ADHD and Sleep

People say things like this to us all the time, “My child is so hyper in the late afternoon – I’m sure he has ADHD.” This may be true. Another possibility is that a hyperactive child is over-tired. When a child is not getting enough sleep, his body makes more cortisol and adrenaline so that he can stay awake. Those hormones are his body’s way of fixing a problem, only, it’s a poor fix. When children are too tired, they can’t fall asleep when they need to and are missing out on important sleep time – time when their brains should be processing the day’s events, the learning that occurred and the emotions that were felt. Being overtired looks a lot like ADHD (attention deficit hyperactivity disorder).

A study summarized here on WebMD suggests that many children are misdiagnosed and in fact, are overtired. This doctor found that children who are getting the ADHD diagnosis mistakenly are children who sleep in a bed with their parents and who do not have a consistent bedtime. He emphasizes that sleep and ADHD are very complicated in their correlation. That is, many children with ADHD have a hard time with sleep and because they are missing sleep, their behaviors are more hyperactive. Of course, we don’t mean to say that all children who are getting an ADHD diagnosis are actually simply overtired, but we are saying that before you seek out this diagnosis for your child, it might be helpful first to examine how much sleep he’s getting and how firm your parenting is around sleep routines.

As with all children, it is important for children who have ADD/ADHD to have a very predictable and consistent pre-bed/nap routine and bedtime. For children who seem more active and who have more challenging behaviors, you might try some or all of the following:

  • Although your child may not want to nap anymore, we highly recommend that children (through kindergarten) take an hour every day for “quiet time.” Alone in her room playing quietly.

  • A weighted blanket may also be helpful. We use these blankets with kids who really find comfort in physical pressure (like hugs). Here’s just one weighted blanket – you can find more on Amazon.com.

  • Dim lights are really important 30 minutes before you would like your child to fall asleep – it helps your body produce more melatonin (the sleep hormone).

  • Limit screen time and no screens after 5pm. If you have a child who seems hyperactive, you might consider limiting screen time to an hour a day and should certainly not allow her to look at a screen within a few hours of bedtime.

  • Try an earlier bedtime – although it is counter-intuitive, your child may be overtired. Try moving bedtime a half hour earlier for 5 days and see what happens. If it’s been working, you can even try another half hour the following week.

  • Be patient! This is so hard – we know! When you’re dealing with a challenging child, it is easy to let your emotions rise to the surface. However, your child can tell how you feel and often, our emotions only escalate our children’s behavior.

If you have tried all of the above and are still finding that your child’s behavior is impulsive and hard to manage and if others who are with your child outside your home (teachers, care-givers) agree, it would be beneficial for you to speak to your child’s doctor and/or a developmental pediatrician.

Back to School…Hit the Hay!

My daughter returned to preschool this week. Last year, after struggling at bedtime and with her waking a few times every night, we moved her bedtime back to 6:30 and all of our problems were solved. (Granted, we did have to pick her up from school 30 minutes earlier than we had been, and we had to shift bath time to the morning.) This year, I thought, “Well, she’s older now and hasn’t gone to bed that early all summer…we’ll go back to a 7-7:30 bedtime.” Boy, was that a mistake! Margo clearly needs more sleep, especially when she’s using her mind and body so much more at school. After two days of total melt-downs around dinner time, my husband and I agreed that bedtime had to be shifted earlier again and, after one night, it worked! We all slept through the night and had a pleasant morning before school. Everyone was happy and I know that our daughter is much better equipped to deal with the excitement of learning.

There was a fascinating article printed in NY Magazine a while ago that is worth reading. As our kids head back to school, we need to think about the importance of sleep and how it affects their ability to learn and develop. This article explains that even a short period of time (a half hour) can have a huge impact on our kids. The research indicates that for every hour of sleep lost, 2 years of cognitive and maturational development are lost. In addition, we learn from the article that a shift in sleep times (they gave the example of letting kids stay up later on weekends) also has a negative impact on ability to learn.

