SLEEP - WE ALL NEED IT!
You know those painful mornings when you roll out of bed after a restless night’s sleep? Maybe you were stressed out from work, up all night with a sick child, or worrying about the endless possibilities of life. If you’ve ever gone without your daily dose of REM sleep, chances are likely that you felt irritable, drowsy, or a bit disorganized the next day. Did you know that these symptoms of sleep deprivation can mimic those of ADHD? Mood changes, daytime sleepiness, difficulty concentrating, poor planning, and disorganization are all symptoms of sleep deprivation...and ADHD!
When you add sleep issues to ADHD, the effects on kids are compounded. The JAMA Network reports that “up to 50% of parents of children with ADHD report difficulties with their children’s sleep.”¹ The National Resource Center on ADHD reports these sleep disturbances to be two to three times more likely in kids with ADHD than kids without². Common sleep complaints are: insomnia, excessive daytime sleepiness, and variability in sleep schedule.¹
Our bodies go through a period of rebooting when we sleep each night. We pass through Rapid Eye Movement (REM) and Non-REM cycles every 90-110 minutes. Our Sleep-Wake patterns (Circadian Rhythms) are essential to falling asleep and waking in a regular timeframe. It is during this normal sleep cycle that our bodies and brains process the events of the day and refresh for a new day! If your child is experiencing sleep disruptions, the effects can disrupt his day and well-being.
ADHD, SLEEP, AND MELATONIN
There are a number of ways to characterize a sleep problem: difficulty falling asleep, difficulty staying asleep, restless leg syndrome, insomnia, parasomnia, behavioral resistance to bedtime, difficulties waking…whatever your child’s sleep disturbances or difficulties, it is important to consult your pediatrician when tackling a sleep “treatment plan.”
When you look at the comorbidity of ADHD and sleep problems, there are behavioral and pharmacological considerations that should be included in a treatment plan. Behavioral strategies can include: establishing a consistent bedtime routine, limiting sugars and caffeine, limiting screen time prior to bedtime, creating a calming bedroom environment, and getting plenty of exercise (sensory input!) throughout the day.
Some doctors and parents are combining behavioral approaches to sleep issues with over-the-counter Melatonin. Melatonin is a hormone that is naturally produced by the pineal gland during the sleep cycle and it has been used to treat sleep disturbances in kids with ADHD. A study in the 2007 Journal of American Academy of Child & Adolescent Psychiatry researched the effects of Melatonin in the treatment of insomnia in children with ADHD and found that circadian rhythms, natural melatonin production, and total sleep time were all improved³. The 2009 Journal of Pineal Research reports that long-term melatonin treatment was effective in 88% of cases and no safety concerns were found for continuing melatonin treatment⁴.
As with all over-the-counter medications, you want to ensure the correct dosage for your child. Because some children with ADHD are also on stimulant medications, finding the right dose of Melatonin can be a tricky task so it’s best to work with your pediatrician to consider all of the variables that are specific to your child.
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REFERENCES
¹ “Sleep Problems in Children With Attention-Deficit/Hyperactivity Disorder | Attention Deficit/Hyperactivity Disorders | JAMA Pediatrics | The JAMA Network.”Jamanetwork.com, 2017, http://jamanetwork.com/journals/jamapediatrics/fullarticle/379359.
² “ADHD, Sleep and Sleep Disorders | CHADD .”Chadd.org, 2017, http://www.chadd.org/Understanding-ADHD/About-ADHD/Coexisting-Conditions/ADHD-Sleep-and-Sleep-Disorders.aspx.
³ “The Functional Impact of Sleep Disorders in Children With ADHD - Jan 16, 2017 .”Journals.sagepub.com, 2017, http://journals.sagepub.com/doi/abs/10.1177/1087054716685840.
⁴“Long-Term Follow-up of Melatonin Treatment in Children with ADHD and Chronic Sleep Onset Insomnia - Hoebert - 2009 - Journal of Pineal Research - Wiley Online Library.”Onlinelibrary.wiley.com, 2017, http://onlinelibrary.wiley.com/doi/10.1111/j.1600-079X.2009.00681.x/full.