Montreal, Canada — ADHD Sleeping Problems are much more common than people realize. For example, did you know that More than 50% of adults with ADHD have on-going sleep problems, and 27% have chronic insomnia? Yet despite this being such a huge problem, there aren’t many websites dedicated to this subject.

“Having adult ADHD insomnia is doubly annoying because lack of sleep mimics ADHD symptoms such as difficulty concentrating, poor memory, distraction and disorganization.”

“It’s such a shame that so many adults with ADHD suffer like this because there are ways to get a good night’s sleep and feel refreshed when you wake up, even if your sleeping problems date back to childhood’ says Jacqueline Sinfield, the ADHD coach for adults.

“If you want to change your sleep patterns from say 4am to noon to one that fits in with the rest of the world, there are strategies to quieten your mind so you can fall asleep, stop waking up in the night, or even how to get up when your alarm rings. There are answers to all these common problems,” says Sinfield.

With the launch of the new website, articles with information, resources and easy to implement tips are being added all the time to help reduce the stress, discomfort and sadness that sleeping problems in ADHD adults can cause.

ADHD Sleeping Problems is currently adding more information to their website in celebration of its launch. Topics covered include clocks, caffeine, medication, falling asleep, waking up, Teeth Grinding, two types of Sleep Apnea, Restless Leg Syndrome and others.

As well as being a registered nurse, Jacqueline is a qualified counselor, has a degree in psychology (Hons) from London, England and is a graduate of Coach University. Her expertise has been featured in the media, including CJAD radio and the Montreal Gazette. Her first ADHD book, “Untapped Brilliance: How to Reach your Full Potential as an Adult with ADHD“, has been endorsed by Dr. Hallowell and Dr. Gabor Mate. She also has her own radio show which airs every Monday.

She has helped hundreds of adults with ADHD all around the world and lives in Montreal, Cananda.

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A study of more than 11,000 children followed for over six years has found that young children with sleep-disordered breathing are prone to developing behavioral difficulties such as hyperactivity and aggressiveness, as well as emotional symptoms and difficulty with peer relationships, according to researchers at Albert Einstein College of Medicine of Yeshiva University. Their study, the largest and most comprehensive of its kind, published online in the journal Pediatrics on March 5.

“This is the strongest evidence to date that snoring, mouth breathing, and apnea [abnormally long pauses in breathing during sleep] can have serious behavioral and social-emotional consequences for children,” said study leader Karen Bonuck, Ph.D., professor of family and social medicine and of obstetrics & gynecology and women’s health at Einstein. “Parents and pediatricians alike should be paying closer attention to sleep-disordered breathing in young children, perhaps as early as the first year of life.”

Sleep-disordered breathing (SDB) is a general term for breathing difficulties that occur during sleep. Its hallmarks are snoring (which is usually accompanied by mouth breathing) and sleep apnea. SDB reportedly peaks from two to six years of age, but also occurs in younger children. About 1 in 10 children snore regularly and 2 to 4 percent have sleep apnea, according to the American Academy of Otolaryngology–Health and Neck Surgery (AAO-HNS). Common causes of SDB are enlarged tonsils or adenoids.

“Until now, we really didn’t have strong evidence that SDB actually preceded problematic behavior such as hyperactivity,” said Ronald D. Chervin, M.D., M.S., a co-author of the study and professor of sleep medicine and of neurology at the University of Michigan.

“Previous studies suggesting a possible connection between SDB symptoms and subsequent behavioral problems weren’t definitive, since they included only small numbers of patients, short follow-ups of a single SDB symptom, or limited control of variables such as low birth weight that could skew the results. But this study shows clearly that SDB symptoms do precede behavioral problems and strongly suggests that SDB symptoms are causing those problems.”

The new study analyzed the combined effects of snoring, apnea and mouth-breathing patterns on the behavior of children enrolled in the Avon Longitudinal Study of Parents and Children, a project based in the United Kingdom.

Parents were asked to fill out questionnaires about their children’s SDB symptoms at various intervals, from 6 to 69 months of age. (Studies of similar questionnaires have shown that parents do a good job of assessing kids’ SDB: their evaluations compare well with data from carefully controlled overnight sleep studies, Dr. Bonuck reports.)

When their children were approximately four and seven years old, parents filled out the Strengths and Difficulties Questionnaire (SDQ), which is widely used to assess behavior.

The SDQ has scales for assessing a child’s inattention/hyperactivity, emotional symptoms (anxiety and depression), peer problems, conduct problems (aggressiveness and rule-breaking), and prosocial behavior (sharing, helpfulness, etc.). The researchers controlled for 15 potential confounding variables, including socioeconomic status, maternal smoking during the first trimester of pregnancy, and low birthweight.

