Sleeping with ADHD, Autism, and Anxiety
Sleep. It’s that ever elusive kudo that comes at the end of each day. For some of us, it happens quite easily. For others, it’s a process that may or may not end up in sweet dreams. For our children with ADHD, anxiety, or autism, sleep is truly of the essence. It’s needed to maintain focus, to regulate mood and allow for learning. Without it, we see our children struggle with more anxiety, more restlessness, more inattention, more irritability, and more difficulty learning. Over time, we, as their parents, become unsure of which came first and we have a vicious cycle that can become hard to break or remedy.
How Much Sleep Do We Need Each Night?
According to Tuck.com, the numbers of hours of sleep needed each night (optimally) is based on age. The following is the breakdown:
Infants Under 1 Year 16-20 Hours
1-2 Years of Age 14 Hours
3-4 Years of Age 12 Hours
5-12 Years of Age 10 Hours
13-19 Years of Age 9 Hours
Adults and Seniors 7-8 Hours
ADHD and Sleep
Children with ADHD often struggle with sleep. CHADD.com says the most common sleep problems for children and adolescents is difficulty fall asleep, difficulty staying asleep, and difficulty waking up. Children and adolescents with ADHD also struggle with sleepwalking, snoring, breathing difficulty, restless sleep, and nightmares. When children are prescribed medication, parents and teachers see an improvement in a child’s ability to maintain focus; however, the stimulant component can also negatively impact a child’s ability to fall asleep and stay asleep each night.
The National Sleep Foundation states children with ADHD who don’t sleep enough hours each night may be even more fidgety, restless, impulsive, and even irritable and aggressive. Children who do not sleep well during the night may struggle socially to interact with their peers and pick up on social cues, understand a lesson presented in class, be able to follow directions given by a teacher when transitioning, for example. Ultimately, this leads to a child who can become ‘tired and wired’, and can become stuck in a non-sleeping pattern for months.
A study completed by Golan, Shahar, and Pillar (2004), showed that there is a high comorbidity between AD/HD and disordered breathing as well as restless leg syndrome. It was recommended that parents discuss these possibilities with the child’s pediatrician in order to gain treatment for these conditions that could be disturbing sleep cycles and contributing to an exacerbation of symptoms.
Autism and Sleep
Children diagnosed with Autism Spectrum Disorder (ASD) also struggle with sleep. As reported by Devnani and Hegde (2015), sleep disturbances are related to decreased hours of sleep and restless sleep. This is due to abnormalities in rapid eye movement sleep. These sleep struggles are also associated with decreased sleep with parents and increased parent stress.
Cortesi, Giannotti, Ivanko, and Johnson show that ASD children and adolescents struggle with insomnia and other sleep struggles at a higher rate than their general education peers (40%-80%). Sleep struggles also negatively impact the child’s ability to interact socially, maintain focus and learn in the classroom. Inconsistent sleep has also been correlated with behavioral non-compliance, impulsivity, and even aggression.
For parents of children diagnosed with ASD, a few areas to assess and rule out, with the help your pediatrician, or other healthcare providers, that may be negatively impacting sleep are:
• Gastrointestinal Diagnoses
• Food and/or Environmental Allergies
• Sleep Apnea
• Restless Legs Syndrome
• Period Limb Movement Disorder
Anxiety and Sleep
KidsHealth.com defines anxiety as a major source of sleep disruption for kids in that there is a struggle with falling asleep and maintaining sleep throughout the night. Often, kids worry about having nightmares or ghosts or other scary objects that may hurt them or sit in the closet or under their bed. It also results in long bedtime routines, late bedtimes, and unproductive sleep.
Daniel, Chorney, Detweiler, Morris, & Kuhn (2008) found that there is a dynamic interplay between sleep and anxiety in that anxiety can lead to decreased sleep, and decreased sleep can lead to greater anxiety, and therein lies a vicious cycle that needs breaking.
Poor sleep comes with many ‘side effects’ that can impact a child’s overall mood and well-being:
• Decreased Appetite
• Increased Appetite and Resulting Weight Gain
• Aggression and Irritability
• Poor Emotional Regulation
• Social Withdrawal
• Poor Attention (that can be mistaken for AD/HD)
• Difficulty Learning (that can be mistaken for a learning disability)
Difficulty Falling Asleep and Its Impact on Waking Up
When our children or adolescents finally fall asleep, waking up in the morning can be painful. Our children struggle to wake once they’ve finally allowed their body to rest. With not enough hours in, our children are groggy, sleepy, and difficult to engage at home and in school. They could be in need of a good alarm clock to wake up to.
