How to Diagnose and Treat Sleep Problems that cause ADHD Behavior


How to Diagnose and Treat Sleep Problems that cause ADHD Behavior

Problems sleeping have caused many kids and adults to be wrongfully labeled because of misdiagnosis of attention deficit hyperactivity disorder.

Recently, many news and research articles have popped up confirming what behavior specialists have “known” for years; children and adults who have problems sleeping are more likely to have behavior problems such as ADHD.

It just seems it took a long time for everyone else to come to grips with the association between a “good night’s sleep” and normal or appropriate behavior. I considered the quality and quantity of sleep to be such a big part of a child’s or adult’s ability to function the next day; I dedicated an entire chapter to the topic in Mistaken for ADHD.

In my last article; Problems sleeping cause ADHD Behavior in Children and Adults, we discussed how any “thing”; medical or otherwise, that caused a child or adult to have problems sleeping could also cause signs and symptoms of ADHD.

As you’re sure to remember, ten year-old Leslie was a perfect example of how a child could be misdiagnosed with ADHD-when in fact suffering from disordered sleep.

Disorders of sleep or disordered sleep are medical problems that may include both physical and emotional things as well as environmental-surrounding factors. Sleep experts estimate up to 25% of Americans suffer some type of sleep disorder or problem sleeping and at least 10% of those persons are children or teens.

As discussed in Mistaken for ADHD, Chapter 8-Sleep Disorders; in excess of twenty things can cause disordered sleep. In this article, you’re going to learn about the things that can mimic ADHD causing misdiagnosis that directly affect a child’s or adult’s breathing and can be definitively diagnosed by a “sleep study”.

These include:

  • Obstructive sleep apnea (OSA) is a condition characterized by episodes of snoring with periods of apnea or cessation of breathing caused by partial or complete obstruction of air flow. It is usually found in those who are overweight and have very thick necks or large abdomen, have something like a mass or tumor in their neck, or have very large adenoids, tonsils or nasal polyps. Technically, OSA can be caused by anything that restricts airflow through the mouth or nose.
  • Central Sleep Apnea (CSA) is a form of sleep apnea that is not caused by obstruction, but is associated with a defect the part of the brain responsible for controlling breathing while asleep.
  • Restless leg syndrome (RLS) causes a person to experience unpleasant feelings in their legs when lying down or asleep. Many describe the “pain” as cramps awakening them from a sound sleep and say that they can usually “walk it off”. As a result, we often refer to RLS as a voluntary leg movement disorder.
  • Periodic Leg Movement Disorder (PLMD) is associated with involuntary movement of a person’s legs while asleep. The movements can’t be controlled or walked off and may or may not awaken the person. However, once awake, most persons note their legs feel tired, but return rapidly to normal.
  • Narcolepsy is a form of uncontrollable-sudden onset of sleep. It is felt to occur as a result of some type of damage in the parts of the brain that control levels of consciousness.
  • Periodic insomnia simply means a person suffers from poor sleep that really doesn’t qualify as disordered sleep, but must be considered when trying to make the diagnosis. Sometimes, this sleep problem can be cured by altering room temperature, avoiding food and caffeine for six hours before going to bed and using good sleep hygiene.
  • Night-time seizures similar to petit mal seizures or mini-seizures can cause what is called partial arousal from sleep, thus interfering with the quality of sleep.
  • Cardiac arrhythmia or rapid-skipping heart beat can awaken a person multiple times during sleep periods by causing a pounding pulse, chest pain or shortness of breath. The most common arrhythmias are usually atrial fibrillation and paroxysmal supraventricular tachycardia (SVT).

As previously noted, each of these causes of disordered sleep can be diagnosed by using a sleep sudden or polysomnography. During the traditional sleep study these things are assessed:

  • Airflow at the mouth-nose level
  • Respiratory rate and depth
  • Oxygen levels
  • Brain wave patterns
  • Muscle movements-especially legs and arms
  • Heart rhythm.

By measuring each of these, a sleep expert can decide which type of breathing disorder exists if any and then, of course, recommend a course of treatment. Treatments for these types of sleep disorders may include:

  • Use of CPAP or continuous positive airway pressure
  • Weight loss
  • Tonsillectomy-adenoidectomy
  • Removal of any neck mass such as an enlarged thyroid or a tumor
  • Medications to control night-time seizures
  • Drugs that control heart rate and rhythm
  • Stimulants to reverse narcolepsy or daytime sleepiness
  • Improving sleep hygiene (no exercise, food, alcohol or caffeine in the six hours before bed)
  • Correcting low iron levels, vitamin B12 levels, vitamin D levels or thiamine levels.

Obviously, there are many more disorders of sleep that can be misdiagnosed as ADHD and cause inappropriate drug therapy for attention hyperactivity disorder in both kids and adults.

If you suspect a sleep problem might be causing your child’s or loved one’s ADHD like behavior, it’s really important you mention so to his or her doctor and ask for a sleep study as soon as possible. The consequences of the sleep apneas and narcolepsy can be quite serious and in some cases, life threatening.

In our next article, we’ll discuss more of the greater than 20 things that cause sleep problems that cause ADHD behavior.

Frank Barnhill, MD

Here are a few resources for you to take a look at:

ADHD Diagnosis: Sleep Problems Cause ADHD Misdiagnosis

Sleep Problems in Children May cause ADHD Misdiagnosis

Sleep Disorders in Children, Bullying and Aggressive Behavior

Barnhill, Frank MD. Mistaken for ADHD. How you can prevent mislabeling your child as a failure in life…Chapter 8, pp. 105-140. Published March 2010.


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