Is It Really ADD or ADHD?
Asking the right questions can lead to insights that were previously unknown. Did you know that 25–50% of children diagnosed with attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD) also have sleep-related problems? Michael Fulbright, DDS, states that sleep apnea is often a missed diagnosis in children who experience symptoms associated with ADHD. Ongoing research findings show there is a correlation between sleep apnea and ADHD. Doctors and parents may be missing the sleep connection when having their child’s symptoms evaluated for ADHD, symptoms such as behavior issues, an inability to concentrate, and apparent hyperactivity. Left untreated, sleep disorders can lead to serious medical conditions.
ADHD and Sleep Disorders
The terms ADD and ADHD are often used interchangeably to refer to a brain disorder marked by an ongoing pattern of inattention and/or hyperactivity that interferes with functioning or development. Children who have ADHD symptoms tend to demonstrate difficulty with concentration and can be disruptive at home and school. The problem generally occurs equally among males and females. Although behavior issues, an inability to concentrate and hyperactivity may also be associated with sleep disorders, ADHD is currently the medically accepted term for these neurological conditions.
When ADHD symptoms resemble some of the same symptoms as sleep-related breathing disorders, a misdiagnosis and ineffective treatments may result if the sleep factor is not at least considered. Signs of sleep disorders may be sleeping in unusual positions, snoring loudly, and interrupted, intermittent breathing during sleep with snorts, gasps or waking up after a pause in breathing; these symptoms can be accompanied by heavy sweating, dark circles under the eyes, and headaches. It’s not surprising that when behavior becomes disruptive at school, daycare or home, ADHD, not sleep quality, is suspected. However, when the child is also grumpy, aggressive, hyperactive, unable to focus, falling asleep or daydreaming in school or at home and grades become problematic, doctors will often recommend a sleep test to rule out SRBD.
What Is Sleep-Related Breathing Disorder (SRBD) in Children?
When a child frequently stops breathing for a few seconds to several seconds during sleep due to an obstruction or block in the upper airway, such as the soft tissue in the throat collapsing into the airway and interrupting sleep, this is identified as obstructive sleep apnea (OSA). The lack of oxygen in combination with interrupted sleep cycles hinders normal brain and body functions. Snoring, mouth breathing, restless leg, wetting the bed, daytime sleepiness or hyperactivity, behavior issues and night terrors are a few of the indicators of sleep-related breathing disorder. Sleep disorders can make kids miss out on healthy, restful sleep during critical times when their hormones are produced and regulated for growth and appetite control, and their body and brain are recharging. Untreated obstructive sleep apnea can affect learning, behavior, and growth, and can create heart problems and serious medical conditions well into adulthood.
Children suffering from sleep apnea may be found to snore loudly and can be heard gasping for air following pauses in breathing. These individuals may appear active while they sleep — repositioning themselves, having night terrors (nocturnal parasomnia) — and often sweating during sleep. They may develop crowded teeth due to improper jaw development. Sleep apnea is estimated to affect 7% of the adults in North America; however, it often goes undetected in those who live or sleep alone. Sleep apnea can be hereditary and is most noted in children when one or both parents snore or have sleep apnea. Obstructive sleep apnea is estimated to impact up to 5.7% of children between the ages of 2 and 8.
Treatment of Sleep Disorders and Medical Dental Clinics
Once an assessment has been completed, a palate expander may be used to treat a child with sleep apnea. A palate expander is a custom oral appliance that expands the area of the palate and prevents the jaw, tongue, and relaxed muscles from falling back into the throat, obstructing the airway. It also aids in the proper development of a child’s jaw and airway.
Surgical solutions may include removing the adenoids and tonsils, which may contribute to airway blockages. A common treatment that does not involve surgery is the use of a continuous positive airway pressure (CPAP) machine, which often uses a mask to cover the child’s nose and mouth and uses air pressure to force the airway open. Many people find the CPAP machine to be uncomfortable, but it performs well when tolerated.
Parents are encouraged to seek assistance from professionals. The Koala® Center for Sleep & TMJ Disorders and KoalaKIDZzz® program utilizes an integrated care approach, consulting with medical and dental practitioners who are trained and experienced in solving sleeping disorders which include snoring, sleep apnea, and jaw pain (TMJD). Visit us at www.koalasleepcenters.com to find a location near you.