What if Your ADHD Kid Really Has Sleep Apnea?

Attention-deficit hyperactivity disorder is the bane of many parents nowadays, and the subject of a lot of debate. Some believe that the inattentiveness and impulsivity that are characteristic of ADHD is simply behavior within the range of normal restlessness on the part of highly energetic kids. Others say that it’s a genuine neurological disorder requiring some level of clinical and/or pharmaceutical intervention.

But what if some number of cases are neither? What if, in some cases, sleep apnea is masquerading as ADHD? Consider the following example. In the spring of 2010, a patient walked into a doctor’s office reporting problems with procrastination, forgetfulness, and an inability to consistently pay attention – in short, a textbook case of ADHD. The twist was that all the symptoms had only surfaced two years earlier at the age of 31, contrary to the usual childhood onset associated with ADHD.

In time, the patient was found to be suffering from a chronic sleep deficit. (His troubles began when he took on a job that required him to wake up at 5 a.m., conflicting with his natural inclination as a night owl.) Once the patient’s sleep schedule was properly addressed, his symptoms almost vanished within two weeks.

Well, this is all fine and good, particularly for an adult who only began experiencing the ADHD-like symptoms well into adulthood. But this misdiagnosis prompts a closer look at the relationship between sleep and ADHD, challenging the conventional understanding of these conditions. Consider:

  • Research indicates that a significant number of children diagnosed with ADHD also experience sleep-disordered breathing, such as apnea or snoring, restless leg syndrome, or non-restorative sleep. A 2004 study published in the journal Sleep found that children with ADHD displayed a deficit of delta sleep, a deep, rejuvenating sleep crucial for growth and development.
  • A 2006 study in the journal Pediatrics revealed that children scheduled for tonsillectomies due to sleep-breathing problems showed a higher incidence of ADHD compared to a control group. Remarkably, a year after the surgery, half of the children who initially met the criteria for ADHD no longer did. This suggests that what appeared to be ADHD was, in fact, resolved by treating a sleeping problem.
  • While the focus on sleep and ADHD is more prominent in childhood, adults with ADHD exhibit similar sleep dysfunctions. Research from Massachusetts General Hospital draws parallels between sleep issues in adults and children with ADHD. A study published in the journal Nature Neuroscience indicates a correlation between the amount of delta sleep in seniors and memory test performance, reinforcing the significance of quality sleep across all age groups.

None of this should be interpreted to claim that ADHD isn’t an actual condition, or that some (or even most!) of the people who are diagnosed with it wouldn’t benefit from the right kind of clinical or pharmaceutical treatment. But before reflexively going for a prescription, it might be worth looking to see if your kiddo isn’t simply suffering from a sleep disorder such as pediatric sleep apnea. Giving a sleep-deprived kid some meds to keep them focused seems like cruel and unusual punishment.

Source: Diagnosing the Wrong Deficit (NYT)

Obstructive sleep apnea is a condition typically associated with adults. But pediatric sleep apnea – snoring in children – happens much more frequently than many people realize. As it turns out, there are some very good reasons why. In some ways, young children can be more predisposed to snoring than adults.

  • A child’s airway is generally a small diameter and shorter than an adult’s airway, particularly in the glottis (the portion of the larynx that contains the vocal cords).
  • The epiglottis (the flap of cartilage that keeps food from entering the airway) is relatively long and floppy for small children.
  • The tongue in the oropharynx (the portion of the throat at the very back of the mouth, behind the oral cavity) is relatively larger in kids than in adults.

Put it all together – the relatively larger tongue, the naturally smaller airway, the greater likelihood for the epiglottis to get in the way – and children can be naturally predisposed to chronic snoring. It’s a major reason that parents of newborns are strongly advised to lay their babies on their sides when putting them down to sleep as a preventative measure against crib death.

What’s more, children can come up against upper respiratory illnesses more frequently than adults. As pretty much any parent can readily attest, runny noses, nasal infections and head colds can be more or less nonstop for toddlers and preschoolers. And kids are especially susceptible to croup, which is characterized by swelling of the airway.

With all that in mind, it shouldn’t be surprising that it’s not uncommon for children to become accustomed to breathing through their mouth when they’re little. We’ve covered the issue of mouth breathing – breathing through the mouth instead of the nose while asleep – in other blog posts. The upshot is that it contributes heavily to obstructive sleep apnea, or chronic snoring.

But for kids who are still undergoing a lot of growth and development, mouth breathing can present some serious consequences. In nasal breathing, the tongue rests along the roof of the mouth, and the regular pressure against the teeth can help the form outward properly. Mouth breathing forces the tongue to rest on the lower jaw instead of against the roof of the mouth, which can cause both the upper and lower jaw to poorly form at the same time.

This can have severe long-term consequences for children. They can end up with crooked teeth, misalignment of the joints in the jaw resulting in TMJ disorder, and airway development problems causing obstructive sleep apnea.

So if your child is dealing with this, how can you address it so they get back on the path to healthy development, along with getting back to a good night’s sleep?

  • Address their upper respiratory issues early if possible. Yes, it’s easier said than done, but if you can help your little one avoid the upper respiratory issues that can lead to mouth breathing, you can typically prevent him or her from developing the habit of mouth breathing in the first place.
  • Oral appliances for children have become a proven solution to help children with jaw development issues. By using the right kind of oral appliance, the inside of the oral cavity is reshaped to create more space. And for small children, it’s generally much easier to treat with early intervention. Even in cases in which an oral appliance is needed to improve jaw alignment, children often need to wear the appliance for a much shorter time than adults to achieve the same effects.

Early intervention for children who are still growing and developing can be critical to helping them avoid more serious complications down the road.