The Nightly Challenge: Sleep Disorders in ADHD Children

My ADHD son is a night owl. He will be awake long after I am sound asleep, watching a video on YouTube, gaming on his computer, or talking with friends. Sleep disturbances are common in individuals with ADHD and may occur in up to half of the ADHD population, making a restful night’s slumber difficult. Prior to puberty, 10 to 15 percent of children with ADHD have trouble getting to sleep. This is twice the rate found in children and adolescents who do not have ADHD. Approximately half of children with ADHD have difficulty falling asleep almost every night by the time they reach adolescence. Sleep disturbances in ADHD don’t only lead to difficulty falling asleep, but also difficulty staying asleep and waking up.

Why have sleep disturbances been overlooked?

According to ADHD expert, William Dodson, MD, sleep disturbances in ADHD have been overlooked since they, on average, occur later (around 12 years old) than the diagnosis cutoff age of 7 years old specified in the Diagnostic and Statistical Manual of Mental Disorders (DSM, American Psychiatric Association, 2013).

The association between ADHD and sleep disturbances is not fully understood. Other disorders associated with sleep disturbances, like bipolar disorder, autism, post-traumatic stress disorder, and obsessive-compulsive disorder often co-occur with ADHD. In addition, the use of stimulant medications to treat ADHD symptoms has also been attributed to sleep disturbances (rather than ADHD itself). However, in some cases stimulant medication has been found to improve sleep, having a paradoxical effect of decreasing restlessness through the alleviation of ADHD symptoms.

Why is it important to address sleep concerns in ADHD?

The obvious answer is to decrease drowsiness and tiredness during the day to increase focus and productivity. In addition, sleep disorders like obstructive sleep apnea, restless leg syndrome, and circadian rhythm disruptions occur at a higher rate in individuals with ADHD than in the general population, posing adverse health effects, like high blood pressure.

How can we help our ADHD kids with sleep disturbances?

We spend a significant amount of time helping our ADHD kids manage their symptoms during the day, but ADHD does not go away at night. Many individuals with ADHD will report that they have difficulty “shutting off their brains” at night when it’s time to hit the hay. My son mentions that he must be naturally tired and will often fall asleep watching YouTube videos on his phone. He often finds it difficult to fall asleep at a reasonable time, even if he needs to be up early the next day.

• Establish healthy sleep practices

Sleep hygiene includes behavioral and environmental factors that can promote a good night’s sleep. Good sleep hygiene includes things like establishing a bedtime routine, having a calming, pleasant sleep environment, and avoiding naps during the day. Other considerations are the use of electronic devices and caffeine consumption close to bedtime. The set of sleep hygiene conditions is highly individualized. For example, my son likes to use a white noise machine to help him fall asleep, which may be annoying to some. Other individuals may need to put in earplugs and wear a sleep mask to block out all noise and light. Setting an alert on your smartphone or watch 30 minutes before bedtime, indicating it’s time to wind down, may also help.

• Melatonin

Pharmacological treatments, like melatonin supplements, may be useful for sleep disturbances associated with ADHD. The hormone melatonin is produced in the brain in response to darkness, signaling to our bodies that it’s time to go to sleep. In children (and adults) with ADHD the onset in the production of melatonin is delayed, occurring around 10:15 PM. In addition, it can take up to two hours after melatonin production for sleep to occur, which can contribute to your ADHD child being a night owl. Melatonin supplements help to induce and maintain sleep, including in children with ADHD. Although melatonin supplements are safe, before starting a pharmacological treatment be sure to consult your child’s doctor.

• Consider your daily schedule

School and work schedules are, in general, not flexible. However, sometimes it may be possible to set up a schedule that works with being a night owl. For example, my son prefers his college classes to be scheduled between 11:00 AM and 5:00 PM, since he likes to stay up late, and his focus is better in the afternoon and evening. Although it’s not always possible for him to schedule his classes during his preferred times, when he can he does. And if my son needs to make it to an 8:00 AM class he uses a two-alarm method: he sets a first alarm with a soothing sound, and a second alarm with a loud, obnoxious sound which he labeled “Rise and shine, you dimwit!” I have also been known to call my son at 4:00 AM to make sure he is awake and will make it to the airport on time for his early flight home from college.