In 2016, the U.S. Centers for Disease Control and Prevention estimated by a parent report that 6.1 million children had been diagnosed with attention -deficient/hyperactive disorder. Slightly more than 1 in 10 children have been diagnosed as such.

This is a disorder that begins in childhood and encompasses well-known symptoms of not focusing, hyperactivity and impulsivity. These symptoms interfere with functioning at school, at work and in social situations.

One of the common problems associated with ADHD are sleep problems. These problems range from insomnia to secondary sleep disorders.

Recently, Dr. Alex Dimitriu and Danielle Pacheco from the Sleep Foundation wrote an article discussing the relationship with sleep problems and ADHD. People with ADHD are more likely to experience shorter sleep time, problems falling and staying asleep and a higher risk of developing a sleep disorder.

Sleep problems in ADHD appear to differ depending on the type of ADHD. Individuals with predominately inattentive symptoms are more likely to have a later bedtime, while those predominately hyperactive-impulsive symptoms are more likely to have insomnia.

Many of the symptoms of ADHD are similar to the symptoms of sleep deprivation. Sleep deprivation problems include forgetfulness and difficulty concentrating. Children who are fatigued may present as being hyperactive and impulsive. This can lead to misdiagnosis or may allow sleep disorders to go undetected.

It’s unclear what the biology of the ADHD-sleep connection is. ADHD sleep problems may be a side effect of impaired arousal, alertness and regulation circuits in the brain. Other researchers believe ADHD sleep problems can be traced to a delayed circadian rhythm with a later onset of melatonin production, but there hasn’t been a consistent pattern found.

Some individuals find it easier to sleep with the calming effects of stimulant medicine commonly prescribed for ADHD, but others find that stimulant medicines cause a number of sleep problems.

Circadian rhythm sleep disorder is common with individuals with ADHD, particularly adolescents, who are more alert in the evening. Sleep disordered breathing (snoring and sleep apnea) affects up to 1/3 of individuals with ADHD.

Treatment may reduce the need for stimulant medications. Restless legs syndrome may occur in almost 50 percent of people with ADHD. Researchers believe restless legs syndrome is caused by iron and dopamine deficiencies, which also are implicated in ADHD.

Treating underlying sleep disorders and improving sleep is an important part of treating ADHD. It may be advisable to have a sleep study to rule out underlying sleep disorders. Daytime sleepiness can have serious effects on school and work.

Some tips for improving sleep and possibly ADHD are as follows: Cut out sugar and caffeine hours before bedtime; avoid screen time for at least an hour before bed; avoid stimulating projects that require hyper focusing before bed; make bedtime a stress-free zone reserved for sleep; develop a bedtime routine such as reading; keep bedroom dark, cool and quiet; and most important, get enough exercise and daylight during the day.

Sleep medications may or may not be appropriate and should be discussed with your doctor.

Sally Robinson is a clinical professor of pediatrics at UTMB Children’s Hospital. This column isn’t intended to replace the advice of your child’s physician.

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