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Sleep Deficits and Disorders

You would think the issue of sleep is too obvious to bother dwelling on. Surely parents of difficult children would know enough to get them to bed on time, and adults with problems concentrating would get a good night sleep.  Think again!

A year 2000 study compared the sleep patterns of unmedicated ADHD children to those of average children by having all the children wear monitoring devices on their wrists for five nights.[1]  Researchers found that the ADHD children had significantly more variability in their sleep patterns.   This difference was so pronounced that researchers were able to predict ADHD in the basis of sleep patterns alone with an astounding success rate of 70%.  This is extremely important information when one considers that a lack of sleep can induce the symptoms of ADHD in normal people.

“The core symptoms of ADHD, i.e.., inattention, difficulty in regulating behavior and emotions, and hyperctivity, are strikingly similar to the difficulties caused by disrupted sleep and sleep deprivation as has been addressed by numerous investigators and clinicians.” – Reut Gruber, Laboratory for Children’s Sleep and Arousal Disorders, Dept. of Psychology, Tel Aviv University.

There is such a strong association with sleep and ADHD that at one time sleep problems were one of the diagnostic criteria for the disorder.   I personally have found it to be the number one factor in my own son’s behavior.    As my son’s fatigue increases, he becomes more active, louder, more accident prone, and more argumentative.  He doesn’t seem at all sleepy. On the contrary!  He becomes more wound-up, as if he has been drinking strong coffee all day.  As he passes a certain threshold he become downright giddy and nonsensical.  When he was a preschooler, complete gibberish would erupt from his mouth.  People would give us confused looks as if to say, “Is he alright in the head?” Asking him to carry out a simple task at this point was pretty much impossible.  He spun faster and faster until he honestly could not control himself.   We even noted a strong correlation between sleep and injuries.

My husband and I made a rule that on days when my son was behaving in this way, he needed to go to bed early. Not as punishment, and we were clear to tell him this, but because he was “acting tired.”  This is a self-regulating system that has worked great for us.   But going to bed is not the same as going to sleep.  Some people simply have a hard time winding down, and my son is one of them.  We can hardly ask him to go to sleep five minutes after getting home from an evening basketball game or immediately after eating a late dinner.   Two or three days of this in a row almost guarantee behavior problems and injuries.    Even watch TV or playing a computer game just before bed is a bad idea.   The safest bet is to have a reading hour before bed.

Our system stopped working unexpectedly when my son was seven years old.  We kept putting him to bed early, but the next day he was back to the same frightful behavior.  We just could not figure out why the early bedtimes were not helping as they always had.  Family relationships were deteriorating rapidly. The mystery was solved after a few weeks of this when I peeked into his room and found he had pulled his light fixture onto his bunkbed and was reading “Calvin and Hobbes” after he had been put to bed.  After catching him doing this a few nights in a row, we put his light fixture up in the attic.  The problem continued.  Then we found he had a flashlight in bed.  We removed the flashlight.  Still more problems.  Sure enough, he had squirreled away a second flashlight.  This kid is resourceful!  Finally we made a rule that if he got caught with another light in bed he would have to write fifty times “I will not sneak a light into bed.”  That cured him, except that he then announced that he could still read by the outdoor lights shining in his window.  So now we make sure all outdoor lights are off.  Problem solved!

Several years ago I found out just how important sleep was to my own well-being.  For about three weeks I followed an allergy elimination diet to see if foods might be affecting my sinuses. As part of this process I kept a journal of all the food I ate, which included a rough graph of how I felt throughout the day on a scale of 1 to 10.  After three weeks I took a look at the journal for any relationship between what I ate and how I felt.  I didn’t find one.  But I noticed that on the days I reported low scores for how I felt, I had always jotted a note in my journal: “Tired, but I didn’t get enough sleep.”   As I flipped through my journal of the last three weeks  I was struck at how many days I reported not feeling well because I was tired.  If that three weeks was representative of my life, I was spending one third of it in a foggy stupor because I didn’t have enough sense to go to bed at a reasonable hour.

