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Sleep

Dr-Anu-Sheth-and-Dr-Rashad-Nawaz-3We all know a good night's sleep is good for us but how do you wind down when your mind is racing. For those with ADHD, that is often the case. We spoke to two leading pediatricians Dr. Anu Sheth, founder of Pediatric Associates of Lawrenceville, and Dr. Rashad Nawaz an ADHD specialist working in partnership with Together Trust's project Sleep Tight Trafford - a charity dedicated to helping families get a better night's sleep.

 

Disclaimer: the information contained on this website does not constitute medical advice. If you have concerns about your own health or the health of someone else, you should speak to your doctor.

 

What type of sleep patterns are typical for someone with ADHD?


Dr. Anu Sheth: The biggest problem is that they cannot fall asleep - they can't shut their mind off. It’s challenging for them to be able to switch off and be able to rest. That’s why most kids with ADHD will have sleep problems because they simply can't fall asleep. And, when they do fall asleep, they don't stay asleep and therefore they wake up tired the next day.


Do you think there is link between ADHD, sleep and learning (e.g., memorizing new material)?


Dr. Rashad Nawaz: In short, yes. I would say that, based my own personal experience, having a good night's sleep helps with remembering things that you've done during the day. There is a strong link between sleep and how effective your memory and learning are the following day. When we sleep, we go through several sleep cycles – essentially different stages of sleep. Learning and memory is associated with two key phases of sleep: Non-Rapid-Eye Movement Sleep (NREMs) and Rapid-Eye Movement Sleep (REMs). NREMs help us to store our memories from short-term memory into long-term memory, while REM sleep is thought to help us analyze and understand these memories [1].


In some cases, I get patients who are waiting for their medication for ADHD. While they are waiting, they focus on their sleep routine and getting a better quality of sleep. Many report back and say they feel they are learning more and their grades are improving as a result.


How much sleep should people with ADHD be seeking to get every night?

 

Dr. Anu Sheth: Sleep is age-dependent – younger kids need more sleep up to 10 to 11 hours. Middle school kids should aim for around 10 hours and high school kids optimally 8 to 10 hours of sleep. With high school kids this is a challenge; they’re usually up late trying to get their work done. I always tell them if they can at least try to sleep for two sleep cycles, which is about two and a half to three hours per sleep cycle (6 hours minimum), then they will be able to function. However, it’s worth caveating this by saying that sleep depends on each person and how they sleep.

 

What are the benefits of a good night’s sleep for someone with ADHD?


Dr. Rashad Nawaz: The benefits are being more alert, less impulsive and the ability to focus better. It really helps with the core symptoms of ADHD. Sleep is huge factor with ADHD. of the first things I talk to patients about is about their sleep and what they eat. Those two things are critical because, before considering medication, those are the two basics that you’ve got to get right.


Are most clinicians aware that people with ADHD are more likely to have sleep problems?


Dr. Rashad Nawaz: I would like to yes but from experience I don't think that most clinicians actively screen for sleep problems at the first consultation or thereafter. I personally have a vested interest in child and sleep problems as well as ADHD. If sleeping problems aren’t investigated, then it is possible that a clinician could assume that the ADHD is getting worse, when in fact it could be attributed to sleep. It could be that the patient has significant sleep difficulties which has an impact on their behavior during the day, which doesn't require increasing the medication. It requires more intensive approach around sleep.


How do clinicians assess sleeping problems in patients referred for ADHD – what questions are typically asked?

 

Dr. Rashad Nawaz: I always spend time talking to parents and the patient about their sleep when I first see them - it’s now a routine part of my questions. Some common questions include:

  • How well does your child sleep?
  • Can you (the patient) tell me about your sleep?
  • What time do they go to sleep?
  • What time do they wake up?
  • Do they sleep all night through or do they wake during the night?
  • What is their routine in the evenings?

Are there any other tools, tips and tricks that can help people with ADHD get to sleep?


Dr. Anu Sheth: We aim for a consistent approach to a child’s sleep routine. Each night a child should have the same routine, including weekends. We also advise parents to consider:

  • What they eat and drink before bed:
    • Are they eating enough?
    • Are they drinking sugary or caffeinated drinks before bed (tea, coffee, fizzy drinks)
  • The bedroom environment:
    • Humidity
    • Temperature
    • Lighting
    • Comfort (mattress)
  • Reducing the amount of screen time before bed, particularly video games
  • Reducing the number of electronic devices in the bedroom – this should be kept to a minimum
  • How tidy the bedroom – excess clutter can interfere with sleep

Ideally you shouldn’t eat at this time either. I often recommend that patients shouldn't be reading in bed because your bed is supposed to be associated with just sleep – reading stimulates the brain. Learning to do meditation or yoga can also be helpful. Meditation can also include breathing techniques to manage stress and create a sense of calm before bed.


I often recommend an app called Calm which offers guided meditation. It also provides natural sounds and white noise which can be soothing for people struggling to sleep. Calm is an effective way to teach yourself and our children how to meditate. Meditation is a personal choice and at some ages children are more driven to try this. Children often model their parents by copying their behavior. If you can encourage these behaviors by adding them to your own routine then you’re more likely to encourage your children to adopt these behaviors too.


Do video games impact the quality of our sleep?


Dr. Rashad Nawaz: There is some research linking screen light with a negative impact on our sleep. The small amount of literature on this suggests that it's to do with a specific type of wavelength that comes out of the screens or the blue light, hence why you've got certain manufacturers like Apple and their iPads and iPhones in the evenings you can switch to night mode. A different type of lighting can affect our eyes which may also affect the quality of sleep. A routine screening question is to ask how much screen time a child is getting especially before bed. My advice is that children should get a break from screens for at least one hour before going to bed.

[1] Boyce R, Williams S, Adamantidis A (2017) REM sleep and memory. Current Opinion in Neurobiology Jun;44:167-177

 

 

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