ADHD – You’ve probably heard of it. Your child, or children you know, might have been diagnosed with ADHD. What does that mean, and what connection does it have to breathing during sleep?
ADHD (Attention Deficit Hyperactivity Disorder) is a medical condition that refelcts the development and activity of the brain. Some researchers believe it may be an inherited condition.
In children, ADHD is marked by inattentiveness, distractibility, restlessness, and impulsivity. Often, kids with ADHD have trouble controlling their urge to move around or speak out of turn. These impulsive behaviors can be disruptive to other children in a classroom setting. ADHD can also affect a child’s ability to focus and pay attention, which can lead to learning problems and poor school performance.
A teacher or doctor may let you know if your child is exhibiting symptoms of ADHD. However, before concluding that your child has this condition, take a close look at their sleep. Many parents don’t realize that there is a relationship between fragmented sleep and ADHD. Some children who present with symptoms of ADHD may in fact be suffering from poor quality, fragmented sleep due to sleep disordered breathing (SDB) or an undiagnosed case of obstructive sleep apnea (OSA). These are disorders of sleep that prevent a child from getting enough air, and therefore oxygen, during the night. Often they are caused by some sort of physical blockage or anatomical issue affecting the throat, mouth, tongue, palate, or nasal passages.
So if your child shows signs of sleep disordered breathing—including issues like dark circles under the eyes, daytime sleepiness, bedwetting, night terrors, and mouth breathing—as well as the classic ADHD symptoms, it could be that sleep apnea is the real cause. Treating the childhood sleep apnea may in fact reverse or improve some of the behavioral problems (and some of the other sleep-related issues, as well).
What Is Sleep Apnea and How Does it Fragment Sleep?
Obstructive sleep apnea is a sleep disorder wherein a physical airway blockage in the back of the throat interrupts or blocks normal breathing during sleep. For example, in children, inflamed or oversized adenoids or tonsils are often to blame.
When a child with sleep apnea can’t get air through the airway and into the lungs, blood oxygen levels sink and the child wakes up momentarily in order to resume breathing—often accompanied by gasps or sighs and choking sounds. These sometimes alarming events are called apneas or hypopneas, and they can happen anywhere from once or twice per hour to hundreds of times per night. Apnea may or may not be accompanied by snoring, as well. (Adults are more likely to snore than children.)
Apnea awakenings can, and often do, happen all night long, disrupting each of the sleep cycles. Humans require progressing through all the cycles of sleep, uninterrupted, to be healthy and to feel rested. Waking multiple times throughout the night leads to what’s called fragmented sleep. For all intents and purposes, fragmented sleep is just as bad as getting no sleep at all. The effects on cognitive abilities, mood, and general health are roughly the same.
Why Look for Sleep Apnea if Your Child Has ADHD?
The American Sleep Apnea Association estimates that up to 4% of children between the ages of 2 and 8 have sleep disordered breathing or sleep apnea, meaning their sleep is harmed by difficulty getting enough air. At the same time, additional studies estimate that up to one quarter (25%) of school-age children diagnosed with ADHD may actually have sleep apnea. Misdiagnosis is not a slim risk—it’s a likely one.
This mislabeling of sleep apnea can occur because some of the side effects of apnea in kids—mood dysregulation, high levels of frustration and impatience, inability to concentrate at school, and so on—are similar to the symptoms of children who have attention deficit hyperactivity disorder. The behaviors are the same, but the biological causes of the behaviors are completely different. The treatments, therefore, need to be different.
Diagnosing and treating sleep apnea and breathing issues in kids is important for numerous reasons. Consider some of the medical and social consequences of not treating childhood apnea, or misdiagnosing apnea as a case of ADHD:
- Your child may take medications they don’t need. If your child shows ADHD symptoms like aggression, inability to pay attention in school, failing grades, or fidgety behavior, there’s a chance these may be resolved completely by diagnosing and treating an underlying sleep disorder or breathing issue. Obstructive sleep apnea in kids is often misdiagnosed and mistaken for attention deficit and hyperactivity, when in fact those classic ADHD behaviors may be symptoms and side effects of poor quality sleep and chronic sleep deprivation. To address the symptoms your child is experiencing, a well-meaning doctor could end up prescribing your child ADHD medication (often a stimulant)—all to treat the side effects of exhaustion. Your child could end up taking medication they don’t need, without addressing the root cause of the mood and behavioral issues.
- Sleep deprivation from undiagnosed apnea can hurt school performance. A child with undiagnosed sleep problems may be battling fatigue and cognitive problems. They may lead to learning challenges or poor memory, and the children may be disruptive in class—similar to kids with ADHD. Regarding this last: one study showed that behavioral problems may be up to six times more common in children with ongoing sleep apnea. Kids with apnea may also be three times as likely to receive lower grades. Giving a child ADHD treatment and medication when they don’t truly have ADHD is no guarantee that the situation will improve.
- Fragmented sleep from undiagnosed apnea may harm brain development in children. In 2017, a study from the University of Chicago found that children ages 7 to 11 with sleep apnea showed “significant decreases in gray matter” in various parts of the brain; the parts of the brain that control memory, speech, emotions, self-control, and decision-making, among other functions. Neuron damage like this may lead to developmental delays and lower intelligence. A prescription of ADHD medication might mask the side effects of sleep fragmentation without addressing the potentially harmful and permanent problems created by undiagnosed apnea.
- Undiagnosed apnea can create social and emotional consequences for kids. Children who act out in school or suffer mood problems may have trouble getting along with other children. SDB and apnea is also linked to sleep behaviors like snoring, sleepwalking, sleep talking, and bedwetting—behaviors that may lead to teasing or embarrassment in social situations like sleepovers.
- Untreated apnea can cause health problems. Cardiovascular disease, stunted growth, and vulnerability to colds, flus, and infection are just a few medical issues that can affect children who don’t get enough sleep on a regular basis.
What Are the Reasons Sleep Apnea Causes ADHD?
Sleep apnea doesn’t cause ADHD. However, apnea does cause sleep fragmentation and a host of side effects that result from it, many of which are nearly indistinguishable from the symptoms of ADHD.
Researchers are still studying the effects of sleep fragmentation on child development. However, we do know that getting enough high-quality sleep every night allows the body to release growth hormone and to manage a large number of processes, including cell repair, mood regulation, and memory and cognitive development.
Simply put, children need ample, high-quality sleep to function and grow. Adults aren’t much different. If school performance, work performance, and quality of life are suffering due to exhaustion, fatigue, and a feeling of edginess, it’s worth talking to a physician about the possibility of apnea. A sleep study can help you get a better understanding of what’s really causing these issues so you can treat them effectively.
If your child has been diagnosed with ADHD and you think that they may have an underlying sleep related breathing disorder like sleep apnea, call Premier Sleep Associates today at (425) 698-1732.