ADHD is very challenging when it comes to sleep. As almost every parent of a child with ADHD knows, sleep patterns and the amounts of sleep needed are different from normal. (Children who have ADD without hyperactivity are often exceptions to this, though.) It is believed that further sleep disturbance can also be caused by ADHD medication. Some researchers believe that correction of sleep problems can greatly reduce the effects of ADHD for many children, or even that some children, when treated for sleep disorders, might turn out not to have ADHD¹ (Neves 2007).

Behind, and in addition to different sleep patterns, some children with AD(H)D also have sleep disorders. A recent study² (Gorava, 2009) found that tested children had either obstructive sleep apnea, periodic limb movements of sleep, upper airway resistance syndrome, or obstructive hypoventilation. In contrast to children who did not have ADHD, the ADHD group had decreased sleep efficiency, increased arousal index, increased wake after sleep onset, decreased oxygen saturation nadir, and increased snoring.

Those who had disordered breathing were the ones with the most disrupted sleep patterns. Neves (2007)¹ also found examples of agitated sleep, insomnia, disorders linked to sleep habits, little time for sleep, awakening at night, talking in sleep, excessive daytime sleepiness, sleep paralysis, nightmares, sleeping during the day, tooth grinding, and night terrors. Sleep disturbances were found to increase if children had comorbidities as well as ADHD.

Some children with signs of sleep disorders may benefit from medical referral to a sleep clinic. A small number of these are scattered around the UK. For parents in the UK who want extra advice over children’s sleep, in connection with ADHD or another brain-related condition, Cerebra has a dedicated sleep service.

The website of the U.S. National Sleep Foundation contains wide-ranging information and advice on sleep.

Nocturnal enuresis

The presence of ADHD increases the likelihood that a child will wet the bed at night, and that this will be hard to treat³.

A review of interventions for enuresis in difficult cases⁴ concluded that alarms were most effective, possibly in conjunction with training. Compared with no intervention at all, dry bed training on its own, or full spectrum home training on its own.

For an overview of enuresis, please see Cerebra Newsbeat, Autumn 2008, pages 16-17, “Bedwetting: when it’s not the child’s fault”.

Education and Resources for Improving Childhood Continence (ERIC).

For hard-to-treat enuresis, the government-funded Family Fund may be able to provide a washing machine.

References

1. Neves SN and Reimão R. 2007 Jun. Sleep disturbances in 50 children with attention-deficit hyperactivity disorder. Arquivos de Neuropsiquiatria 65(2A):228-33.
2. Gorava JS et al. 2009 Jan. Sleep study abnormalities in children with attention deficit hyperactivity disorder. Pediatric Neurology 40(1):42-6.
3. Baevens D et al. 2005 Nov. Attention-deficit/hyperactivity disorder (ADHD) as a risk factor for persistent nocturnal enuresis in children: a two-year follow-up study. Acta Paediatrica 94(11):1619-25.
4. Glazener CMA et al. 2004. Complex behavioural and educational interventions for nocturnal enuresis in children. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD004668. DOI: 10.1002/14651858.CD004668.