Counting Sheep for Kids with ADHD

ADHD children with sleeping difficulties may need interventions to help them fall asleep

January 29, 2013 / Author:  / Reviewed by: Robert Carlson, M.D

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(dailyRx News) One of the challenges of parenting can involve helping children maintain healthy sleep habits. Children with conditions like ADHD may need even more help with sleep.

A recent study looked at sleeping patterns among children with attention-deficit hyperactivity disorder (ADHD).

The researchers found that children with ADHD often have a difficult time falling asleep at night and during the day, regardless of how well they slept the night before.

It's possible that children with ADHD may need more time spent in quiet activities before bedtime to help them get to sleep.

"Ask your pediatrician for help with kids' sleep."

The study, led by Sabrina Wiebe, a research assistant at the Attention, Behavior and Sleep Lab at Douglas Mental Health University Institute in Montreal, Canada, looked for information about sleep among children with ADHD.

The researchers studied the sleep patterns of 82 children, aged 7 to 11, for six days. The 26 children with ADHD and the 56 children with typical mental development underwent a sleep study at their homes for one night.

For the other five nights, the children wore a watch-like device called an actigraph that measured their movement and provides an estimation of the amount of sleep they got.

The researchers also measured the children's daytime sleepiness with a questionnaire and by testing how long it took the children to fall asleep during a series of nap opportunities at a lab during the daytime.

The children were asked not to take medication or have products with caffeine for at least two days before the study began.

When the researchers compared the results, they found that there were no major differences between the two groups on the daytime sleepiness questionnaire or in how many children chose to nap during the day when given the opportunity.

However, there were some other differences between the two groups.

Children with ADHD who spent more time in the slow wave sleep phase also took longer to fall asleep during the day, therefore showing less sleepiness. Further, based on their actigraphs, these children also took longer to fall asleep if they spent more time awake each day.

Meanwhile, the typically developing children only took longer to fall asleep during the day if they also took longer to fall asleep at night.

"These findings suggest problems [among ADHD children] with initiating and/or maintaining sleep affect both nighttime and daytime sleep," the researchers wrote.

Basically, kids with ADHD took longer to fall asleep, regardless of whether they were well rested or if they slept restlessly the previous night.

"It is possible that children experiencing restless sleep are overtired, thereby further contributing to increased difficulties sleeping," the researchers proposed. "In children, symptoms of sleepiness include increased activity likely compensating for increased fatigue. Thus, increased activity may be difficult to shut off when given a sleep opportunity."

The researchers said their study means that children with ADHD may require quiet activities to help calm them down before bedtime. Children who continue to struggle with getting to sleep may need other interventions, they wrote.

As William Kohler, MD, a dailyRx expert, also pointed out, however, sometimes ADHD symptoms can arise due to sleeping problems in the first place.

"ADHD is a syndrome, a constellation of symptoms that has potential many different causes, and one of the causes of ADHD symptoms is disrupted sleep," said Dr. Kohler, the Medical Director of the Florida Sleep Institute in Spring Hill, Florida and Director of Pediatric Sleep Services at Florida Hospital Tampa.

Whether the ADHD is caused by sleep problems, by defects in the brain or some other cause, however, it's important that parents seek help for children who have difficulty with sleep.

"The bottom line should be that you should pay attention to sleep problems and seek appropriate remediation by checking with your pediatrician, or if the pediatrician can't help, check with a pediatric sleep specialist concerning methods to improve sleep," Dr. Kohler said.

"We need to emphasize paying attention to sleep problems because of the significant co-morbid problems that occur and also for the prevention of the cognitive and behavioral deficits that occur if sleep is properly achieved," he added.

The study was published in the February issue of the Journal of Sleep Research. The research was funded by the Canadian Institutes of Health Research and the Fonds de la recherche en santé. The authors declared no conflicts of interest.