Table of ContentsView AllTable of ContentsDefinitionADHD and Sleep DisordersStimulantsTreatment
Table of ContentsView All
View All
Table of Contents
Definition
ADHD and Sleep Disorders
Stimulants
Treatment
What is the relationship between attention-deficit hyperactivity disorder (ADHD) and sleep? Children who have sleep disorders and attention-deficit hyperactivity disorder (ADHD) may have similar symptoms, such as inattentiveness, overactivity, and restlessness. The interplay between these two disorders of ADHD and sleep disorders is significant and one may be misdiagnosed as the other because of the overlap of symptoms.
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Defining ADHD
ADHD is a neurodevelopmental disorder affecting about 10% of children and 4% of adults. Those with ADHD often experience a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with their social, occupational, or academic functioning. Each of these criteria may manifest in different ways, including:
Relationship of ADHD to Sleep Disorders
There are many sleep disorders that may affect children. Most of the disorders found in adults can also occur in children, includinginsomnia,bruxism,periodic limb movement disorder,somniloquy,obstructive sleep apnea,somnambulism, andcircadian rhythm disorders. Children more commonly experiencenight terrorsthan adults do, however.
Children who have ADHD may be expected to have disrupted sleep. There is a behavioral component to sleep, andparenting difficultiesoften will extend to bedtime in kids with ADHD. In addition, there may be psychiatric symptoms, such as anxiety or depression, that can disrupt sleep. Studies have consistently shown higher rates of sleep disorders among children with ADHD.
An estimated 25% to 50% of people who have ADHD also have sleep problems.These have enormous and varying impacts on family dynamics, school success and other health issues.
Restless Little Legs
Studies have shown that 20% to 25% of people with ADHD have RLS, compared to just 1.5% to 2% of controls.The number of disruptive movements at night are strongly associated with the degree of hyperactivity during the day.
Snoring, Sleep Apnea and Hyperactivity
Children may have difficulty breathing at night, ranging frommild snoringto fullsleep apnea. The causes include:
Again, children with these sleep difficulties are not usually excessively sleepy. Rather, they will havebedwetting, sweating, developmental delay and learning or behavior difficulties.
The relationship between the number of breathing disruptions and drops in oxygen levels in the blood and hyperactivity has not been established; however, one study suggests that 81% of habitually snoring children who have ADHD (up to 33% of children with ADHD) could have their ADHD eliminated if their habitual snoring and other sleep-related breathing disorders were effectively treated.
Are Sleep Disorders More Common in ADHD?
Up to 74% of parents report sleep-related problems in their child with ADHD. In reviewing the available medical literature, there are trends in the data that suggest some sleep disorders may be more common in ADHD. When comparing children with ADHD who are not being treated with medication to children without ADHD, there are a few trends that may prove to be true:
ADHD Fatigue: Understanding the Connection
Role of Stimulants
The use of prescription drugs, such as Ritalin (methylphenidate), to treat ADHD may add another level of complexity to the issue. Stimulants are often used to treat ADHD, as well asnarcolepsyandchronic fatigue syndrome. Parents of children treated with stimulants perceive a higher prevalence of sleep problems, including longersleep latency, worsesleep efficiency, and shorter sleep duration. These effects are especially noted when doses are too close to bedtime. How these medications may affect other aspects of sleep is not well understood.
The Importance of Treatment
Untreated ADHD leads to significant impairment in interpersonal, vocational and cognitive domains, including intelligence quotient scores and achievement test scores that are lower than controls. It is important that children who experience inattention, impulsivity and hyperactivity be evaluated for ADHD and, as appropriate, sleep disorders.
