ADHD or Sleep Problem?

A moody, distracted, and difficult-to-control child can often be frustrating for parents and caregivers.  You may notice that your child has a hard time staying awake during school, has trouble focusing on assignments, or even has behavioral problems at school and home.  Poor sleep can lead to a decreased ability to perform certain tasks, which may mimic attention-deficit/hyperactivity Disorder (ADHD).  Some of these symptoms may include:

  • Tiredness
  • Difficulty focusing attention
  • Learning problems
  • Impulse problems

According to studies, children who have been diagnosed as having sleep-disordered breathing (SDB) for at least 5 years exhibited symptoms that included:

  • Hyperactivity
  • Impulsivity
  • Aggressive behaviors
  • Poor social skills/communication
  • Decreased adaptability

How common are sleep problems?

According to the 2014 Sleep in America poll from the National Sleep Foundation children of all ages are, on average, getting at least an hour less sleep per night than is recommended, and most parents admit that their children need at least an hour more than they are currently getting.   Over time, this adds up to an overtired brain and many of the above symptoms.

What can we do to determine what may be causing these symptoms with my child?

Children with these symptoms should be evaluated for sleep disorders.  This doesn’t mean that every child will require a formal sleep study.  A screening questionnaire can be completed by the child’s parent or caregiver to help make a good assessment of whether a sleep problem could be contributing to the child’s behavioral problem.  Questions include:

  • Bedtime problems
  • Excessive daytime sleepiness
  • Awakening at nighttime
  • Regular bedtime and awakening time
  • Snoring or other difficulty breathing at night

What can I do at home to help my child if he/she has these symptoms?

With the ever increasing and overwhelming activities, schoolwork, video games, caffeinated drinks and social media, there are no “quick fixes.”  Some things that can be done at home to improve the amount and quality of your child’s sleep are:

  • Establish a regular time for going to bed and getting up in the morning. Stick to this schedule even on weekends and during vacations.
  • Use the bed for sleep only, not for reading, watching television, or working. Excessive time in bed disrupts sleep.
  • Avoid naps, especially in the evening.
  • Exercise before dinner. A low point in energy occurs a few hours after exercise; sleep will then come more easily. Exercising close to bedtime, however, may increase alertness.
  • Take a hot bath about 1.5 - 2 hours before bedtime. This alters the body's core temperature rhythm and helps people fall asleep more easily and more continuously. (Taking a bath shortly before bed increases alertness.)
  • Do something relaxing in the 30 minutes before bedtime. Reading, meditation, and a leisurely walk are all appropriate activities.
  • Keep the bedroom relatively cool and well ventilated.
  • Do not look at the clock. Obsessing over time will just make it more difficult to sleep.
  • Eat light meals, and schedule dinner 4 hours before bedtime. A light snack before bedtime can help sleep, but a large meal may have the opposite effect.
  • Spend a half hour in the sun each day. The best time is early in the day.
  • Avoid fluids just before bedtime so that sleep is not disturbed by the need to urinate.
  • Avoid caffeine in the hours before sleep.
  • If one is still awake after 15 - 20 minutes, go into another room, read or do a quiet activity using dim lighting until feeling very sleepy.
  • Reduce screen time, especially in the evening hours.  See specific recommendations below.
  • If distracted by a sleeping bed partner, moving to the couch or a spare bed for a couple of nights might be helpful.
  • If a specific worry is keeping one awake, thinking of the problem in terms of images rather than in words may allow a person to fall asleep more quickly and to wake up with less anxiety.

Why is it so important to reduce screen time?

Blue light, which is emitted from television screens, computer monitors, tablets and smartphones, is widely known to suppress the secretion of melatonin, which is a hormone that helps to control your circadian rhythm and sleep cycles.

Statistics:

Kids who sleep near a small screen (like a phone or tablet) get 20 minutes fewer of sleep per night than kids who don’t—and the sleep they do get is poorer quality. (Pediatrics. 2015 Jan 5. pii: peds.2014-2306.)

Teen boys who played video games before bedtime took 20 minutes longer to fall asleep, slept 30 minutes less, and got less REM sleep than teens who didn’t. (J Sleep Res. 2013 Apr;22(2):137-43.)

Kids who watched more than 2 hours of TV on weekdays resisted bedtime more, took longer to fall asleep, woke up more at night, and had poorer quality sleep. But only 7% of parents believed that TV affected their child’s sleep (Pediatrics Vol. 104 No. 3 September 1, 1999 pp. e27)

Kids with TVs and game consoles in their bedrooms go to bed later, sleep less, and complain of being tired more than kids who don’t have TVs and game consoles in their bedrooms (Sleep. 2004 Feb 1;27(1):101-4.)

Recommendations:

The American Academy of Pediatrics recommends the following limits on children’s screen time:

  • No screen time for children under 2 years old
  • No more than 2 hours of screen time per day on children ages 2 and up
  • No screens (TV, game console, etc) in a child’s bedroom

If your child has significant symptoms related to sleep, a formal assessment or consultation with a sleep specialist may also be needed.