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Sleep and Children with ADHD
(by Brittany McKee, Quest Camp Counselor)
Dr. Judith Owens is a behavioral-developmental pediatrician and author who is internationally recognized as an authority on children and sleep. This newsletter is a summary of an interview she gave to Susan Buningh of CHADD to provide helpful information regarding sleep disregulation for children with attention difficulties.
Studies show that up to sixty percent of children and adolescents with ADHD have trouble sleeping. This lack of sleep can impact a child's overall health and development as well as behavior and even performance at school.
What is the difference between insomnia and ADHD "night owlism"?
Children who are "night owls" have a lot of trouble falling asleep at an early bedtime like, for example, 9 pm. They may fall asleep closer to 11pm if not later and if allowed to they may sleep in later the next morning. Alternatively, children with sleep-onset insomnia have difficulty falling asleep no matter what time they go to bed.
Is my child not sleeping well due to ADHD or sleep apnea?
Due to the overlap of symptoms of sleep apnea and ADHD, such as inattentiveness, hyperactivity, poor impulse control, mood changes and school problems, sometimes it can be difficult to tell which condition is affecting your child. However, children with sleep apnea usually have specific nighttime symptoms like snoring, breathing pauses, restless sleep and sweating at night and are more likely to be sleepy during the day in comparison to children with ADHD.
How to help children with ADHD to "wind down" and fall asleep?
-Having a regular bed and wake time on both weekdays and weekends, minimizing light exposure in evenings and maximizing light in the morning are a few helpers.
-There is also a practice called "sleep conditioning" where parents associate sleep-promoting activities such as a set bedtime and avoid wake-promoting activities in bed such as watching television, texting, doing homework or talking on the phone.
-Parents should avoid using the bed for punishment like a time out.
-Sleep practices that promote relaxation, such as reading, and avoid stimulation, such as vigorous exercise before bed, help to foster a good night's sleep.
What types of over-the-counter products help with sleep?
Herbal or "natural" preparations such as chamomile or valerian root are generally safe and for the most part are not known to interact with ADHD medications but also have little scientific data to back up their use in children and could be harmful if given in too large doses. Melatonin, which can be purchased over the counter, is a synthetic form of the sleep-promoting circadian system hormone produced by your brain in response to darkness. Studies show that children with ADHD may have a delay in melatonin production at night that can cause a circadian rhythm disturbance called sleep phase delay. Be sure to check with your doctor before using any of these methods.
Is it true that stimulant medications can actually help with sleep?
This issue is somewhat controversial. While parent-report studies report detrimental effects of stimulants in regards to sleep onset, more objective overnight sleep studies that include EEG measurements have not consistently supported these findings. Children whose sleep onset problems seem to be a result of their stimulant medication wearing off in the late afternoon or early evening with a return or even worsening of ADHD symptoms can cause difficulties with settling down for sleep.
Recommended Sleep for Children and Adolescents:
Infants (2 months-12 months): 14 to 15 hours
Toddlers (12 months-3 years): 12 to 14 hours
Preeschoolers (3 years to 6 years): 11 to 13 hours
School-Aged Children (6 years to 12 years): 10 to 11 hours
Adolescents (12 years to 18 years): 8.5 to 9.5 hours [1]
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