|
Many of the
conditions described on this web site are
associated with sleep disturbances. The following
is just a brief overview:
ADHD and Sleep
Problems
- 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.
Could treating the
PLMS impact the symptoms of ADHD or school
functioning? In an intriguing pilot study, 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. We do not know, at this time, what effect
the stimulant medications usually used to treat
children with ADHD might have on their sleep
patterns.
*Permax
(pergolide) was withdrawn from the market in March
2007 at the request of the FDA due to concerns
about heart valve damage.
Mood Disorders and
Sleep Impairment
Depressed patients
commonly complain of difficulties initiating sleep,
maintaining sleep, and awakening early in the
morning, and as any parent of a child or teenager
with depression will tell you, getting depressed
children up for school in the morning is a
herculean task.
Hypomania and mania
are features of Bipolar Disorder, and are also
associated with sleep disturbance. Sometimes the
first warning sign that a child or adolescent is
going into a hypomanic or manic phase is that they
go without sleep for one or two nights, but do not
report feeling tired.
The treatment of
unipolar or bipolar depression is complex, and if
establishing good sleep hygiene via habits and
lifestyle changes isn't sufficient, a referral to a
sleep specialist may be indicated.
Tourette's
Syndrome and Sleep Problems
Children and
adolescents with Tourette's Syndrome
(TS) report significantly more sleep problems
than their non-TS peers. In boys with TS, sleep
problems occur even more often when there is also
comorbid Attention Deficit Hyperactivity Disorder.
Children with TS are more likely to have disturbed
sleep quality and efficiency. For children or
teenagers with Tourette's, sleep onset may be
delayed because they first have to "get their tics
out." They lie down to go to bed and may
tic explosively or vigorously for an hour or
more.
Obsessive-Compulsive
Disorder and Sleep Problems
Children and
teenagers with Obsessive-Compulsive Disorder also
experience sleep problems, but of a different kind.
Students with OCD may stay up late into the night
working to get a paper "perfect," or may be so
anxious about a school assignment that they can't
get a good night's sleep. Other children and
adolescents with OCD may have time-consuming
rituals that they must engage in at night that
prevent them from getting to sleep at a reasonable
hour: toys must be lined up "just so," there may be
extensive and time-consuming hygiene rituals
instead of just being able to take a quick shower
and get to bed, the bedding must be in a particular
way, or they may have extensive "good night"
rituals involving a parent. These are just some
examples.
Autism/Asperger's
and Sleep Problems
Sleep problems have
long been noted in autistic children, but the
impression of the extent and nature of difficulties
depends, in part, on what methodology the
investigators use to study the problem. Of
particular note for educators is a study by Elia et
al. (2000), who found that some of the sleep
measures were significantly correlated with the
child's functioning. Nonverbal communication showed
significant correlation with sleep period time,
wakefulness after sleep onset, and total sleep
time. Relating to people and activity level items
were found to be significantly correlated with
rapid eye movement density.
|
