July 2012 : Sleep Matters-Could Your Child's Sleepless Nights Be Causing ADHD, Depression, and Problems with Thinking?
The Big Picture VII
“My son just can't get to sleep at night. He is 10 years old. I think Jake worries about everything. It is as if the ‘tape recorder' in his brain keeps on going. On top of that, he has problems focusing at school. Jake seems so tired.”
“Jackie was just diagnosed with ADHD. It took 15 minutes for the doctor to diagnose her. I don't feel quite right about the whole thing. Jackie is 17 years old. She abused Xanax in the past and I think she is drinking at parties. Jackie and I are in a downward spiral. I do not know what to do.”
“Tatum sleeps with her mouth open. She just got her braces off but she has always slept with her mouth open. I hear her snoring at times. Do you think this is a problem? Should I be concerned?”
“My son is sleeping now and no longer has trouble staying asleep. He was just diagnosed with moderate sleep apnea and wears a CPAP unit. Max is completely different now. He wakes up with energy and is really ‘on' during the day. I wish we would have known about this sooner. That is why he was having problems focusing in school. He was sleep deprived.”
“My son just got concussed again when playing football during practice. He had two ‘dings' before that this last year. Eric has been sleeping a lot these last seven days. It seems as if it is taking him longer to get going in the morning. He is also very tired and I have to repeat myself a lot. Should I be worried?”
Sleep, attention, learning, and emotion. Have you ever wondered if there was a connection here? We all intuitively know that sleep matters. Research indicates 7 to 8 hours of sleep per night for an adult may be the optimal amount for health benefits. However, many of us obtain 7 or fewer hours of daily sleep. Loss of sleep may be caused by stress, lifestyle, and shift-work. Research also indicates that sleep disorders are a common cause of sleep loss. It is estimated that as many as 10% of the population has a chronic sleep disorder.
Children also suffer from loss of sleep. Parents, teachers, and some healthcare professionals may overlook this problem. For example, a mother of a 14-year-old girl recently told me that her daughter had trouble falling asleep and typically went to bed around 1:00 A.M. and then got up at 6:00 A.M. This pattern continued for approximately 4 years. Research suggests that the adolescent requires approximately 9 hours of sleep a night and the 8 or 9-year-old about 10 hours of sleep a night. Sarah had chronic sleep loss. She was also very depressed. Her mother was depressed too!
Sleep loss may be caused by a general medical, psychological, or neurological condition. Sleep deprivation can also negatively affect a child's health, mood, attention, memory, learning, and even safety. As a neuropsychologist, I have assessed many teens that were involved in car accidents because of sleepiness being the primary cause.
Surveying the “big picture” is critical. Your child may exhibit restlessness and inattention during the school day. Even though your child may have a real problem with attention, he/she may exhibit other contributing disorders that are masquerading as A-D/HD (Attention-Deficit/Hyperactivity Disorder). For example, your child may have a learning challenge such as a Reading Disorder and problems with spelling. Loss of sleep also affects mood. Insomnia often coexists for those who are depressed and anxious. Fatigue, tiredness, and abnormal sleep, with an increased number of awakenings can occur for those students who have had a concussion.
Sleep disorders are also common in children. I will never forget the case where a child was incorrectly diagnosed with A-D/HD. Daniel was not improving after a significant amount of money was spent on behavioral interventions and medication. Daniel's mother knew something was “a little off.” Fortunately, she listened to her “gut” and requested an assessment from a sleep specialist at an accredited sleep disorders center. Testing revealed Daniel (14 years old) had obstructive sleep apnea (OSA). The prevalence of OSA in children is estimated at 2 to 3 percent. Daniel presented with the following behaviors:
Daniel's treatment plan was modified, with his medication discontinued. Opening Daniel's airways with continuous airway pressure (CPAP) was key to eliminating his difficulties with attention and concentration.
Other children may exhibit behaviors consistent for a movement-related sleep disorder such as Restless Legs Syndrome (RLS). This disorder is characterized by an urge to move the legs during sleep. This can result in awakenings at night and disrupted sleep. The National Institutes of Health estimate that one million school-aged children in the United States have RLS, with one-third exhibiting moderate to severe symptoms. Children with RLS exhibit behaviors such as restlessness, inattention, and problems in school. Daniel experienced these behaviors.
This information has important implications for all healthcare professionals and caregivers. I think many people undervalue the significance of sleep. A sleep problem, if not diagnosed, can lead to improper treatment planning, with the family paying a high price because the problems caused by the sleep problems will continue. In addition, poor sleep will negatively impact the child's quality of life not only at home but also at school and socially. Research indicates that as many as 1 in 4 children present with undiagnosed sleep problems.
What can you do if you suspect your child has problems with sleep? First, discuss your concerns with your child's pediatrician. Behavioral interventions for young children have been shown to produce significant improvements. In addition, your child's lifestyle such as television viewing and cell phone/texting/video game use will be investigated. These activities can lead to delayed bedtimes and decreased sleep. You may be encouraged to record your child's sleep-wake habits for several weeks. An example of a diary can be located at the sleep education website endorsed by the American Academy of Sleep Medicine (AASM) and is available for free download via the Internet. On the other hand, your child may be referred to a certified sleep specialist at an accredited sleep disorders center for overnight polysomnography (PSG) for the assessment of sleep-related breathing disorders such as OSA. The bottom line is this: Be mindful of your child's sleep hygiene and take action if you suspect something is “not quite right.”
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Copyright Karen L. Schiltz 2001