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ADHD and Sleep

One important cause often ignored with ADHD is sleep. Not only is it a problem for those taking stimulant medication, but too little sleep can be the cause of ADHD symptoms in children who do not have ADHD at all. Lack of sleep also has the effect comparable to reducing IQ from 100 to 80.

It is now 50 to 60 years since the breakthrough discoveries about sleep that revolutionized our understanding of the sleep process. That was when REM sleep (Rapid Eye Movement sleep) was discovered. REM is a vital part of our nightly sleep cycles. But for the first 30 years the focus was on adults. Only in the last two decades have children been seriously studied. This is unfortunate since sleep is such a vital part in the healthy mental development of a child.

This is even more disturbing considering the diagnosis of ADHD has increased to epidemic proportions during these same two decades.

Now sleep research with children is explaining the role of sleep in the development of ADHD like symptoms.

The difficulty with studying the effects of sleep deprivation in children is that it is unethical to study children by putting them under stress, which sleep deprivation is. Adults can legally volunteer to let themselves be subjected to what amounts to torture: be it for money or payment, or university students thinking it is cool or macho to endure psychological experiments.

Studies with children, where some slept one hour less for 3 or 6 nights, showed a clear difference between children losing as little as that one hour per night.

While staying up all night shows up in obvious signs of lack of sleep, it is the slight sleep deficiency which causes behavior problems. Small amounts of sleepiness can result in excessive activity and inattention identical with ADHD symptoms. If this lack of sleep is ongoing, then the behavior will seem to be chronic.

With up to 55% of parents with children having ADHD like symptoms mentioning sleep problems, it is surprising how little sleep has been mentioned in the ADHD debate. ADHD has been linked to various sleep disorder problems in many different studies. These problems include sleep apnea, behavioral problems with resistance to bedtime, waking in the middle of the night and needing contact with parent, but not being able to, restless legs syndrome, reduced or insufficient REM sleep time, fragmented sleep, etc.

With noticeable effect of missing an hour’s sleep a night for 3 nights in a row, what is the effect when insufficient sleep becomes the regular norm? Then functioning below par will feel “normal.”

So when we are faced with typical symptoms of inattention, hyperactivity or other typical ADHD like behavior, maybe doctors should look at sleep patterns before diagnosing and medicating. The same goes for other problems, such as depression and anxiety.

Since insufficient sleep makes these psychiatric problems worse, and even cause these disorders; how much sleep do we need?

Sleep patterns are a part of who we are

Our sleep patterns are individual. Eight hours is generally considered the norm, but while some people manage with about four hours a night, Margaret Thatcher being one, others need nine hours a night. Trying to do with less than we are biologically tuned for is unhealthy.

Even broken sleep is not unnatural. In fact this was the norm before the Industrial Revolution and electric lighting. If broken sleep is due to anxiety, depression or stress, then the underlying cause needs treating and not the broken sleep. If broken sleep feels OK then don’t worry. Go with the flow of your personal daily rhythm. If need be, go to bed a few hours earlier to compensate for the waking period between the first and second sleep. But do get the sleep you need.

Broken sleep was normal until about 200 years ago. It was called the “first sleep” and the “second sleep.” Between these two sleeps, which could be a couple of hours, people were awake, would sit around and chat, lie and think, pray, visit neighbors and go for walks.

By the beginning of the 18th Century, more than 50 of Europe’s major cities had street lighting at night. The Industrial Revolution changed much in society, including becoming more conscious of time and efficiency. Industrial work reduced the time people had to rest and forced the “one sleep” pattern.

In an 1829 medical journal parents were encouraged to force their children out of the first and second sleep pattern.

“If no disease or accident there intervene, they will need no further repose than that obtained in their first sleep, which custom will have caused to terminate by itself just at the usual hour. And then, if they turn upon their ear to take a second nap, they will be taught to look upon it as an intemperance not at all redounding to their credit.”

Today, with activities like TV and surfing the Internet, most people have active nighttime lives. This makes it difficult to deal with bedtime resistance behavior, which is common in children with ADHD like behavior symptoms. Considering that three quarters of children with ADHD symptoms have sleep problems, and are five times more likely to have sleep problems than non-ADHD children, regular bedtime routines with good sleep is a cheap first option in dealing with ADHD problems.

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