Question:
If my memory serves correctly, the show spoke of a surgical procedure that
cured a young child's sleep apnea. Prior to the procedure, the child's
behavior was typical of ADHD. Afterwards, of course, the child became a
perfect little angel.
You may have already guessed my question. Is this an avenue worth exploring?
I certainly haven't noticed loud snoring from his room at night. Does this
automatically rule out the sleeping disorder theory?
Answer:
Sleep apnea sufferers do have ADHD-like symptoms. That's why it's
important to rule out other causes before diagnosing ADHD. Another
"physical condition" that can cause ADHD like symptoms is
hyperthyroidism. Of course there is a list of mental conditions that
can mimic ADHD as well.
Not quite what you're asking but one doc claimed that (arrgggh I can't
remember the name) where you spontaneously fall asleep at inappropriate
times is a form of adhd.
http://www.drgreene.com/21_621.html
Sleep Deprivation And ADHD
In anger I threw my pager across the on-call room, slamming it against
the wall. I don't anger easily or often, but I was a pediatric
resident who had been awake for 36 hours. The pager had gone off one
time too many. Sleep deprivation had changed me from a calm, caring
person into an irritable, impulsive mess.
As if it shouldn't have been obvious, research has shown that the
sleep deprivation associated with residents' on-call schedules brings
about significant "impairment of physician mood" as the sleep
deprivation increases (Journal of Occupational Medicine, Dec 1992).
The surprising news is that partial, or low-level, sleep deprivation
has a bigger effect on behavior than either the short or long-term
complete sleep deprivation experienced by residents (Sleep, May 1996).
Until recently, the effects of partial sleep deprivation have been
seriously underestimated.
We know, based on common sense, that inadequate sleep makes kids more
moody, more impulsive, and less able to concentrate. We've known for
more than 20 years that sleep deprivation makes it difficult to learn
(Journal of Experimental Psychology, Mar 1975). Recent research has
verified that chronic poor sleep results in daytime tiredness,
difficulties with focused attention, low threshold to express negative
emotion (irritability and easy frustration), and difficulty modulating
impulses and emotions (Seminars in Pediatric Neurology, Mar 1996).
These are the same symptoms that can earn kids the diagnosis of
attention deficit hyperactivity disorder (ADHD, popularly known as
ADD).
ADD is an important problem in its own right, but research in sleep
laboratories has shown that some (and perhaps a great many) kids are
mislabeled with ADD when the real problem is chronic, partial sleep
deprivation.
When children are identified with symptoms of ADD, often no one thinks
to explore the child's sleeping habits, and whether they might be
responsible for the symptoms. (People also forget to consider
childhood depression as a possible cause for these symptoms -- but
that is another story.)
Sometimes it is obvious to parents that their children are not
sleeping well -- but not always!
Any child who snores may not be getting adequate sleep. Obstructive
sleep apnea is a common medical condition that is now being identified
in more and more children. The peak age for this is 2 to 5 years old,
but it can occur at any age. Not all kids who snore have sleep apnea.
Classically, those with sleep apnea snore quite loudly for a bit, then
are silent, then snort briefly, move about, and resume snoring. If
snoring is accompanied by nighttime breathing difficulty and pauses in
breathing, then it may well be sleep apnea. This should be brought to
the attention of your pediatrician. You might want to make a cassette
tape of your child's sleep noises to bring with you.
Children with sleep apnea do not get sound sleep. They may also get
suboptimal oxygen to the brain at night. Obstructive sleep apnea can
have a serious negative impact on a child's intellect and behavior.
The common symptoms of sleep apnea are difficulty paying attention
during the day, decreased academic performance, oppositional behavior,
and restlessness. Not all kids with sleep apnea snore. Even when they
do, sleep apnea is often overlooked. Instead, the child is diagnosed
with a behavioral disorder -- most commonly ADD (Journal of Clinical
Child Psychology, Sep 1997).
Children with sleepwalking, restless leg syndrome, narcolepsy,
insomnia, or other sleep problems may also be misdiagnosed with ADD
(Neurology, Jan 1996).
When parents of children with ADD are interviewed, they usually
identify their kids as poor or restless sleepers (Journal of Pediatric
Psychology, Jun 1997). Kids who have been diagnosed with ADD do wake
up more often at night than their peers (Pediatrics, Dec 1987). Poor
sleep is a common feature of ADD -- a problem that can be made worse
by the use of stimulant medications such as Ritalin or Dexedrine.
In an individual child, it can be very difficult to tease apart
whether interrupted sleep is the cause or the result of ADD. The good
news is that even when ADD is the correct diagnosis, addressing the
sleep issues can dramatically improve the behavior of the child
(Journal of Pediatric Psychology, Apr 1991).
A 10-year-old girl in Pittsburgh, Pennsylvania who had true ADD also
had significant sleep difficulties. She had long delays before falling
asleep. She would often wake up at night and have difficulty falling
back asleep. She received professional help for her sleep problem
(chronotherapy combined with a behavior modification program), which
resulted in an increase of sleep from 7.2 to 9.2 hours per night.
There was significant, measurable improvement in her schoolwork,
teacher evaluations, and behavior. These changes were observed by
teachers and peers who were not aware of her treatment.
If your child has ADD symptoms or other behavior problems, he or she
should be carefully assessed for sleep problems. If sleep disturbances
are present, they need to be addressed, regardless of whether or not
they are the root cause. If your child is not getting sound,
uninterrupted sleep, discuss this with your pediatrician. You may also
want to contact the National Sleep Foundation (202 785-2300) or the
American Sleep Disorders Association (507 287-6006) for information or
referrals. There are now more than 3,000 Sleep Disorders Centers that
can provide the kind of help the little girl from Pittsburgh received.
Another great resource is Helping Your Child Sleep Through the Night,
by Joanne Cuthbertson and Susie Schevill.
As parents, we all know what it feels like to be grumpy, contrary, and
"not at our best" from lack of sleep. If our kids often feel this way,
we owe it to them to find solutions to this problem.
There are two forms of sleep apnea--one is mechanical and usually
produces loud snoring, while the other is neurological and to be honest,
since that's not the form that I have I don't know a whole heck of a lot
about it. Either has long term health consequences if untreated and
either can produce symptoms similar to ADHD. Be aware though that the
diagnostic procedure involves a night in the hospital hooked up to more
wires than you would imagine could be attached to a human body--they're
all stuck on--no needles--so it's not painful, but for a young child
could be quite scary.
It is possible to have both ADHD and sleep apnea (I'm one of those who
got the double-whammy dag nabbit).
For the mechanical form, sometimes surgery is effective, sometimes not.
Quite often the use of a machine called a "CPAP" (Continuous Positive
Air Pressure) to assist breathing at night is required--that takes a
while to get used to but I've gotten to the point that putting the mask
on puts me right to sleep (conditioned response I suppose). If he is
obese, losing weight can help or may even correct the condition all by
itself.
