Restless Children

Many kids find sleep elusive, due in part to an ADHD misdiagnosis

By Nancy Maes

Youngsters of all ages need a good night’s sleep, but for some, that good night is elusive. In fact, it is estimated that more than two million children today have some type of sleep disorder.

It takes some detective work to identify the causes and find the right treatment for sleep disorders. Some children might lack a regular pattern of bedtime rituals and routines to help them fall asleep, or something in their environment, such as too much noise, might keep them awake. Others may wake up frequently because they are restless or have trouble breathing during the night.

And some are taking medications that stimulate the mind and stave off sleep. This is most commonly found in the meds taken by kids with Attention Deficit Hyperactivity Disorder (ADHD). Sleeplessness is a known side effect of drugs like Adderall and Ritalin, which are used to curb the symptoms of ADHD.

“Children may have trouble falling asleep if there is too much of the medication in their system,” says Sara Star, MD, at Highland Park Pediatric Associates, a division of the PediaTrust organization of pediatric practices. “But on the flip side, the medication may help to settle them down a bit so they can sleep better. It’s a delicate balance.”

Individuals metabolize medications differently, Star says, so it’s important to find the right dose for each child that works well enough to treat his or her ADHD symptoms without making it difficult to fall asleep.

Darius Loghmanee, MD, a sleep specialist at the Sleep Medicine Center at the Ann and Robert H. Lurie Children’s Hospital, points out that some children with ADHD symptoms might instead have a sleep disorder. Pediatricians are increasingly aware that behavioral problems associated with ADHD are also the signs of sleepiness. So some pediatricians are sending their patients for a sleep evaluation before diagnosing them with ADHD or starting them on stimulant medication.

“We look for sleep disorders because, when children are sleepy during the day, they try to fight it by moving from one thing to the next to try to distract themselves,” Loghmanee says. “[This makes it] hard for them to pay attention, and they get up and run around to stimulate themselves to fight the sleepiness. We’ve seen a number of kids with ADHD symptoms whose issues have gotten better once we’ve identified and treated their sleep disorder. Some children diagnosed with ADHD have been able to stop taking their medication once we’ve found and treated their sleep issues.”

Teenagers have their own reasons preventing them from falling asleep.

“The biggest problem for teenagers is overstimulation,” Star says. “So I tell them they have to find a reasonable time to turn off all of their screens, including the TV, computer and even [the] vibrate [mode] on their cell phones, at least 30 minutes before bedtime and to listen to quiet music or use relaxation techniques to unwind.”

Loghmanee has an additional suggestion. “A lot of adolescents have difficulty falling asleep because they can’t quiet their minds, but we live in a society where our identity is based on ‘I think, therefore I am,’ so why would they want to stop thinking? Their minds are racing because they have important thoughts. So I suggest journaling before going to bed as a way to address the issues in their lives and express themselves and empty their minds of those thoughts before bedtime.”

Some doctors suggest a dietary supplement of melatonin, the hormone the brain naturally produces in increased amounts in the evening to help us fall asleep. While there have been no reports of children experiencing significant side effects from taking melatonin supplements for a short period of time, according to the National Institutes of Health, no studies have been conducted on long-term use, so check with your pediatrician first.

“Whether it’s helpful because of the medication effect or the placebo effect, it’s helpful for some people, and it’s safe to use after getting the correct dose from a doctor,” Star says.

“I haven’t heard of any serious side effects. For a lot of people, it’s very effective, and for others it’s not,” Loghmanee says. But he considers melatonin supplements a short-term solution.

“There is no sleep button. We can’t just command a child to sleep and expect [compliance], so parents are frustrated because sleep is out of their control. But we’re starting to understand the patterns of children’s sleep well enough that we can evaluate the underlying difficulty effectively enough that there is no need for any pharmaceutical supplement.”

Identifying and treating the cause of sleep disorders, in the end, is the best medicine.