ADHD and Sleep Apnea: The Connection

Attention deficit hyperactivity disorder (ADHD) is a condition that affects behavior. Acting on impulse, restlessness and problems concentrating are traits associated with the disorder. However, some of the symptoms are similar to those displayed by people with a sleep disorder such as sleep apnea.

Increasing attention is being given to the role sleep and sleep deprivation may play in ADHD. The American Sleep Apnea Association reports that as many as 25% of children who are diagnosed with the disorder could also have symptoms of obstructive sleep apnea, the most common form of sleep apnea. 

This presents the possibility that treating the sleep disorder could help with their ADHD symptoms.

What Are the Symptoms of ADHD?

ADHD is often diagnosed in childhood, and while the symptoms may ease, the disorder can still impact adult life. It is estimated that 5% of children aged between 2 and 17 years are affected by this disorder. The symptoms can interfere with a child’s school work as well as causing problems socializing with other children.

Hyperactivity is just one of many potential symptoms a child could display. This is the symptom most people associate with the disorder. However, further symptoms include:

  • Easily distracted
  • Frequent fidgeting
  • Difficulties staying focused on certain tasks
  • Problems following instructions
  • Impatience
  • Tending to lose important items
  • Being very chatty
  • Often interrupting

However, different symptoms can present for different types of the disorder.

The Connection to Sleep

Anyone who has trouble sleeping can display symptoms similar to ADHD. In children the daytime sleepiness resulting from a lack of sleep can present as hyperactivity and impulsiveness.

As an adult it can often result in poor concentration as well as fatigue. The upshot is that a child’s performance at school can suffer, while an adult can see a marked dip in their productivity at work.

For some children, their learning and behavioral issues could be due to chronic sleep deprivation. If diagnosed with ADHD, this lack of sleep could impact on the severity of their symptoms. Therefore, interventions aimed at improving sleep could improve both the quality of sleep and their ADHD symptoms.

One area that is usually considered when addressing sleep issues is the presence of a sleep disorder. One such disorder is sleep apnea, a condition which is thought to affect up to 4% of children.

The Connection with Sleep Apnea

Obstructive sleep apnea (OSA) is the most common form of this sleep disorder. Those with OSA can experience frequent interruptions to their sleep caused by temporary breathing cessations. These breathing issues are caused by an obstruction of the airways. The reduction in oxygen levels prompts the brain to wake the body for air.

These awakenings for air can be so brief that they go unnoticed by the person with OSA. However, the cumulative effect can be chronic sleep deprivation, particularly if the disorder remains undiagnosed.

Obesity is one of the prime contributing factors for OSA in adults. For children the obstruction in their airways while they sleep can be due to large adenoids and tonsils. As well as poor quality of sleep resulting in daytime sleepiness, this can also see them snore.

If obstructive sleep apnea is suspected, your doctor may arrange a pediatric sleep study. Once diagnosed, it can be treated. If the breathing difficulties are due to enlarged adenoids and tonsils, it may be recommended that they are removed.

For adults. CPAP is the leading treatment for OSA. Standing for continuous positive airway pressure, CPAP is a device to supply pressurized air through a mask worn while sleeping. 

The pressurized air helps prevent the airways from collapsing, which allows normal breathing throughout the night. This prevents the breathing cessations that cause the frequent awakenings associated with sleep apnea.

Other symptoms of sleep apnea in children include:

  • heavy breathing
  • pauses to their breathing
  • snorting or choking while asleep
  • bed-wetting
  • excessive sweating
  • morning headaches
  • concentration issues

According to one study, 50% of parents reported that their child with ADHD also experienced difficulties sleeping. However, while not every child with this disorder will struggle to sleep, it can increase their risk from poor quality sleep. 

Therefore, if a child also has an underlying condition like obstructive sleep apnea, treating this condition is key for them to receive better sleep. This in turn could help alleviate the severity of their ADHD symptoms.

Ways to Help Improve Sleep

As well as treating the contributing factors of a sleep disorder like obstructive sleep apnea, understanding methods that encourage sleep is also beneficial. The following are ways that could help a child or adult improve their quality of sleep.

  • Develop a bedtime routine. This involves consistent bedtimes and consistent getting up times the next morning.
  • Do not use electronics before bed, including cell phones, tablets, computers. Instead, look for something relaxing like a warm bath or reading a book.
  • Refrain from caffeine and sugar in the evening.
  • Adults should cut out alcohol in the hours before going to bed
  • Ensure a bedroom environment that encourages sleep. This includes a dark room and one with a cool temperature. Ensure the mattress is comfortable.
  • If the bedroom is often disturbed by exterior noise, a white noise machine can help block this out.
  • Make time for regular daily exercise as this can promote sleep. However, exercise immediately before bed is best avoided

Sleep apnea is quite rare in children. However, as it causes difficulties sleeping, it can impact on the symptoms of ADHD. As both disorders can lead to poor quality sleep, clinicians will likely evaluate for a sleep disorder first before prescribing ADHD medication.