10 strategies to help ADHD-related sleep issues in children
by Shea Brogren, MOT, OTR/LJanuary 31, 2018
Between 6 and 10% of the population has a diagnosis of ADHD. Typically, this diagnosis is made during early childhood. Children diagnosed with attention-deficit hyperactivity disorder present with difficulties in the areas of impulse control and attention.
Some common characteristics of childhood ADHD may include trouble maintaining focus on activities, trouble following directions and listening, trouble sitting still or fidgeting, displaying excess amounts of energy, interrupting others or blurting out, difficulty with organization, becoming distracted easily, being impatient, and frequently forgetting things or losing items.
A formal diagnosis of ADHD must be made by a trained professional, typically a psychiatrist or psychologist, in collaboration with your child’s pediatrician.
Children with ADHD also commonly have trouble with sleep. Studies have shown that children with ADHD have more issues with sleep when compared to children without ADHD. These issues include daytime sleepiness and sleep-disordered breathing. In addition, sleep deprivation can increase symptoms of impulsivity, hyperactivity, and difficulty with attention.
Sleep issues are also commonly linked with behavioral problems, which are also often commonly seen in children with ADHD. Overall, there are several potential links between ADHD and sleep difficulties in children. This article will highlight the most common issues children with ADHD encounter in terms of sleep and ten ways to help sleep-related issues in these children.
Sleep Issues in Children with ADHD
There are several types of issues with sleep experienced by children with ADHD. Some children might display one characteristic, while others might experience all issues described.
The first, most common issue is initiating sleep. Children with ADHD often present with high energy levels and this can make it difficult to initiate sleep at bedtime. For many families, this can often lead to power struggles and, in turn, behavioral issues associated with bedtime.
Another common sleep issue is difficulty maintaining sleep. Children with ADHD often awaken during the night, which is highly disruptive to sleep. There are several potential causes of this including restless legs, sleep apnea, or a general restlessness at night. Due to the previously mentioned issues, many children with ADHD also have difficulty waking in the morning. Often, waking a child with ADHD becomes a difficult task.
Children with this issue often experience periods of daytime sleepiness or fatigue, in addition to periods of intense hyperactivity or impulsivity. Finally, there may be difficulty with consistent sleeping. For example, they may get 8 hours of sleep one evening and 6 the next evening. Again, inconsistent sleep patterns can have an impact on overall behavior and attention.
How can we help sleep-related issues in children with ADHD?
There are several ways to assist with the sleep-related issues that children with ADHD experience. Many of these strategies can be implemented into a child’s routine, while others require consultation with your pediatrician. Below is a list and description of ten potential strategies to address sleep-related issues.
Implement a consistent night-time routine: Most children in general require guidance when it comes to maintaining a consistent bedtime routine. Children with ADHD might need additional assistance, due to distractibility and inattention. A consistent routine will help trigger the brain to relax and prepare for sleep, which can assist with initiating and maintaining sleep for these children. An example sleep routine might include completing hygiene tasks, putting on pajamas, engaging in a calming or wind-down activity, and then bedtime.
Keep bedtime within the same half hour each night: As discussed above, routine and consistency are both important when it comes to addressing sleep-related issues. This should include a consistent time for going to sleep. It is recommended to keep bedtime within a half hour time period each night. For example, setting bedtime between 9 and 9:30 PM each night. This gives some room for flexibility, but maintains the routine, which is critical.
Implement calming strategies and limit screen time before bed: Calming strategies are helpful ways to assist your child’s body and mind with settling before bed. Each child will have their own unique needs and strategies that work best for them. Some might include taking a bath or shower, reading a book or magazine, listening to calming music, etc. It should be noted that activities that involve screen time, such as phone use or watching tv should be stopped at least two hours before bed. The light emitted from screens can actually trigger the brain to stay awake, which can only make sleep problems worse, especially for children with ADHD.
