ADHD And Sleep Problems
Most ADHD experts agree obstructive sleep apnea can cause the core symptoms of attention deficit hyperactivity in children; inattentiveness, impulsivity, and hyperactivity. It stands to reason the earlier we suspect, detect and treat obstructive sleep disorders, the more likely we can prevent the symptoms of ADHD in the first place and avoid the misdiagnosis of ADHD.
Approximately 2.5 to 4 million children ages 3 to 17 years are misdiagnosed with ADHD in the U.S. each year. Of these, several hundred thousand will suffer the terrible stigma and discrimination of being labeled as ADHD and the side effects of unneeded medications. All because their sleep-time breathing disorder went undetected and untreated.
Much research is now being reported about the association of disorder breathing such as obstructive sleep apnea (OSA), and cognitive learning problems and ADHD-like behavior disorders in children as young as age 3 years.
A recent study presented at the Annual Meeting of the Associated Professional Sleep Societies showed nerve based abnormalities that affected cognition in brains of children with OSA were reversible with treatment of the OSA.
Obstructive Sleep Apnea Studies
Studies had already shown a clear association between deficits in attention, executive brain function and cognition-learning; as well as problems with memory. In this study at the Children’s Hospital Colorado Sleep Center, children with OSA underwent neuropsychological testing and in some cases, magnetic resonance spectroscopy to detect neuronal abnormalities.
After appropriate treatment for their OSA, these children were restudied and found to have normal brain metabolites in both frontal lobes resulting in an improvement in attention span and verbal memory.
Most children with disordered sleep breathing problems such as central sleep apnea (CSA), obstructive sleep apnea (OSA) and upper airway resistance syndrome (UARS) go undiagnosed until age 10 to 12 years because few doctors and parents think or even imagine a child could have problems breathing at night unless they have asthma or are sick.
Many of these kids will suffer inattentiveness and learning problems as a result of not sleeping well and will often fall asleep in class the next day. When they awaken or are awakened, they sometimes become very hyper and impulsive leading teachers to believe they have ADHD. Unfortunately, it seems most parents and teachers think any learning or attention span problem automatically means a diagnosis of attention deficit hyperactivity disorder.
While the actual diagnosis of a sleep-breathing disorder requires testing by a sleep study, a parent or teacher should be able to suspect and request workup for the disorder by watching their children for:
- Unexplained sudden behavior changes.
- New onset of a learning disability that did not previously exist.
- Frequent upper airway infections.
- Falling asleep when least expected (while others are excited and wide-awake).
- New onset or worsened snoring.
- Chronic mouth breathing.
- Change in sleep pattern-new nightmares, restlessness, kicking covers off, rolling off into the floor.
There are many more subtle signs and symptoms of disordered sleep breathing that occur in younger children (under age 5) that would help in making an accurate diagnosis. Many of these require close observation with a high level of suspicion.
Diagnosis Sleep Apnea In Young Children Suspected Of ADHD
More and more children ages 3 to 17 in the United States, as well as other countries, are being diagnosed with ADHD each year. US Statistics show a huge increase in kids under age 7 years being diagnosed and treated for attention deficit hyperactivity disorder particularly in the past three years.
Just in the U.S. alone, the number of kids ages 3 to 17 diagnosed with ADHD has skyrocketed to in excess of 10,000,000 ( Yes…that’s ten million) and that number is expected to increase by 15 to 20 percent over the next year.
Likewise, during this same period, as many as 4 million or 40 percents of those children ages 3 to 17 years, will have been misdiagnosed with ADHD.
ADHD Misdiagnosis Problems
Obviously, it’s very important that we diagnose ADHD and other behavior problems carefully and accurately in order to avoid wrongfully labeling a child with ADHD when indeed he or she is not ADHD.
Currently, there are in excess of 95 medical, social, and environmental things that can cause ADHD-like behavior, confusing the diagnosis; causing misdiagnosis of ADHD. One of the most common seen in kids under age 7 years is sleeping disordered breathing or sleep apnea.
When a child suffers sleep apnea, their breathing becomes shallow or periodical ceases causing inadequate amounts of oxygen to be delivered to the brain. And of course, our brains do not work well without oxygen, even when we are asleep.
During these shallow breathing episodes (hypopneas) or total cessation of breathing (apneas), partial or complete awakening will occur as the body tries to correct the disordered breathing. Near awakening or what experts call partial arousal episodes cause as much disruption in a child’s sleep pattern as total awakening or complete arousal.
It’s these awakening events that cause the basic problem that leads a child to display ADHD-like behaviors-inattentiveness, restlessness, poor concentration, irritability and mixed hyperactivity. As the old saying goes, if you don’t rest well at night, then you’re wasted the next morning.
I know many adults who discovered this truth the hard way as the stayed out all night long at parties, sporting events or tried to get the last minute of a vacation at 4 am, yet still had to be at work at 7:30 am.
Obviously, lack of sleep and poor sleep quality produce the same hang-over effects for a child. They just can’t function normally after tossing, turning and awakening all night long. These are the kids who will suffer inattentiveness and learning problems and will often fall asleep in class the next day. Once awakened, they sometimes become very hyper and impulsive leading teachers to believe they have ADHD. It’s often then, that they are misdiagnosed as ADHD.
Sleep Apnea Symptoms
The earlier we suspect, detect and treat breathing- sleep disorders, the more likely we can prevent a child from developing the symptoms of ADHD in the first place and of course, the more likely we avoid the misdiagnosis of ADHD.
With that goal clearly in mind, let’s discuss the things you might observe in your child that would lead you to suspect his or her behavior was being caused by sleep apnea or disordered breathing sleep.
Many young kids with sleep apnea will:
- Appear to mouth breathe much of the time. This might be due to allergies, stuffy nose, enlarged tonsils or adenoids or may be caused by a growth in their nose or neck.
- Have poor appetite.
- Toss and turn all night long, kicking covers off the bed or rolling out of bed.
- Snore softly or loudly at night or when lying down to rest during the day.
- Have sighing respirations when asleep.
- Suffer nightmares or sleep-talking or sleep walking.
- Wet the bed (enuresis).
- Are difficult to awaken or get out of bed.
- Show early morning sleepiness and irritability that often gets better as the day goes on.
- Complain of a headache and being tired even though they “slept all night long” and might fall asleep in morning classes.
- Suffer frequent leg cramps or as some call them…” growing pains”.
By now, I’m sure you’ve noticed all of these signs and symptoms of sleep disordered breathing share some common threads: they either interfere with the amount of sleep or interfere with the quality of sleep or affect the way a child feels the next day.
All sleep problems can cause poor concentration, difficulty with executive thought-decision processing, forgetfulness, inattentiveness, poor memory, an increase in irritability and hyper-ness and test taking abilities. These children often perform poorly on tests simply because they can’t focus on the task at hand.
As you can see, it’s terribly important to detect and treat a child’s sleep problems in hopes that doing so will prevent academic failure, poor self-image leading to depression and anxiety, and failure to grow into a mature adult capable of independent living.
Remember… the actual diagnosis of a sleep-breathing disorder requires testing by sleep study or polysomnography. However, knowing what you now know…you as a vigilant parent or teacher should be able to suspect the disorder simply by watching their children for the signs and symptoms of breathing disorder sleep.