“We found that children with sleep-disordered breathing were from 40 to 100 percent more likely to develop neurobehavioral problems by age 7, compared with children without breathing problems,” said Dr. Bonuck.  “The biggest increase was in hyperactivity, but we saw significant increases across all five behavioral measures.”

Children whose symptoms peaked early—at 6 or 18 months—were 40 percent and 50 percent more likely, respectively, to experience behavioral problems at age 7 compared with normally-breathing children. Children with the most serious behavioral problems were those with SDB symptoms that persisted throughout the evaluation period and became most severe at 30 months.

Researchers believe that SDB could cause behavioral problems by affecting the brain in several ways: decreasing oxygen levels and increasing carbon dioxide levels in the prefrontal cortex; interrupting the restorative processes of sleep; and disrupting the balance of various cellular and chemical systems.

Behavioral problems resulting from these adverse effects on the brain include impairments in executive functioning (i.e., being able to to pay attention, plan ahead, and organize), the ability to suppress behavior, and the ability to self-regulate emotion and arousal.

“Although snoring and apnea are relatively common in children, pediatricians and family physicians do not routinely check for sleep-disordered breathing,” said Dr. Bonuck. “In many cases, the doctor will simply ask parents, ‘How is your child sleeping?’ Instead, physicians need to specifically ask parents whether their children are experiencing one or more of the symptoms—snoring, mouth breathing or apnea—of SDB.”

“As for parents,” said Dr. Bonuck, “if they suspect that their child is showing symptoms of SDB, they should ask their pediatrician or family physician if their child needs to be evaluated by an otolaryngologist (ear, nose and throat physician) or sleep specialist.”

According to the AAO-HNS, surgery is the first-line treatment for severe pediatric SDB in cases where the tonsils and adenoids are enlarged. Another option is weight loss for overweight or obese children.

Dr. Bonuck’s paper is titled “Sleep Disordered Breathing in a Population-Based Cohort: Behavioral Outcomes at 4 and 7 Years.” In addition to Dr. Bonuck, other Einstein contributors were Katherine Freeman, Dr.P.H., and Linzhi Xu, Ph.D. The study was supported by grants from the National Heart, Lung, and Blood Institute, part of the National Institutes of Health.

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Children and adolescents with obstructive sleep apnea had substantial improvements in attention, anxiety and quality of life after treatment with positive airway pressure (PAP)—a nighttime therapy in which a machine delivers a stream of air through a mask into the nose.

“The benefits occurred even when children didn’t fully adhere to the treatment,” said study leader Carole L. Marcus, M.D., a sleep specialist and director of the Sleep Center at The Children’s Hospital of Philadelphia. The Sleep Center follows thousands of children and adolescents with sleep problems.

The study appears online ahead of print in the American Journal of Respiratory and Clinical Care Medicine.

Obstructive sleep apnea syndrome (OSAS) is a condition of interrupted breathing caused by a narrowing in the throat or upper airway, related to large tonsils and adenoids, obesity or other medical problems. Using continuous positive airway pressure commonly relieves OSAS in adults, in whom it has been studied extensively. However, there have been few studies of PAP in children with OSAS.

“The vast majority of children with OSAS undergo surgery on their tonsils and adenoids instead of receiving PAP therapy,” said Dr. Marcus. “It is difficult to get children to wear the mask used in PAP treatments.” However, surgery is not always effective in treating OSAS in children, especially in obese children,” said Dr. Marcus.

She added that many children who require PAP therapy have underlying chronic illnesses such as Down syndrome, or developmental delays. Furthermore, the rising incidence of obesity among children and adolescents has also increased the rate of OSAS in young people.

The current study followed 52 children and adolescents with OSAS at Children’s Hospital. The patients had a mean age of 12 years old, and 10 of them had significant developmental delays. The study team assessed sleepiness, behavioral problems, attention, and quality of life at baseline and after three months of PAP treatment.

The researchers found significant improvements in attention deficits, daytime sleepiness, behaviors such as anxiety and shyness, and quality of life. Both the parents and children reported on quality of life using standardized questionnaires that asked about feelings, daily activities, getting along with other children, and keeping up with schoolwork.

“We found that improvements occurred even when children were only using PAP as little as three hours a night,” said Dr. Marcus, who noted that higher compliance would be expected to yield greater benefits. She added that getting children to fully adhere to treatments requires a commitment by parents and family members to a behavioral plan that supports the treatments.

Dr. Marcus said that further pediatric sleep research is warranted, such as blinded studies to compare treatment to a placebo group and further investigations of neurobehavioral outcomes. “This study was the first comprehensive study of PAP use in children, so more research should be performed, but our results have encouraging implications for using this treatment in children with sleep apnea,” she concluded.

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