Rule Out Sleep Issues First

iStockSleeping child

I often ask parents to tell me about how their child sleeps.  Why?  Lack of sleep can look very much like attention problems, and can contribute to difficulties with learning and behavior.  Think about how well we as adults perform (without benefit of caffeine) when we haven’t gotten a good night’s sleep.  Imagine what it might be like for our children when poor sleep happens over days or weeks.  I ask whether the child snores, or breathes heavily through his mouth while he sleeps.  I ask about the quality of the child’s sleep:  Does your child sleep through the night?  Does your child have trouble getting to sleep?  Does your child seem sleepy during the day, or does he wake up irritable?

Years ago, during my child’s annual physical, our pediatrician asked about my son’s sleep: “How many hours of sleep per night does Griffin get?”  She saw nothing wrong with my answer that Griffin slept nine to ten hours per night.  Later, I began to suspect a sleep problem when, in spite of a full night’s sleep, he seemed pretty groggy in the mornings or woke up extremely irritable.  I remember asking our pediatrician about sleep apnea when Griffin was seven because he was a mouth breather and he had always snored heavily.  Our pediatrician told me to stand beside the bed after he fell asleep and see if he stopped breathing.  I did this, and, relieved, I found that his breathing did not stop.

At age ten, my son had difficulty focusing in school.  He was having frequent meltdowns and was miserable.  His uncontrollable behavior led us to a difficult decision to try medication.   Over time, we saw that the medication helped him to stabilize and returned some tranquility to our family life.  Fast forward to age fifteen.  My son was still snoring and we finally went to a neurologist who ordered a sleep study.  We went to a special office that had bedroom suites where my son spent the night hooked up to monitoring equipment.  The results showed that he aroused twenty to thirty times during the night due to involuntary muscle movements and breathing that stopped due to an obstruction in the throat (sleep apnea).  The neurologist prescribed medication for the muscle movement and my son had to have his enlarged tonsils and adenoids removed.

We repeated the sleep study post surgery, and discovered that he was still waking up due to a physical closure in his airway.  Part of this second sleep study was a trial on a CPAP (Continuous Positive Airway Pressure) machine.  The principal behind the CPAP is simple:  If air continues through a mask during the night, the airway cannot shut down. With a CPAP, my son slept through all the cycles needed to feel rested and refreshed.  In short, my son was waking up several times per night because he was not breathing.  As a result, he never got into deep sleep, or Delta cycle, so the quality of his sleep was terrible, even though he “slept” for nine or ten hours every night.

After a few nights on the CPAP,  my son was much more rested he when he got up in the morning.  It was magical how quickly his mood and outlook improved. Later that year, when Griffin had his wisdom teeth extracted, the oral surgeon showed us on the x-rays how physically narrow his airway is, so that when Griffin is lying down, it all but closes off. Ever since this discovery, I began to ask about sleep.

Some physicians are beginning to consider the possibility that sleep issues may be closely related to ADHD.  The New York Times printed an article titled Diagnosing the Wrong Deficit. A second article in the New York Times titled In Blur of A.D.H.D., Sleep Troubles May Be a Culprit suggests that sleep issues be ruled out first before diagnosing ADHD or prescribing medication for attention deficit.  I think this is wise.

Update: 7/17/17

Here is a link to a recent article in the Washington Post that outlines the reasons it is important to pay attention to sleep patterns and the amount of sleep older children and teens get. There are more distractions (i.e. screens, peers) and more school demands placed upon teens, it can be easier to lose precious time to sleep.

Why You Need to Pay Attention to Older Kids’ Sleep Habits

 

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