End the ‘I Can’t Sleep’ Cycle of Exhaustion

It is common for people with attention deficit disorder (ADHD or ADD) and sleep issues. A British research study shows that three times as many children with ADHD have difficulty falling or staying asleep, and 57 percent of their parents slept less than six hours. More than half of the kids got up four times during the night. Almost half woke up before 6:00 a.m. It doesn’t take much to figure out what’s going on here: When children are awake, it’s hard for parents to get any shuteye.

Sleep deprivation makes both adults and children irritable, impatient, and less efficient at everything. Adults who haven’t gotten a good night’s sleep are more likely to miss work. Studies show that not getting enough rest can worsen ADHD symptoms, leading to loss of emotional control. It can also adversely affect working memory, a problem many of our children suffer from.

There’s a biological reason why children with ADHD tend to sleep less: Many of the same regions of the brain regulate both attention and sleep. A child who has attention problems is likely to have sleep problems, as well. You can’t change your child’s biology. But there are ADHD-friendly strategies to help kids overcome their sleep problems. Here’s what you need to do.

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Most sleep medications that work well for adults haven’t been adequately tested for safety and effectiveness in children. That goes for the over-the-counter sleep aid melatonin, as well as prescription sleeping pills. Doctors sometimes prescribe clonidine for children with ADHD and who have trouble falling asleep. The drug does make it easier to fall asleep, but many kids who take it wake up around two o’clock in the morning.

Encourage your child with ADHD to exercise — jog, jump rope, ride a bike, walk — in the morning or during the day. Physical activity helps our bodies make the transition between the phases of sleep. Also, since exercise places physical stress on the body, the brain increases the time a child spends in deep sleep.

Accept the fact that your child may need less sleep than other kids his age. If you put him to bed too early, there’s a chance that he’ll just lie there, wide awake, becoming increasingly anxious. Whatever bedtime you establish, enforce it consistently — on weekends as well as during the week. Letting your child stay up late on Friday and Saturday nights will disrupt his circadian clock; come Monday morning, he’ll wake up with something akin to jet lag.

Evening rituals signal the brain and body to slow down. The hour or so leading up to your child’s bedtime should be devoted to reading, listening to music, or some other calm, relaxing activity. Violent TV programs and video games should be strictly off-limits at this time. No roughhousing, either. Tell or read a bedtime story to a younger child. Allow older children to read in bed. Be sure your child has her favorite blanket or stuffed animal. Older kids may prefer to cuddle with a squishy, soft pillow.

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Avoid eating and snacking two or three hours before bedtime. Digestion, especially of foods containing caffeine or sugar, can keep your child up. If he insists on snacking, give him warm milk, saltines, or a little turkey, which has the natural sleep-inducing chemical tryptophan. Your child should drink enough water during the day to prevent his asking for a glass of water at bedtime — and his subsequent bathroom break later.

In addition to cueing your child that it’s time to go to sleep, darkness eliminates the visual distractions that keep him from falling asleep. If a child can’t see his toys, he’s less likely to get out of bed to play with them. What if your child is afraid of the dark and needs a light on to fall asleep? Make sure that the light is dim, and that it goes off once he falls asleep (use a timer). Choose a clock with a face that lights up only when a button is pressed. Reduce light from windows by putting up blackout curtains.

Deep breathing or listening to soothing music can make it easier to fall asleep. A foot rub or back rub relaxes a restless child. Have your child focus on breathing while visualizing an elevator gently ascending and descending with every inhalation and exhalation. Consider an evening prayer or calming mantra.

• Chilly feet keep some children awake; wearing socks may send them into dreamland.
• Remove any scratchy tags from pajamas.
• Don’t combine flannel pajamas and flannel sheets. The fabrics may stick together and make it difficult to turn over in bed.
• If the room is warm, all-cotton sleepwear can prevent sweating — and tossing.
• Air conditioning or a fan will cool down the room — and the whirring sound of the fan blades is calming.

Some children with ADHD — especially those with oppositional defiant or anxiety disorder — will do anything to avoid sleeping. Try a behavioral approach: Give strict orders for your child to stay in bed between certain hours. Sit outside her door and calmly tuck her back into bed if she gets up. After a few nights, you’ll no longer have to sit vigilantly outside. Don’t attempt this unless you have the resolve to follow through. If you allow your child to break the rules, even once, you’re sunk.

Dealing with a child’s sleep problem isn’t easy, but it’s worth the effort. Given the consequences of chronic sleep problems — for the entire family — it’s best to take action sooner rather than later.

[Free Webinar Replay: Sleep and the ADHD Brain: Why It’s Critical and How to Get More]

Patricia Quinn, M.D., is a member of the ADDitude ADHD Specialist Panel.