For some children, they don’t hear their alarm clock for heavy sleep or ignore their parent’s pleas to wake up. Sometimes waking up can even become a ‘fight’ either verbally or physically. Many adolescents and young adults who are now responsible for waking themselves up in high school and college may miss their school bus, or miss their classes because they struggle to hear their alarm clock for heavy sleep and wake up in time to be prepared for their day. Not having the best alarm clock for heavy sleepers can be a challenge.
A few adolescents and young adults with whom I’ve worked have stated that they have set their alarm clock for heavy sleep only to not it them and they once again, sleep in and miss their classes, the shuttle, the school bus, their internship, or their job.
One tool that I’ve found helpful is the Sonic Boom alarm clock, the best alarm clock for heavy sleepers. I’ve proudly displayed my Sonic Boom in my office so that I can share with parents, adolescents and young adults. It has an unmissable sound and an extra feature – a sonic shaker that you can place under your pillow. The alarm clock for heavy sleep vibrates strongly in an effort to effectively wake your sleepiest of children, adolescents, or young adults. Although it may wake your entire house, the alarm clock for heavy sleep gives our children the independence in waking up that can decrease the amount of arguing and fighting first thing in the morning. A good alarm clock rectifies these issues.
A Few Sleep Strategies
Chadd.com offers a few strategies to help your child, adolescent and young adult find a schedule and routine to help promote and maintain good sleep each night.
• Practice Good Sleep Habits.
Maintain a regular bed and wake schedule, even on weekends; avoid caffeine after late afternoon; avoid nicotine and alcohol close to bedtime; use the bed for sleeping only and avoid having children watch television or videos before bedtime.
• Set up a Realistic Time For Bed, Stick to That Schedule
Behavioral techniques may be necessary to help children with ADHD stay in bed. Children with ADHD do better with structure and knowing what to expect ahead of time.
• Pay Attention to The Room Environment.
Keep the bedroom dark, quiet, cool and comfortable for the best sleep. Using a fan or humidifier to create white noise can help. Minimize potential interruptions, such as outside noise; keeping televisions, computers, video games, and other electronic equipment out of the bedroom helps create a sleep-friendly environment. The light emitted from electronics can delay the release of the sleep-inducing hormone melatonin. In addition, these devices can overstimulate the brain, making it harder to go to sleep.
• Get Exercise During The Day
Exercise helps dissipate hyperactivity and feelings of restlessness in those with ADHD. However, exercising close to bedtime can make it more difficult to fall asleep, so exercise should be completed at least three hours before bedtime.
• Monitor Eating Times
Eating heavily too close to bedtime can inhibit a good night’s sleep. However, because some children with ADHD don’t get enough calories throughout the day to maintain proper nutrition, a small snack close to bedtime can ease bedtime hunger pains and help maintain a healthy weight.
• Establish a Routine
People benefit from a relaxing routine at the end of the day. This helps ease the transition from the activities of the day to the calm restfulness of sleep. This is especially important for children, as they thrive on and need routines.
• Consult Doctor if Necessary
Using prescribed or over-the-counter medications to improve sleep is a decision that needs to be made with a physician. Type of medication, duration and side effect are some of the considerations that need to be taken into account before starting any medication for sleep problems. Medications can affect people differently. Discuss any medication taken with a physician to determine if there are any side effects that could affect the quantity or quality of sleep.
Cortesi F, Giannotti F, Ivanenko A, Johnson K. Sleep in children with autistic spectrum disorder. Sleep Med. 2010;11:659–64. [PubMed]
Chorney, D., Detweiler, M., Morris, T., & Kuhn, B. Journal of Pediatric Psychology, Volume 33, Issue 4, 1 May 2008, Pages 339–348, https://doi.org/10.1093/jpepsy/jsm105
Golan, N, Shahar, E, Pillar, G. (2004). Sleep disorders and daytime sleepiness in children with attention deficit/hyperactivity disorder. Sleep. March 15;27(2):261-6.
Dr. Liz Matheis is a certified school psychologist and licensed clinical psychologist in private practice in Livingston, NJ. She and her team of therapists specialize in the special needs child, adolescent and young adult with ADHD, Anxiety, Autism, and Learning Disabilities. She is also the proud mother of 3 children. Visit her at www.psychedconsult.com.