13 Sources
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Spruyt K, Gozal D.Sleep disturbances in children with attention-deficit/hyperactivity disorder.Expert Rev Neurother. 2011;11(4):565-577. doi:10.1586/ern.11.7Xu G, Strathearn L, Liu B, Yang B, Bao W.Twenty-Year Trends in Diagnosed Attention-Deficit/Hyperactivity Disorder Among US Children and Adolescents, 1997-2016.JAMA Netw Open. 2018;1(4):e181471. doi:10.1001/jamanetworkopen.2018.1471Kessler RC, Adler L, Barkley R, et al.The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication.Am J Psychiatry. 2006;163(4):716-723. doi:10.1176/ajp.2006.163.4.716American Psychiatric Association.Neurodevelopmental Disorders. In:Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013. doi:10.1176/appi.books.9780890425596.dsm01Van Horn NL, Street M.Night Terrors. In:StatPearls. Treasure Island, FL: StatPearls Publishing; 2019.Wajszilber D, Santiseban JA, Gruber R.Sleep disorders in patients with ADHD: impact and management challenges.Nat Sci Sleep. 2018;10:453-480. doi:10.2147/NSS.S163074Gagliano A, Aricò I, Calarese T, et al.Restless Leg Syndrome in ADHD children: levetiracetam as a reasonable therapeutic option.Brain Dev. 2011;33(6):480-486. doi:10.1016/j.braindev.2010.09.008Carter KA, Hathaway NE, Lettieri CF.Common sleep disorders in children.Am Fam Physician. 2014;89(5):368-377.Chervin RD, Dillon JE, Bassetti C, Ganoczy DA, Pituch KJ.Symptoms of sleep disorders, inattention, and hyperactivity in children.Sleep. 1997;20(12):1185-1192. doi:10.1093/sleep/20.12.1185Noble GS, O’Laughlin L, Brubaker B.Attention deficit hyperactivity disorder and sleep disturbances: consideration of parental influence.Behav Sleep Med. 2011;10(1):41-53. doi:10.1080/15402002.2012.636274Mignot EJM.A practical guide to the therapy of narcolepsy and hypersomnia syndromes.Neurotherapeutics. 2012;9(4):739-752. doi:10.1007/s13311-012-0150-9Kidwell KM, Van Dyk TR, Lundahl A, Nelson TD.Stimulant Medications and Sleep for Youth With ADHD: A Meta-analysis.Pediatrics. 2015;136(6):1144-1153. doi:10.1542/peds.2015-1708Arnold LE, Hodgkins P, Kahle J, Madhoo M, Kewley G.Long-Term Outcomes of ADHD: Academic Achievement and Performance.J Atten Disord. 2020;24(1):73-85. doi:10.1177/1087054714566076
Spruyt K, Gozal D.Sleep disturbances in children with attention-deficit/hyperactivity disorder.Expert Rev Neurother. 2011;11(4):565-577. doi:10.1586/ern.11.7
Xu G, Strathearn L, Liu B, Yang B, Bao W.Twenty-Year Trends in Diagnosed Attention-Deficit/Hyperactivity Disorder Among US Children and Adolescents, 1997-2016.JAMA Netw Open. 2018;1(4):e181471. doi:10.1001/jamanetworkopen.2018.1471
Kessler RC, Adler L, Barkley R, et al.The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication.Am J Psychiatry. 2006;163(4):716-723. doi:10.1176/ajp.2006.163.4.716
American Psychiatric Association.Neurodevelopmental Disorders. In:Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013. doi:10.1176/appi.books.9780890425596.dsm01
Van Horn NL, Street M.Night Terrors. In:StatPearls. Treasure Island, FL: StatPearls Publishing; 2019.
Wajszilber D, Santiseban JA, Gruber R.Sleep disorders in patients with ADHD: impact and management challenges.Nat Sci Sleep. 2018;10:453-480. doi:10.2147/NSS.S163074
Gagliano A, Aricò I, Calarese T, et al.Restless Leg Syndrome in ADHD children: levetiracetam as a reasonable therapeutic option.Brain Dev. 2011;33(6):480-486. doi:10.1016/j.braindev.2010.09.008
Carter KA, Hathaway NE, Lettieri CF.Common sleep disorders in children.Am Fam Physician. 2014;89(5):368-377.
Chervin RD, Dillon JE, Bassetti C, Ganoczy DA, Pituch KJ.Symptoms of sleep disorders, inattention, and hyperactivity in children.Sleep. 1997;20(12):1185-1192. doi:10.1093/sleep/20.12.1185
Noble GS, O’Laughlin L, Brubaker B.Attention deficit hyperactivity disorder and sleep disturbances: consideration of parental influence.Behav Sleep Med. 2011;10(1):41-53. doi:10.1080/15402002.2012.636274
Mignot EJM.A practical guide to the therapy of narcolepsy and hypersomnia syndromes.Neurotherapeutics. 2012;9(4):739-752. doi:10.1007/s13311-012-0150-9
Kidwell KM, Van Dyk TR, Lundahl A, Nelson TD.Stimulant Medications and Sleep for Youth With ADHD: A Meta-analysis.Pediatrics. 2015;136(6):1144-1153. doi:10.1542/peds.2015-1708
Arnold LE, Hodgkins P, Kahle J, Madhoo M, Kewley G.Long-Term Outcomes of ADHD: Academic Achievement and Performance.J Atten Disord. 2020;24(1):73-85. doi:10.1177/1087054714566076
Vaidyanathan S, Shah H, Gayal T.Sleep Disturbances in Children with Attention - Deficit/Hyperactivity Disorder (ADHD): Comparative Study with Healthy Siblings.J Can Acad Child Adolesc Psychiatry. 2016;25(3):145-151.
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