Attention-deficient/hyperactivity disorder (ADHD) gets a bad rap. That girl at the back of the classroom who can’t sit still? ADHD. That co-worker who takes forever to get things done? ADHD. ADHD is a common neurodevelopmental condition affecting around 5% of children and adolescents globally. For about two-thirds of these children, ADHD symptoms will persist into adulthood. As the name suggests, ADHD symptoms encompass inattention, hyperactivity, and impulsivity. But what does ADHD have to do with snoring?
ADHD and Sleep
It’s known that up to 50% of people with ADHD have co-existing sleep problems. These include insomnia (difficulty falling asleep), late bedtimes (due to a disruption to the body’s normal wake-sleep clock), restless legs syndrome (a type of periodic limb movement disorder involving a tingling sensation in the legs), narcolepsy (suddenly falling asleep during the day) and sleep-disordered breathing (including snoring and sleep apnea). Different types of ADHD can be more strongly related to different sleep disorders. For example, people diagnosed with mainly hyperactive-impulsive ADHD tend to be more prone to insomnia compared to someone with predominantly inattentive-type symptoms.
The relationship between ADHD and sleep disorders can be complex. ADHD symptoms can cause problems with sleep; sleep disorders can cause or imitate ADHD symptoms. ADHD and sleep problems can also interact and exacerbate each other. And possibly, ADHD and sleep disorders may share a common underlying cause.
Because of the complicated link between ADHD and sleep disorders, some experts believe that children can be misdiagnosed with ADHD when in reality their true issue is an underlying sleep problem. Plus, both ADHD and poor sleep quality can lead to problems functioning during the day, which makes it even more difficult to dissect exactly what is causing the problem. To make the situation even more complicated when it comes to children – is this child not paying attention in class because they’re tired from a bad night’s sleep, or do they have ADHD, or is the lesson simply boring them out of their mind (or all the above)?
Snoring and Sleep Apnea in ADHD
Around one-third of people with ADHD will experience sleep-disordered breathing, a range of conditions covering obstructive sleep apnea (OSA) and primary snoring (simple snoring without other associated problems). One study suggests that chronic snoring is found more often in people with predominantly hyperactive/impulsive-type ADHD.
It’s been well-documented that OSA can lead to changes in behavior and mental functioning during the day. OSA involves frequent pauses in breathing during sleep, which causes the body to wake up (even if you don’t recall waking). Understandably, this cruddy night’s sleep can make one feel excessively tired and grumpy during the day, leading to the characteristic symptoms of OSA. These symptoms, such as irritability, and difficulties with concentration and memory, can mimic those commonly found in ADHD.
The lines between ADHD and sleep apnea can be so blurred that one of the recommendations by the American Academy of Pediatrics is to screen children for sleep apnea as part of an evaluation for ADHD. Having a diagnosis of a sleep disorder such as OSA can modify the approach a doctor may take to manage a person with ADHD.
What Can be Done About Sleep Apnea and Snoring?
OSA is a serious health concern even for those without ADHD. It’s associated with hypertension (high blood pressure), heart attack, strokes, irregular heartbeat, liver problems, and type 2 diabetes. Even without these complications, the symptoms of obstructive sleep apnea are not particularly desirable:
- Loud snoring (as reported by your unfortunate bed partner)
- Dry mouth
- Headaches in the morning
- Poor quality sleep
- Excessive daytime fatigue
- Difficulties with concentration and memory
- Irritability
For people with ADHD, as sleep apnea can both exacerbate ADHD symptoms as well as complicate an ADHD diagnosis, it’s worthwhile addressing the OSA first.
In children with sleep apnea and suspected ADHD, doctors typically recommend surgically removing the adenoids and tonsils in a procedure called an adenotonsillectomy. These structures can often be the culprit for causing snoring and OSA in children as they partially obstruct the airways during sleep if they’re large. Multiple studies have reported that treating OSA with an adenotonsillectomy can result in improvements in behavior, academic performance, and ADHD-related symptoms, including hyperactivity. By treating OSA with an adenotonsillectomy in children with ADHD, it may also be possible to reduce or eliminate the medications needed to manage the ADHD symptoms – a win-win on all fronts.
When it comes to adults, continuous positive airway pressure (CPAP) treatment is more appropriate and has also been shown to help with ADHD symptoms. CPAP therapy involves wearing a mask during sleep to deliver a positive air pressure. This helps to keep your upper airways open and maintain that precious oxygen flowing into your lungs.
Getting out your child’s tonsils isn’t guaranteed to boost their literacy skills at school or make them pay attention to everything you’ve asked them to do. However, the research does tell us that there is an undeniable association between ADHD and sleep disorders, including sleep apnea and snoring. Treating underlying obstructive sleep apnea could possibly be the key to managing ADHD symptoms in some people (while maybe boosting literacy skills), and so is always worthwhile investigating.
If you have a child with ADHD and problems sleeping, contact our ENT Doctors today to schedule an appointment for an evaluation.