It’s not your imagination. Kids with ADHD have more sleeping problems than their peers, but setting a sleep schedule can help.
According to the American Academy of Sleep Medicine, even moderate sleep deprivation — losing less than one hour per night of sleep — can affect the academic performance of children with ADHD. Yet ADHD and the medication used to treat the condition are known to disrupt sleep patterns, making it difficult to fall and stay asleep — and making bedtime a nightmare for parents of kids with ADHD.
In many cases, creating a consistent sleep schedule and environment can help. “For families who have children with ADHD and sleep problems, it’s often a struggle to create some structure around that hour prior to bedtime,” notes Richard Gilman, PhD, director of psychology in the division of developmental and behavioral pediatrics at the Cincinnati Children’s Hospital Medical Center in Ohio.
“Many of the things that we suggest are minor tweaks to what they already do. We just make it more predictable, more consistent for the child. And the results are well worth it. A lot of the times, parents tell me, ‘If I would have done this years ago, I would have slept better myself.’”
Scheduling Tweaks for Better Sleep
Here’s how to help your child overcome sleeping problems:
- Buy an egg timer. Using a tangible instrument like an egg timer helps keep your family on track with bedtime schedules.
- Commit to a set schedule. Make sure that your children go to bed at the same time every night and wake up at the same time every morning, including weekends. Allowing children to stay up later on weekend nights and wake up later the next morning just makes their weekdays more difficult, says Gilman. If they are fighting fatigue despite the set schedule, you might need to increase their sleep time. Remember that younger children do need more sleep than older children.
- Remove sources of stimulation. During the hour you get your kids ready for bed, turn off the TV, music, computers, and video games. Don’t engage in arguments or initiate any rough play. This is an hour that should be very peaceful, says Gilman. That means that parents also need to be peaceful — no arguing with each other or the children.
- Use a reward system. Allow children to earn tokens, stars, or stickers that can be traded in the next morning for a small reward, such as a favorite breakfast food or being allowed to choose the music on the ride to school. These rewards come when expected actions, like brushing teeth, are completed on time. Rewards may also be earned by staying in bed after lights-out.
- Keep the house quiet. During the bedtime preparation and once your children are in bed, keep the house quiet and calm. Parents and older children might be up later, says Gilman, but it’s a good idea to keep your voices down and turn down TV and music.
- Return children calmly to bed. Even with a reward system and a cozy bed, some children will still get up to find you. Return them to bed without indulging in arguing, threatening, lecturing, or any other energizing activity.
- Allow a full hour to get ready for bed. Once you have your egg timer, you can use it to count down the hour your children need to wind down. Here’s how to break down the hour:
- First 30 minutes: Set the egg timer for 30 minutes. This period of time is for hygiene — bathing, brushing teeth, and putting on pajamas.
- Next 15 minutes: Set the egg timer for 15 minutes. This period of time is for a relaxing activity, such as reading a book, doing some relaxation exercises, or practicing deep breathing.
- Final 15 minutes: Set the timer for 15 minutes. This is for getting into bed (and staying there). “In bed, there should be some sort of ritual between the parent and the child,” says Gilman. Consider reading a favorite book, snuggling, praying, identifying good things that happened that day, telling a favorite story, or some other soothing and affectionate activity. Lights go out at the last “ding.”
- Invest in white noise. A white noise machine is a great way to limit the ability of normal house and family noises to interfere with sleep. As a bonus, turning off the white noise machine in the morning is a helpful way to gently wake up your child.
- Wake up gently. You need a good plan for waking up ADHD children, says Gilman. The “bugle call” approach can actually set them up for a day-long spiral of ill temper. Instead, try a gentle action, such as opening the blinds or turning off the white noise machine.
- Build in getting-ready time. ADHD children may need a morning schedule that is just as generous in time and structure as their pre-bed ritual. A chaotic rush to get out the door sets the wrong tone for the day.
- Monitor naps. Naps can be excellent if they are also structured and time limited, says Gilman, and younger children need them whether or not they have ADHD. Older children, however, can do serious damage to their sleep pattern (and the family schedule) if they are allowed to indulge in a two- or three-hour nap. Opt for a power nap of about 20 to 30 minutes if absolutely necessary.
- Consider melatonin. This popular supplement does help children sleep. However, Gilman stresses that you should ask your child’s doctor before using it. Many parents give more than a child needs for sleep improvement. Additionally, a doctor can advise on the best time to give the melatonin. It takes some time to work, so providing it right before bed could still leave a period of frustration for everyone.
When Sleeping Problems Go Beyond Setting a Schedule
If you make all these changes and find that your child still isn’t sleeping well, talk to your child’s doctor.
Researchers are finding physiological commonalities between ADHD and some sleep disorders. For example, in ADHD as well as restless leg syndrome (RLS) and periodic limb movements in sleep, dopamine levels are abnormal. However, even though these conditions share some similarities and even possible genetic links, they have to be treated separately. It is important to take your child’s complaints about going to sleep or staying asleep seriously.
“Children need to be able to describe RLS in their own words for a diagnosis,” says sleep medicine specialist Arthur Walters, MD, associate director of the Vanderbilt Sleep Disorders Center in Nashville, Tenn., and co-author of the first review of the connection between ADHD and sleep disorders. “They might say their legs hurt or that they have an ‘owie’ or the heebie-jeebies.”
He also notes that the catch-all diagnosis of “growing pains,” which may be given when children complain about ongoing leg discomfort, could be a red flag for a sleep disorder. Other disorders that are linked to ADHD include narcolepsy, sleep apnea, delayed sleep phase syndrome, disorders of partial arousal sleepwalking, and night terrors.
Sleep scheduling is excellent for many ADHD children, says Dr. Walters, “but if the kid stops breathing up to 15 times an hour [as can occur with sleep apnea], all the sleep scheduling in the world won’t help.”
By working with your child and your child’s physician, you should be able to create a sound sleep environment to help your child succeed with ADHD.