“A good laugh and a long sleep are the best cures in the doctor’s book.” So goes the old Irish proverb, and it has more than a grain of truth to it. Sleep is perhaps one the most important and overlooked foundations of good health. Sleep related issues are of particular importance in ADHD.
There are three important sleep related issues that need to be considered in every ADHD case. Firstly, sleep problems can often cause symptoms that mimic ADHD, and it is essential to rule them out before establishing a diagnosis of ADHD. Secondly, for those who do suffer from ADHD, sleep difficulties are a common symptom of ADHD. Finally, sleep problems are often a side effect of the medications commonly used in treating ADHD. Lets take a closer look at these three issues.
During assessment for possible ADHD it is important to consider other psychological and medical conditions that can mimic ADHD. One of the main culprits are sleep disorders. A common condition, known as obstructive sleep apnea (OSA) is of particular importance. The condition occurs in both children and adults. In this condition, enlarged tonsils or adenoids can block the upper airways when lying down, causing apnea (stretches of sleep without breathing). Patients who suffer from OSA often are often loud snorers, and open mouth breathers. OSA disturbs sleep and causes frequent waking. Patients often feel unrested in the morning and suffer from daytime drowsiness, inattention and difficulty concentrating. Other behavioral problems such as irritability and hyperactivity are common as well. So carefully ruling out a sleep related cause of the symptoms is critical. It would be unfortunate to miss such a problem, misdiagnose ADHD and unnecessarily prescribe stimulant medications.
Many people who suffer from ADHD have associated sleep problems. These issues are part and parcel of general difficulties with sensory processing and self-regulatory mechanisms in the body. Common problems include daytime drowsiness, sleep onset delay (difficulty getting to sleep) and restless leg syndrome. It is important to screen all patients with ADHD for sleep issues and make appropriate treatment recommendations.
One of the most common side effects of medications used to treat ADHD is sleep disturbance. In particular, the stimulant medications can cause sleep onset delay and insomnia. This can be particularly problematic, because as noted, lack of sleep exacerbates the very symptoms the medication is being prescribed for in the first place! Some effective solutions include: vigorous exercise 3-4 hours prior to bed time, maintaining a regular bedtime routine, eating a hot, hearty meal for dinner, avoidance of exposure to artificial light prior to bedtime (such as TV or computer screens), reading in bed with a night-light, and ensuring the bedroom is cool, dark and quiet. All of these techniques can increase our natural melatonin levels that help to induce sleep. Often the doctor might recommend taking the medication earlier in the morning and sometimes will consider prescribing melatonin tablets to induce sleep. If needed, the doctor might consider lowering the dose or switching to a shorter acting form medication that will wear off by bedtime. Strattera is a non-stimulant medication used to treat ADHD that does not cause insomnia and is a good option when sleep disturbance is a significant issue.
It is important for both doctors and patients to be aware of sleep related issues in ADHD. Screening for primary sleep disorders that cause ADHD like symptoms, identifying sleep issues that are secondary to ADHD and managing sleep related side effects of the medications are all essential elements in every case.