with abnormal blood gases.
Snoring is common in childhood, and a small fraction will have abnormalities to be concerned over. Parents need to decide if an evaluation of severe snoring may be associated with apnea which is cessation of breathing. An ear, nose, and throat specialist may be needed and a sleep study may be conducted for children. Enlarged tonsils appear to be one of the major issues doctors are treating. The second major issue for children is obesity which causes a narrowing of the airway.
Many people with ADHD have difficulty with sleep, teaching a child with ADHD how to self-calm and fall asleep is important for their overall health. Establishing a regular bedtime with bedtime rituals will help children fall asleep. ADHD stimulant medications can often interfere with falling sleep during the first few weeks of treatment and usually goes away after a week or two of taking the medication.
As I said, in some cases it is difficult to tell if a sleep disorder is related to ADHD or causing the ADHD symptoms. After having our sleep study done for Jeremiah and receiving the diagnosis of Obstructive Sleep Apnea Syndrome we have decided to move forward with the removal of his tonsils and hope this helps him better sleep and enjoy the day time when he is awake.
I will keep you posted after his surgery and as the future unfolds.
Related Blogs:
- Sleep Disorders
- Facts About Sleep Apnea
- Childhood Obesity Rising
- ADHD: To Medicate or not to Medicate–That is the Question
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