Sleep, Interrupted

The links between ADHD, anxiety, and insomnia in children.

Sleep, Interrupted

Anyone who has ever lost a lot of sleep knows that concentration falls, memory slips and a bit of crankiness is justified. Isn't that why we don't want our kids staying up until all hours at a sleepover?

Researchers in Sydney, Australia are taking a different research road to understand ADHD and sleep problems. Dr. Arthur Teng and his colleague, Grant Betts, are studying 50 children in the sleep medicine unit at Sydney Children's Hospital. Their theory is that these children are overly restless, cranky and uncontrollable simply because an underlying sleep problem is depriving them of a healthy sleep.

The researchers are testing children diagnosed with mild ADHD before and after they receive treatment for sleep disorders to see whether behavioral symptoms improve. The common sleep problems among these children: snoring and apnea, which is disrupted breathing. They believe enlarged tonsils and adenoids may cause sleep apnea, the periodic missed breaths during the night.

The Australian researchers have already completed the first part of testing on a few dozen children, and that includes memory and attention tests prior to treatment for their sleep disorders. They also obtain extensive parent and teacher ratings on behavioral and attention issues. Four months after the treatment, the children will be retested to see whether their ADHD problems have lessened.

This is just one theory - and needs proper testing before anyone makes the great leap to sleep treatment to rule out ADHD. In fact, John Harsh at the University of Southern Massachusetts is also testing whether children with ADHD are sleepier in the daytime than children without ADHD. During a recent meeting of the Associated Professional Sleep Societies, held in Chicago, Dr. William Orr, an Oklahoma City sleep specialist, said that he also believes that treating sleep disorders improves daytime behavior in children.

"ADHD seems to be a 24-hour condition, disrupting daytime and sleep," says Lynne Lamberg, co-author of The Body Clock Guide to Better Health. Most people, she adds, "think about behavioral treatments but not the basic physiology and how that contributes to the symptoms." During the recent sleep meeting, she listened to French researchers describe how giving Ritalin and similar medicines in the evening paradoxically decreases activity during sleep.

Dr. Ronald Chervin is acting director of the University of Michigan's Sleep Disorders Center and a leading expert in ADHD and sleep. Chervin says that scientists are testing the idea that an ADHD child's biological clock, the body's internal ticker that tells us when to fall asleep, may be slightly off. A recent study by Reut Gruber of the federal National Institute of Mental Health in Bethesda reported that children with ADHD have a more varied sleep schedule than children without the behavioral disorder. Gruber found that children without ADHD fell asleep at roughly the same time during a five-day study period, within 40 minutes of lights out. But the ADHD children had a very erratic 'falling to sleep' schedule, two to three times longer than the non-ADHD children. The study was published in the April issue of the American Academy of Child and Adolescent Psychiatry.

The bottom line in all of these studies is this: Parents should tell their child's doctor about sleep patterns, and ask if there is anything they can do to better help their child fall asleep at night.

Children need anywhere from 9 to 11 hours of sleep nightly, and it doesn't take a scientist to tell you that the nation's sleep debt is great. Last February, the federal government embarked on an educational campaign to promote healthy sleeping habits in children. (See the American Academy of Child and Adolescent Psychiatry's signs of sleep deprivation, above right.)

No one knows why humans require sleep for at least a third of their day. There is strong evidence that sleep is restorative, the body needs quiet time each day to process the activities of the day. Scientists have discovered that dreams, which take place during a period of sleep called Rapid Eye Movement or REM, are important for learning and memory.

Rosemary Tannock advises parents that the best way to avoid sleep problems is to secure a set bedtime and make it pleasurable. "The child should know that at a specific time every night they can expect to be alone," she says. "Give a 10-minute warning and then share a pleasant activity with your child. And make sure they have water before they can ask for it. Make it a relaxing routine."

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