Is ADHD Actually a Sleep Condition?

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Currently, scientists say about 75 percent of people with attention deficit hyperactivity disorder (ADHD) also have sleep troubles, but until now these occurrences have been thought to be separate issues.

Brand new research has revealed some surprising connections between individuals who suffer from ADHD and the quality of their sleep.

Currently, scientists say about 75 percent of people with attention deficit hyperactivity disorder (ADHD) also have sleep troubles, but until now these occurrences have been thought to be separate issues.

However, scientists of a new study are proposing a different theory. Their idea: ADHD may be a problem associated with lack of sound, regular sleep. Their reasons why: In 75 percent of ADHD patients, the physiological sleep phase – where people show the physiological signs associated with sleep, such as changes in the level of the sleep hormone melatonin, and changes in sleep-related movement -- is delayed by 1.5 hours. Core body temperature changes that occur during sleep are also delayed (reflecting melatonin changes) in people who have ADHD. Many common sleep-related disorders are associated with ADHD, including restless-leg syndrome, sleep apnea, and the circadian rhythm disturbance, the delayed sleep phase syndrome. ADHD people often show greater alertness in the evening, which is the opposite of what is found in the general population

When asked what to make of these findings, study presenter and professor Sandra Kooij, professor of Psychiatry at VU University Medical Centre, Amsterdam said: “We are working to confirm this physical-mental relationship by finding biomarkers, such as Vitamin D levels, blood glucose, cortisol levels, 24 hour blood pressure, heart rate variability, and so on. If the connection is confirmed, it raises the intriguing question: does ADHD cause sleeplessness, or does sleeplessness cause ADHD?”

That said, many experts warn against making any assumptions, especially when it comes to kids.

“Yes, a large portion of ADHD patients do suffer from sleep issues, explains Jill Fodstad, Ph.D., HSPP, BCBA-D, clinical psychologist at Riley Hospital for Children. “However, it’s important to remember that only a small portion of our population truly suffer from ADHD. Many people can experience ADHD-like symptoms when they receive poor sleep since sleep is so essential for us to perform and behavior optimally—and in those cases, that can be a temporary issue that dissipates with time.”

Some experts also believe other conditions should be explored.

“While I don’t think ADHD is caused by sleep problems, in my clinical experience it can be common for children with ADHD to experience sleep problems,” explains Sarah Honaker, pediatric sleep specialist at Riley Hospital for Children at IU Health.

And, she says, there are some cases in which a child can present with what looks like ADHD when they are in fact suffering from a chronic sleep disorder. “And then when the child is treated for the sleep disorder they no longer show symptoms of ADHD,” she says. “It’s not the norm, but it can occur.”

One of these sleep disorders? Obstructive sleep apnea.

“This sleep disorder often manifests as hyperactivity the next day and that behavior can look like ADHD to some,” explains Dr. Honaker. “Kids who have this condition snore regularly, three or more days per week and they will stop breathing during sleep. This results in their brains not receiving enough oxygen at night, which can manifest as hyperactivity the next day.” And this hyperactivity, she says, can lead some people to think a child has ADHD.

The bottom line: According to American Academy of Pediatric guidelines, Dr. Honaker says, children who snore regularly and have ADHD should be evaluated for sleep apnea, even if they are not showing any other symptoms.

“In general, kids are often more irritable and impulsive when they have not slept enough—and the same is true to children who have ADHD,” she says.

Her advice: If you have concerns, seek the advice of your pediatrician. Have a detailed conversation about your concerns with child’s behaviors—and the quality of their sleep.

-- By Sarah Burns

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