Attention-Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) encompasses inattention, hyperactivity, and impulsivity. These symptoms interfere with school, work, and social functioning. ADHD affects children and, for most, continues into adulthood.

Sleep disorders can cause symptoms mistaken for ADHD: inattention, hyperactivity, behavioral problems, and low academic performance. A child may additionally have difficulty conveying what they feel, leading to an ADHD misdiagnosis when their issues stem from a sleep disorder in actuality. Screening a child or adult diagnosed with ADHD for sleep problems is essential. 

ADHD and a sleep disorder may co-exist, worsening depression, anxiety, hyperactivity, inattention, difficulty processing information, and weight gain. Just as sleep can impact ADHD, so too can ADHD affect sleep. Internet addiction, hyperactivity, stimulant use, substance abuse, poor sleep hygiene, anxiety, and depression, seen in ADHD, can impair sleep. A child with ADHD and sleep problems poses additional parental stress, leaving mom and dad depressed and stressed. 

What we offer at Sleep and Brain

At Sleep and Brain, we conduct a detailed clinical history and specialized physical examination to evaluate if a sleep disorder is misdiagnosed as ADHD or if a sleep disorder coexists with ADHD. We prudently assess for sleep disorders such as the following:

• Circadian Rhythm Sleep Disorder

  • You may notice being more alert in the evening. An atypical sleep schedule can make it challenging to honor work or school commitments.

• Sleep-Disordered Breathing (SDB)

  • Snoring and apnea disturb sleep and cause daytime sleepiness and other symptoms typical of ADHD. Up to a third of children with ADHD also have sleep apnea, and treating SDB may reduce a child's need for stimulants.

• Restless Legs Syndrome (RLS)

  • Having restless, tingly legs with an urgency to move them can disrupt sleep. RLS may occur in almost half of children with ADHD. Having both ADHD and RLS could mean a child is spending more time in light, non-restorative sleep.

• Periodic Limb Movement Disorder

  • Your may unknowingly kick their legs intermittently during sleep. The limb movement can disrupt sleep and cause symptoms of inattention and hyperactivity.

• Narcolepsy

  • An individual with narcolepsy will fall asleep suddenly during the day and often has difficulty sleeping soundly at night. Daytime sleepiness can impair school and work performance. Adults may judge a child for sleeping at inappropriate times without realizing that it is part of their condition and unavoidable. Interestingly, adults with narcolepsy are more likely to have had ADHD as a child.

• Sleep Deprivation

  • ADHD symptoms are similar to sleep deprivation symptoms: forgetfulness, inattention, hyperactivity, irritability, restlessness, and impulsivity. Over the long term, chronic sleep deprivation can leave a child vulnerable to physical health problems.

Nasal inflammation or structural abnormalities and a small maxilla can increase nasal resistance and reduce nasal airflow. Nasal obstruction is suffocating and triggers a fight-or-flight response, leading to anxiety. The body is not accustomed to being in a chronic state of distress, and, ultimately, anxiety gives way to depression. Nasal obstruction can also affect sleep quality, leading to inattention and distractibilty. Nasal obstruction can also contribute to headaches.

Understanding the cause of your sleep problems is essential to customize a treatment regime for both the sleep disorder and ADHD. Treating sleep problems may improve ADHD because, as mentioned, disordered sleep symptoms can mimic or exaggerate ADHD symptoms. We direct treatment toward the sleep disorder as exampled below:

• Taking melatonin supplements at specific times or using bright light therapy may help adjust your sleep-wake schedule.

• Removing the tonsils, expanding the palate, and starting CPAP may help an individual’s ADHD and disordered sleep symptoms.

• Iron and dopamine deficiencies can cause RLS, PLMD, and, in part, ADHD. We treat RLS with iron supplements, medication, and non-medication therapies.

• Lifestyle management and medications are the cornerstones of narcolepsy treatment.

In addition to treating an underlying sleep disorder, we institute robust behavioral sleep interventions, as described in part below, to vitally improve life quality, daily functioning, behavior, and working memory:

• Cut out sugar, caffeine, and alcohol a few hours before bedtime

• Avoid screen time after sunset

• Avoiding stimulating activities and projects that require hyper-focusing in the evening

• Make the bed a stress-free zone reserved for sleep

• Get exercise and sunlight during the day

• Develop a bedtime routine, such as reading a book, playtime with pets, or taking a warm bath

• Keep the bedroom dark, cool, and quiet, using a white noise machine if necessary to drown out intrusive noises

• Awaken at the same time every day and acheive an age-appropriate total sleep time

• Use a weighted blanket

It is prudent to evaluate for sleep disorders before prescribing medication for ADHD. Although we rarely recommend sleeping pills for children, we can adjust a child's medication schedule to optimize sleep. Some children find it easier to sleep with stimulant medications' calming effects, whereas for other children, stimulants cause insomnia. Sometimes, taking stimulant medication an hour before awakening improves alertness.  

Racing thoughts and bursts of energy at night can interfere with sleep. Hyper-focusing on a nighttime project can make it hard to sleep. Over time, you may develop feelings of stress toward bedtime, worsening insomnia. We can mitigate the negative spiral of thoughts and actions.

Hypocapnia reduces blood flow to the prefrontal cortex, impairing functions like attention, decision-making, and impulse control. This can lead to ADHD-like symptoms such as difficulty focusing, poor concentration, and impulsivity, affecting cognitive performance and organization.