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Information
Section: Conditions
Condition:
Sleep
Disorders
Source: Leslie E. Packer,
PhD
This File Last Updated:
February 2009
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2
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SLEEP DISORDERS
- OVERVIEW
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Sleep disorders are
an important contributor to problems for
adults, teenagers, and yes, even young
children.
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INTRODUCTION
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How common are sleep problems in the general population?
Owens et al. (2000) reported that 37% of school
children they tested (from grades K - 4) suffered
from at least one sleep-related
problem.
For adolescents, Roane and Taylor (2008) found that 9.4% reported symptoms of insomnia. Insomnia symptoms correlated significantly with use of alcohol, cannabis, and drugs other than cannabis; depression; suicide ideation; and suicide attempts. Insomnia symptoms during adolescence predicted depression in young adulthood. Their findings suggest that if an adolescent is reporting insomnia on a regular basis, they may need treatment that might help prevent developing other problems or depression in young adulthood.
Sleep disorders
contribute significantly to academic, motoric,
behavioral, and social-emotional difficulties, but
Restless Legs Syndrome, Periodic Limb
Movements of Sleep, narcolepsy, insomnia, and sleep
apnea do not all have the same effect on daytime
functioning. Because children and teenagers with
the kinds of neurobehavioral disorders described on
this web site are likely to have sleep-related
problems, this article will provide a brief overview of
some different types of sleep
disorders and what we know about the kinds of sleep problems associated with different disorders.
In addition to sleep
problems described below, it is important to note
that some children and adolescents also suffer from
sleep-related side effects of medications that are
used to treat the disorders. Stimulant medications
used to treat Attention Deficit Hyperactivity
Disorder, medications used to treat mood disorders,
and some of the medications used to treat tics can
all produce sleep problems that can affect the
child in the classroom.
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TYPES OF SLEEP DISORDERS
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Insomnia
Out of all the sleep
disorders, the one most familiar to the public is
insomnia. Insomnia is a sleep disorder
characterized by difficulty falling asleep,
difficulty staying asleep, and/or poor quality
sleep. Insomnia can lead to difficulties in daytime
functioning and psychological distress. Although
estimates of how common insomnia is have varied
across studies, insomnia appears to occur in about
10% of the population, and is more common in women
and the elderly. As Walsh (2004) summarizes:
although insomnia is often perceived as a symptom
of depression, it is also both a precursor of
depression and is associated with a substantial
increase in the relative risk of major
depression.
Restless Legs
Syndrome
Restless legs
syndrome (RLS) is a neurological disorder
characterized by sensations of discomfort in the
legs during periods of inactivity. People with RLS
report sensations of crawling, creeping, and/or
pulling or tingling. The sensation causes an
irresistible urge to move the legs, and the
discomfort is generally relieved by moving or
stimulating the legs. RLS symptoms usually occur
before sleep onset and make it difficult for the
individual to fall asleep.
Periodic Limb
Movements of Sleep
Periodic limb
movements of sleep (PLMS) involves episodes of
repetitive, stereotyped limb movements during
sleep; these movements are usually leg movements
and associated with increased awakenings during the
night. The individual may not be aware of these
movements and/or of the awakenings.
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RELATIONSHIP BETWEEN OTHER DISORDERS AND SLEEP PROBLEMS
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Many of the
conditions described on this web site are
associated with sleep disturbances. In some cases, such as mood disorders, sleep disorders are even part of the diagnostic criteria. The following
is just a brief overview of some of the research on various disorders and sleep problems:
ADHD and Sleep
Problems
Sung, Hiscock, et al. (2008) investigated the prevalence of sleep problems in 239 children with ADHD and attempted to correlate sleep meausres with quality of life (QOL), daily functioning, and school attendance; caregiver mental health and work attendance; and family functioning. The study did not use objective measures of sleep problems, and used caregiver reports as their mesaures of severity of sleep problems, if any. They found that sleep problems were common: only 26.7% of caregivers reported that the child had no sleep problems, while 28.5% reported mild problems and 44.8% reported moderate or severe sleep problems.Moderate or severe sleep problems were associated with poorer child psychosocial QOL, child daily functioning, and caregiver mental health (yes,if our kids have moderate or severe sleep problems, it can stress us out: children with sleep problems are more likely to be late to school, and parents are more likely to be late to work). But what kind of sleep problems do children and adults with ADHD have?
In 1999,
Picchietti et al. reported that unmedicated
children who were newly diagnosed with ADHD had
significantly more periodic limb movements in
sleep (PLMS), and that they had significantly
more arousals (awakenings) and overall less
sleep than their non-ADHD peers. Similarly,
Owens et al. reported that children with ADHD
had more difficulty falling asleep and staying
asleep than their non-ADHD peers, and
recommended that all children with ADHD be
screened for sleep disturbances, particularly
sleep-disordered breathing. More recently, Cortese et al. (2005) found that 44% of clinical samples of patients with ADHD have Restless Legs Syndrome.
Sobanski et al. (2008) investigated sleep problems in adults with ADHD using objective and subjective measures. Compared to non-ADHD controls, adults with ADHD demonstrated more nocturnal activity, reduced sleep efficiency, more nocturnal awakenings, and and reduced percentage of REM sleep.
Could treating the
PLMS impact the symptoms of ADHD or school
functioning? In an intriguing pilot study by Walters et al. (2000), 7
children with ADHD and PLMS or ADHD and
Restless Leg Syndrome (RLS) were given monotherapy
with either levadopa or pergolide* (both medications
affect dopamine levels in the brain). The
investigators reported that after treatment, three
children no longer met the criteria for ADHD and
three reverted to normal on the Test of Variable
Attention. ADHD symptoms improved in all seven
children (as measured by both the Connors and the
Child Behavior Checklist). A significant
improvement also occurred in the visual, but not
verbal, memory scores on the Wide Range Assessment
of Memory and Learning. Five of the seven children
continued on dopaminergic therapy for at least 3
years after treatment initiation with good
response.
The stimulant medications typically used to treat ADHD all list insomnia as a possible side effect. Research by Corkum et al. (2008) confirmed that although methylphenidate was effective in treating the symptoms of ADHD in children, it resulted in significantly less total sleep time and significantly longer latency to sleep. In adults with ADHD, however, methylphenidate appeared to improve sleep. Sobanski et al. (2008) found that methylphenidate improved sleep efficience as well as subjective feelings of improved restorative value of sleep.
Shochat et al. (2009) studied 45 children with ADHD. Not surprisingly, they found a correlation between parental reports of sleep problems and behavior, but the relationship was not as strong as we might have expected once they took sensory defensiveness into account.
Tactile sensitivity was a was a significant predictor for sleep, while sensation seeking and tactile sensitivity were significant predictors for behavior. Although this was just a preliminary study, it suggests that treating any tactile sensitivity might improve sleep and improve behavior.
Continue to Page 2
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Information
Section: Conditions
Condition:
Sleep
Disorders
Article: About Sleep
Disorders
Source: Leslie E. Packer,
PhD
This File Last Updated:
February 2009
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Page 1 of
2
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Tourette
Syndrome "Plus" © Copyright 1998 - 2009 Leslie
E. Packer, PhD. except as noted.
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This page last annotated February 5, 2009.
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