You probably wouldn't think of your hyperactive child as being sleepy, but new evidence suggests he could be. According to Ronald Chervin, M.D., associate professor of neurology and director of the Sleep Disorders Center at the University of Michigan, a significant number of children may be receiving treatment for ADHD when being treated for a sleep disorder would solve the problem.
Exactly how many isn't known, as the topic hasn't been studied enough. But there's a large enough minority to make it worth pursuing.
Sleeping without breath
Between one and three percent of preschool and school-aged children suffer from sleep apnea, a breathing disorder that makes it difficult or even impossible for a person to sleep and breathe at the same time. When we sleep, the muscles in the upper part of our throat relax, staying open just enough to allow air to continue flowing. In people with sleep apnea, the passage is so narrow that when these muscles relax, the airway closes completely. Their breathing stops for 10 to 20 seconds or more until their brain senses trouble and wakes them up just enough to start their breathing again. The downside to this is that the person never gets the restorative sleep their body needs because they are constantly being awakened.
Sleep apnea in children is usually caused by enlarged tonsils and/or adenoids obstructing the child's airway. The most common and most effective treatment is to remove them. According to the American Academy of Otolaryngology Head and Neck Surgery, the primary reason that nearly 400,000 American children have their tonsils and adenoids removed each year is to treat sleep apnea. And here's where the ADHD link comes in: Preliminary research conducted by Chervin and his colleagues shows that a good number of children no longer qualify for a diagnosis of ADHD after they have been treated for sleep apnea.
Sleepy kids
The major sign of sleep apnea in adults is excessive daytime sleepiness. But sleepiness is very hard to identify in children because they show their sleepiness in a different way than adults do. Sometimes their way of showing sleepiness ends up looking a lot like ADHD. Sanjay Patel, M.D., assistant professor of medicine at Case Western Reserve University in Cleveland, says, "Children rarely act sleepy. What happens instead often times is that they actually act sort of hyperactive or irritable. You can get kids who look just like they have ADHD when the cause is really sleep apnea."
Why would a sleep-deprived child act this way? Well, it could be their way of trying to stay awake. As no self-respecting child would ever admit to being sleepy, they may instead try to create more stimuli in their environment by shifting their attention, fidgeting, getting up, or causing a commotion. It's actually consistent with other observations. Most people wouldn't immediately imagine that a stimulant (such as Ritalin) would help someone who is hyperactive, but it does. And why is that? Well there's some evidence that hyperactive children are extra sleepy.
Signs to look for
So how can you tell if your child is one of the small, yet significant minority whose ADHD-like symptoms are caused by a sleep disorder such as sleep apnea? The most important clue is whether the child snores and stops breathing, then suddenly starts again. Also watch for labored breathing, a loud snort or gasping noise as the child resumes breathing, and strange sleeping positions.
Other signs of sleep apnea in children include:
* heavy sweating during sleep
* behavior problems
* difficulty waking up
* headaches, especially in the morning
* irritability
* breathing through the mouth
Sleep apnea, whether in children or adults, is a very treatable disorder. It's hard to believe, but those who suffer from it usually have no idea what goes on while they sleep. By the time they wake up, their body has already acted to fix the problem. A few minutes spent watching for the signs of sleep apnea in your child could mean the difference between a life with good quality sleep, and a life without it.
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