Get enough activity during the day: For children with ADHD, it is essential that they have sufficient time during the day to expend any additional energy. This will assist with falling and staying asleep. A sensory diet may be beneficial to your child. This is a term used to describe a prescribed list of activities, completed at certain times of the day, to assist with helping your child meet their unique sensory needs. An occupational therapist can help you further explore this option. However, you can also assist your child with getting enough activity in during the day, to assist with energy expenditure. Simple activities such as running, playing sports, going on a walk, and doing jumping jacks are great ways to encourage movement throughout the day. Exercise or active activities should be completed three hours before bedtime to ensure sufficient time for the body to calm down.
Limit caffeine intake: If possible, drinks or food with high caffeine amounts should be avoided for children with ADHD, especially in the evenings. Caffeine activates our brain centers, which is the opposite of what needs to occur to ensure healthy sleep.
Try a weighted blanket: A weighted blanket can be an effective way to help children with ADHD fall asleep and stay asleep. A weighted blanket provides extra input or weight to your child’s body. This additional weight stimulates the muscles, which signals the brain to release calming hormones. These hormones are responsible for helping us sleep. Check out Harkla’s weighted blanketshere, if you are interested in trying this.
Take a look at your child’s sleep environment: To ensure proper sleep, your child must have an environment that is set up to promote healthy sleep. There are some environmental modifications that can be made to assist with better sleep. This might include darkening the room with room darkening shades, using a white noise machine or a sound machine, ensuring the temperature is between 68 and 71 degrees fahrenheit during the evening, etc. These options might take some exploration with your child, to find out what works best for them.
Make sure important tasks are completed before beginning nighttime routine: Children with ADHD often struggle with organizing tasks. Therefore, it is important to help your child develop some type of organizational system, to ensure that important tasks, such as homework or gathering lunch money or other supplies for the next day, are completed before the nighttime routine starts. This helps ensure that your child can focus their mind on unwinding and preparing for sleep, other than worrying about the tasks needing to be completed for the next day. A simple checklist with visuals can assist your child with implementing a routine and remembering to complete important tasks.
Use an alarm as a cue: Many children with ADHD respond well to cues in their environment. It might be helpful to set some type of alarm each evening, indicating it is time to begin the nighttime routine. Repeated use of an alarm can help the brain adapt better to the routine. In addition, it may be useful to set an alarm in your child’s room, 10-15 minutes before they need to get out of bed to begin their morning routine. Again, this is a helpful cue for your child and can help them self-initiate their routine.
If you need additional help, talk to your child’s pediatrician: If you’ve tried these strategies and they haven’t been successful, it is best to discuss options with your pediatrician. Your child’s doctor may be able to recommend sleep aids, such as melatonin. If your child takes a stimulant medication, it is important to note that a side effect may include sleep problems. Your child’s doctor should be notified, as the time your child takes his or her medication or the dosage may need to be adjusted, to facilitate better sleep. A pediatrician can assist you with exploring these options further.
When your child is having difficulty with sleep, chances are that you and your family are also not sleeping well! Sleep is restorative and critical for everyone, so it is important to address these issues.There are several possible strategies to try, which can be implemented into your child’s daily routine. Some may need further exploration with your child’s pediatrician or an occupational therapist.
Overall, it is important to know that there are options when it comes to helping your child and family get the sleep they need!
Foitzik, K., & Brown, T. (2018). Relationship between sensory processing and sleep in typically developing children.American Journal of Occupational Therapy, 72,1-9.
Spruyt, K., & Gozal, D. (2011). Sleep disturbances in children with attention-deficit/hyperactivity disorder.Expert Reviews on Neurotherapy, 11(4), 565-577.
Shea Brogren, MOT, OTR/L
Shea Brogren, MOT, OTR/L, is an occupational therapist with over three years of experience in pediatrics and child/adolescent mental health and has also worked as an adjunct lecturer at the University of North Dakota. Shea has a special interest in program development and developed and implemented occupational therapy programming at a residential treatment center for children. She now practices in an outpatient setting. Her primary area of interest involves working with children who have experienced developmental trauma. Shea has advanced training in: SMART treatment (Sensorimotor Arousal Regulation Treatment), the Zones of Regulation, using sensory-based interventions to address trauma, infant mental health, attachment, and arousal regulation related to trauma disorders.