Diagnosed with ADHD? Check Sleep Patterns
By SUE PASCOE
Palisadian Dr. George Labrot, a board-certified sleep specialist, listened as a man in the audience told him:
“My granddaughter was diagnosed with ADHD [Attention-Deficit/Hyperactivity Disorder] when she was young. As a teen she was diagnosed as bi-polar, and now they’ve discovered it was sleep apnea. She’s off everything and she’s fine.”
At the conclusion of this story, I noticed that Labrot was smiling and I later asked him why. “I’m surprised they found the right diagnosis,” he said. “Too often they don’t.”
Speaking at the July 17 Palisades Optimist Club meeting, Labrot said, “If your child has been diagnosed with ADHD, you might also consider having them tested for sleep apnea. One should rule out excessive daytime sleepiness as the cause of the behavior before making the alternative diagnosis of ADHD.”
He continued, “I would recommend that the primary caregiver of any child exhibiting ADHD-like behavior should complete a two-week sleep log that can be compared to the appropriate hours of sleep for the child based on his or her age.
The symptoms of sleep deprivation and ADHD are similar. “The most common symptom of sleep deprivation relates to problems with concentration and paying attention,” according to the American Sleep Apnea Association.
Other symptoms, according to the American Academy of Sleep Medicine, include “anxiety, lack of concentration, attention deficits, longer reaction times, distractibility lack of energy, restlessness and lack of coordination.”
According to the National Institute of Mental Health, ADHD symptoms include: 1. overlooking or missing details; 2. problems sustaining attention in tasks or play; 3. seeming not to listen when spoken to directly; 4. failure to not follow through on instructions, failure to finish schoolwork, chores or duties; 5. having problems organizing tasks and activities; and 6. becoming easily distracted by unrelated thoughts or stimuli.
Labrot said there are at least two reasons for children not getting adequate rest: sleep apnea and parents not enforcing bedtime hours.
“The most common cause of sleepiness in kids is probably inadequate amounts of sleep,” the doctor said. “This is most often the result of the failure of parents to set limits around the issue of going to bed or staying in bed during the night.”
Labrot said that parents who have difficulty finding a gentle method of limit setting might considering consulting with a pediatric sleep specialist. “Many sympathetic general pediatricians are also capable of helping out in this area of parenting.”
What if parents are sure the child is getting enough sleep, but still seems to lack focus at school?
Labrot points out that restorative sleep is the key. If kids have sleep apnea, which prevents restful sleep, the child may display sleep deprivation symptoms.
“An overnight study performed in a sleep lab would document that the sleep is restorative, without anything, including obstructive sleep apnea (OSA), which would make the sleep non-restorative,” Labrot said. “Other rarer conditions which might contribute to non-restorative sleep in children include movement disorders and pediatric nocturnal seizure disorders.”
Labrot said he would not be surprised if half or more of ADHD kids were actually sleepy, and if half of that group had OSA.
According to the American Sleep Apnea Association, “Studies have suggested that as many as 25 percent of children diagnosed with ADHD may actually have symptoms of obstructive sleep apnea and that much of their learning difficulty and behavior problems can be the consequence of chronic fragmented sleep.”
Labrot said children with ADHD are given stimulants, such as Ritalin, which is a Schedule II drug (the same classification as cocaine, morphine and amphetamines). Other drugs given kids with ADHD are Concerta and Adderall (a mixture of amphetamine and dextroamphetamine.
In testimony before the U.S. Senate Judiciary Committee on Crime and Drugs, the director of the National Institute on Drug Abuse said: “The number of prescriptions [for Ritalin] rose from 5 million in 1991 to 35 million in 2007. Doctors, it seems, are using this medication more each year.”
Parents who have high school-aged kids have heard about some kids taking Ritalin, even if it wasn’t prescribed for them, because it’s considered a “smart drug” that helps school performance—by helping with alertness and giving an “up” feeling.
Called the “poor man’s cocaine,” Ritalin is easy to get, but also addictive, and parents should be aware of the consequences of the drug.
“About 90% of children with OSA can be cured by a tonsillectomy,” Labrot said. “Generally, you remove the tonsils and the apnea goes away.”
Once a child gets restorative sleep, negative behaviors usually disappear.
“Extensive data shows the negative effects of OSA in children on behavior, school performance, and bed-wetting.” according to the American Academy of Otolaryngology-Head and Neck Surgery. “Improvement for such behaviors following tonsillectomy is very well documented.”
The number of tonsillectomies, once routinely done in the United States, have declined significantly since the 1970s.
Yet even as they have declined, the number of cases of ADHD has gone up, since statistics were first kept in 1997.
And what about the latest report that teens who frequently text and use social media could be at greater risk of developing attention-deficit hyperactivity disorder (ADHD)? Check to make sure your youth is getting enough sleep.