Yes, I know, it shouldn’t have taken a journal for me to realize this.  But it did.  And it’s not just me.  The majority of Americans don’t get enough sleep.  You’ve probably already heard this because it’s made headlines for years.  People today get nowhere near as much sleep as they did 100, 50, or even just 20 years ago.  Lack of sleep results in an inability to concentrate, memory problems, irritability, fatigue or depression, and coordination problems.  Many adults compensate by drinking lots of coffee or other caffeinated beverages, which in turn causes more problems (more on that later).

“By any measuring stick, the deaths, illness, and damage due to sleep deprivation and sleep disorders represent a substantial problem for American society,” – The National Commission on Sleep Disorders Research.

Many children stay up too late.   Some researchers also argue that television before bed can interfere with their sleep.[2]   For younger children, a missed nap can be a recipe for disaster.  I found this to be a highly significant factor in daycare. I was told by a new teacher that the staff could not require my three year son to nap against his will!  This was a complete disaster, and over the course of a week my son turned into an angry, hitting, biting, uncontrollable terror on two legs, and I do mean an extreme case. After I spoke to the Director and had some changes implemented, the problem immediately ended.  At the time, I was surprised at how many of my peers did not require their three year olds to nap because it was “just too much of a hassle.”    I then watched their children deteriorate (predictably) into nasty behavior day after day.

It is well known that teenager’s biological clocks pressure them to stay up late and sleep in late, while school schedules require them to start school early.  This tendancy can be excacerbated by teens who drink lots of caffeinated sodas, often from school vending machines.   This is such a significant problem that some school districts are considering a change in school hours.

A common problem with adults, based on my conversations with people who say they are ADD, is a simple reluctance to go to bed on time.   This was my biggest problem.  Like many others, I am a night owl.  After the kids are in bed, the evening is my time to relax and play, and I don’t want to go to bed! Many people I have spoken to are people who, once they become fired up over a project they find interesting, are simply too revved up to go to sleep.  Such people are sometime classified as biploar by doctors, although this diagnosis is questionable.   They may go a few days all charged up and not getting enough sleep, only to crash when they can no longer keep up the pace.   Thomas Edison and his crew were famous for this, often staying up all night in search of a new invention.

Some MBTI temperament types are known for this type of behavior.  ENTPs and ENFPs are known for being “project oriented”, becoming wildly enthusiastic when immersed in a new project, especially one involving new ideas, but rather bored and depressed when routine is involved (incidentally, Thomas Edison is generally assumed to have been an ENTP).   It’s hard to turn off that enthusiasm each night so that one can get a good night of sleep.   If you are one of these people, you should try and get into the habit of avoiding your pet projects an hour before bedtime.  If surfing the Internet gets your gears turning, don’t do it!

Insomnia, a prolonged inability to fall asleep, affects up to 40 percent of Americans.[3]  Causes include anxiety, stress, use of stimulants (including caffeine and ADD medications), alcohol, lack of exercise, too much noise or light, and certain physical illnesses.   If you experience chronic insomnia and cannot aleviate it through lifestyle changes, you might want to visit a sleep clinic.   Most medications used to help you fall asleep are actually counterproductive and you won’t feel rested the following day.

Sleep apnea is caused by the repeated collapse of the windpipe during sleep, which interrupts the sleep cycle.  It occurs in as many as 2% of adult females and 4% of adult males.[4] My friend’s husband went to his doctor complaining of his inability to concentrate.  When standard tests did not turn up any problem, he was referred to a phsychiatrist, who quickly diagnosed him with ADD.   The Ritalin he was advised to take did not help, however.   His doctors never once suggested sleep apnea: It was his wife who suspected it. She videotaped him sleeping and showed the doctor.   The diagnosis was confirmed at a sleep clinic.   Children, too, can have sleep apnea, although it becomes much more common as people age.  This condition should be suspected if a person chronically snores or stops breathing while they are asleep.  Other risk factors are nasal congestion, obesity, and smoking.

[1] “Instability of Sleep Patterns in Children With Attention-Deficit/Hyperactivity Disorder”, Gruber, R., Journal of the Am. Academy of Child and Adolescent Psychiatry, April, 2000.

[2] “TV Makes for Restless Kids – Watching TV before bed may cause sleep problems”,  By Tammy Webber, The Associated Press,

[3] Dr. Thomas Roth, board member of the National Sleep Foundation and director of research at the Henry Ford Hospital sleep clinic, as reported on Dateline MSNBC.

[4] The Sleep Apnea Society of Alberta, webpage