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American Sleep and Epilepsy Centers
ADHD and Sleep

Attention deficit/hyperactivity disorder (ADHD) is a term used to describe hyperactivity, inattentiveness,
and/or impulsivity. It is a common condition that begins in childhood and may persist into adulthood.
Children with ADHD typically have trouble sitting still, staying focused, and/or controlling their behavior
and emotions, which can lead to lower social skills, isolation, dependence, and poor performance in
school. For this reason, children with ADHD often require special attention from parents, teachers,
school systems and healthcare and mental health professionals in order to succeed.
ADHD is linked with a variety of sleep problems. For example, one recent study found that children with
ADHD had higher rates of daytime sleepiness than children without ADHD. Another study found that
50% of children with ADHD had signs of sleep disordered breathing, compared to only 22% of children
without ADHD. Research also suggests that restless legs syndrome and periodic leg movement
syndrome are also common in children with ADHD.

In general, sleep deprivation is a problem among children in America. According to NSF's 2004 Sleep in
America poll, more than two-thirds of children experience one or more sleep problems at least a few
nights a week. For children with ADHD, poor sleep (too little sleep or symptoms of sleep disorders) may
profoundly impact ADHD symptoms. In fact, one study found that treating sleep problems may be
enough to eliminate attention and hyperactivity issues for some children.
Children and adults behave differently as a result of sleepiness. Adults usually become sluggish when
tired while children tend to overcompensate and speed up. For this reason, sleep deprivation is
sometimes confused with ADHD in children. Children may also be moody, emotionally explosive, and/or
aggressive as a result of sleepiness. In a study involving 2,463 children aged 6-15, children with sleep
problems were more likely to be inattentive, hyperactive, impulsive, and display oppositional behaviors.
Sleep problems are also common in adults with ADHD. In one study, researchers compared adults with
narcolepsy, idiopathic hypersomnia, and AHDH and found a high percentage of symptom overlap,
suggesting the possibility of ADHD misdiagnosis among adults.

According to a report by the Centers for Disease Control and Prevention, the prevalence of ADHD is 4-
5%. The report also found that ADHD occurs much more often in boys than girls, but the prevalence
among adult men and women is about equal. The cause of ADHD is not known but experts suspect
that it may be related to anatomic abnormalities in the brain, maternal smoking, exposure to toxins,
and/or genetic factors.

ADHD is linked with emotional problems, higher rates of drug and alcohol abuse, and poor
performance at school and work. Similarly, sleep problems are associated with mood disorders and
intellectual impairment. Treating sleep problems in children and adults with ADHD may improve
symptoms and quality of life. For information about treating ADHD and sleep problems associated with
it, see "treatment" and "coping."

The primary symptoms of ADHD are:
•        Hyperactivity
•        Inattention
•        Impulsivity
•        Distractibility
•        Difficulty waiting or taking turns

Most children display these behaviors at least sometimes. But for a diagnosis of ADHD, the symptoms
must be present for at least six months and must occur in at least two settings (e.g., home and school).
By comparison, sleep deprivation in children may result in:
•        Hyperactivity
•        Inattention
•        Impulsivity
•        Oppositional behavior
•        Moodiness and irritability
•        Difficulty waking up in the morning

There is a clear relationship between symptoms of ADHD and consequences of sleep deprivation. If
your child has any of the symptoms listed above, carefully record when and under what circumstances
they occur and bring this information to your child's pediatrician. Also, use a sleep diary to keep a
record of your child's sleep. His or her pediatrician will need this information for a medical evaluation.

The most common treatment for ADHD is medication, with stimulant medications prescribed most often.
These do not cure ADHD but they can help control the symptoms. There is controversy surrounding
drug treatments for ADHD, partly because of concerns regarding long-term safety but also because
they may have side effects such as weight loss, effects on the heart, and liver damage. Another side
effect of stimulant drugs is insomnia, which can actually worsen ADHD symptoms. Scheduling drug
administration to optimize their benefit, such as during school hours or homework time, but limiting their
effect on nutrition and sleep, is a challenge for parents of ADHD patients taking stimulant medications.
Many patients and parents choose to complement or if possible avoid drug treatment in favor of
behavioral therapies, psychotherapy, and social skills training.

In addition to drug and behavioral remedies, improving sleep can lead to improved daytime behavior in
children. For example, in one research study of children with sleep-disordered breathing, surgery to
remove tonsils and adenoids also improved ADHD symptoms, possibly because of improvements in
sleep quality following the surgery. Regular physical activity and healthy sleep can also improve ADHD
symptoms. Try these tips for improving your child's sleep.

If you or your child has been diagnosed with ADHD, it is important to follow your treatment regimen as
directed. There are also a number of self-directed therapies that help you to cope with ADHD, including:

•Create stable routines around the home
•Avoid difficult situations such as having to wait for long periods
•Keep your child's life calm, predictable, and organized
•Offer rewards for a child's good behavior
In addition, healthy sleep is essential to coping with ADHD. Here are some tips for sleeping well:

•Maintaining a regular relaxing sleep and wake schedule
•Establish a relaxing bedtime routine
•Create a healthy sleep environment
•Exercise daily
Coping with a child's ADHD can be difficult and parents of children with ADHD have higher rates of
marital problems and divorce. Some social and mental health services offer advice and techniques to
parents on how to cope with a child with ADHD.

NSF's 2004 Sleep in America poll found that two-thirds of children experience frequent sleep problems
and that children's poor sleep habits take a toll on parents/caregivers, some of whom lose an estimated
200 hours of sleep a year due to their child's nighttime awakenings. NSF's 2007 Sleep in America poll
found that 20% of women are awakened to give care to a child during the night.