Deirdre Budd’s Blog

Posts Tagged ‘ADHD

The higher incidence of sleep disorders in children with handicapping conditions has long been recognised. Children with Autistic Spectrum disorders and those who are Epileptic may be on medications which may contribute to the sleep disorders. Many have sleep disorders which can be resolved or reduced by modification of their sleep and pre sleep routines.

In a recent study of children with ADHD, 17 percent  were currently suffering from primary insomnia, versus 7 percent of controls; lifetime primary insomnia occurred in 20 percent of children with ADHD, compared to 10 percent of controls. Nightmare disorder affected 11 percent of children with ADHD and lifetime nightmare disorder affected 23 percent, versus 5 and 16 percent of controls. The presence of at least one psychiatric co-morbid condition increases the risks for insomnia and nightmares.

According to principal investigator Susan Shur-Fen Gau, MD, PhD, symptoms and consequences of ADHD and sleep problems in children often overlap. Some primary sleep disorders are found to be associated with inattention, hyperactivity, behavioral problems and impaired academic performance, which are often mistaken for symptoms of ADHD. 

Adolescents with a childhood diagnosis of ADHD, regardless of persistent ADHD were more likely to have current sleep problems and sleep disorders such as insomnia, sleep terrors, nightmares, bruxism (jaw clenching and/or tooth grinding) and snoring.

Findings of the study indicated that the rates of nightmare and lifetime nightmare disorder were more prevalent in girls and snoring was more prevalent in boys. Snoring may be more prevalent in boys due to an increased rate of sleep-disordered breathing in boys. Mothers were found to be more aware of symptoms related to ADHD in the presence of primary insomnia, sleep terror disorder or sleepwalking disorder, whereas teachers may be more sensitive to ADHD symptoms in the presence of primary hypersomnia and nightmare disorder.

According to the study, sleep problems in children with ADHD may be caused by a variety of factors, including Internet addiction, hyperactivity, use of stimulants and the presence of other psychiatric disorders. Authors of the study state that the etiology of sleep problems and disorders need to be identified in children with ADHD, in order to create a modified treatment regime for sleep disorders and ADHD symptoms.

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Narcolepsy is a chronic disorder caused by the brain’s inability to regulate sleep-wake cycles normally. It is relatively rare and accompanied by a significant degree of functional impairment. The hallmark of Narcolepsy is excessive daytime sleepiness. Other symptoms include cataplexy sleep paralysis and hallucinations during sleep onset or awakening. It is not usually definitively diagnosed until about 10-15 years after symptoms appear.

Recent research shows that narcolepsy is related to unique gene variants and auto-immunity. It is reported in Nature Genetics that it is hoped that defining the changes in the T cell receptor associated with narcolepsy and catoplexy it may later be possible to develop drugs which will prevent the onset of narcolepsy.

At the moment the symptoms of narcolepsy are often misdiagnosed, particularly in children and adolescents, as psychiatric or behavioural disorders such as ADHD, depression and even psychosis. Most people find that the symptoms worsen over the two or three decades after they symptoms first appear.

Current treatment of Narcolepsy can usually result in control the daytime sleepiness, and the loss of muscle tone (cataplexy). Each treatment plan includes medication, education and behavioural changes. Narcolepsy is a chronic lifetime disorder that will always require management. The goal of treatment is adaptation and improved quality of life.

Periodic Limb Movement Disorder PLMD – is characterised by a partial arousal or waking, with repetitive, stereotypical limb movements during sleep. Some patients are totally unaware of these movements and others are wakened by them. The movements typically occur in the legs and ankle and are rhythmical in nature. PMLD can co-exist with RLS ( see previous post) and may occur in as many as a quarter of children who have been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD).

 While there are theories about the causes of PLMD there are as yet no firm conclusions. Studies show that some of the associations of RLS apply equally to PMLD. Secondary PMLD can occur where there is iron deficiency anaemia and where there are diagnosed metabolic disorders including uremia.

Regular physical exercise does seem to help sufferers both by improving the overall sleep pattern and by releasing Beta-endorphins.


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