Bottom line: our kids need sleep. While we don’t like to give hard and fast numbers for how long your child should sleep, we have heard from pediatricians that school-aged children still need anywhere from 10-12 hours of sleep per night. Melissa and I have found that our children have a pretty large sleep need and our kids tend to do best when they can get the maximum amount of sleep possible. As parents, it is really important that we have consistent bed times and that we allow our children to sleep for as long as possible. If you have a child in school, it is important to maintain your routine even on weekends (when possible).

Check out our Bedtimes by Age guidelines. Figure out what time your child needs to wake up in order to get to school on time and count backwards to find the suggested bedtime. Tell us what you think – are your kids getting enough sleep? Do they have trouble adjusting when going back to school? If you struggle getting your child to bed or find that he’s grumpy in the morning or throws tantrums in the late afternoon, give an earlier bedtime a try for a few weeks and let us know if you see an improvement.

 

Simplifying Bedtime

Kids need plenty of sleep to stay healthy and happy, and an age-appropriate bedtime is key. Kids also thrive on routine, so try to keep your bedtime activities as regular as possible. It’s so important to get your kids to bed early enough to enable them to get the sleep they need, but this means parents sometimes miss out on playtime at night or even seeing their children awake at the end of the day. Please let them get to bed on time, and try to find other times to spend with them – maybe making more time in the morning or spending special quality time during the weekend.

If you find that your bedtime routine and kids’ antics are dragging on longer and longer, here are three tips to help you get your kids to sleep on time. 

  1. START EARLY
    This may be tough if you work a long day, but the bedtime routine can even start before you or your kids get home. If your child is at daycare until the early evening, ask your provider if she can feed him dinner or change him into his PJs before you pick him up. That will be one less thing you have to do once you get home. The goal with a bedtime routine is to slow down and begin readying the mind and body for sleep. By starting the process earlier, it gives you and your kids the opportunity to ease into bedtime without increasing stress or rushing to beat the clock. And please try to turn off the TV at least an hour before bedtime!

  2. SIMPLIFY
    Cut down your routine to the basics. Think about what things you can do at other times of the day. For example, ask your nanny to bathe your little one during the day (maybe before a nap). Read more stories at other times of the day so that you can just have one special book before bed. If you are transitioning from a longer routine, cut back gradually over a few days to allow your child to adjust to the shorter routine.

  3. WRITE IT DOWN
    Regularity is key, so list the steps, order, and timing of your routine. It will help you be consistent, but it will also enable other caregivers to follow the routine if you aren’t there. For toddlers and older children, try making a simple picture chart of the routine that they can follow to keep the bedtime simple and fun. You can even reward following the routine and completing the steps by giving stickers or other positive reinforcement.

For more sleep tips, please see our Rules to Sleep By.

Bedtime Routines: Your Questions Answered

As sleep consultants, we focus quite a bit on establishing bedtime routines with our client families. Parents seem to have lots of questions about bedtime routines: Why do we need one? When should we start a bedtime routine? What should we include in the routine? How long should it last? What makes a good bedtime routine? Read on…I’ll answer each of these questions right now. Continue reading…

Bedtimes by Age

This month, Sleep Sisters is focused on bedtime. We thought it best to start off with a review of age-appropriate bedtimes. As certified infant and child sleep consultants, we are often asked what time kids should be going to sleep and whether it really makes a difference.

The answer is YES, the time your child goes to sleep does make a difference. We all have a biological clock and our circadian rhythms can help us sleep if we honor them by getting to bed at the right time. In addition, maintaining a consistent bedtime (and wake time) helps keep our internal clock “set” and is a critical part of healthy “sleep hygiene,” according to Harvard Medical School’s Division of Sleep Medicine.
Continue reading…

Post-Vacation Sleep Blues

It’s holiday time, and for many of us, that means packing up the kids and taking a vacation. Even if your kids are sleeping well and you have a great routine, a vacation can throw a wrench in the works. Most of us can make it through even the worst sleep situations while on our trip, but when you return home, you want everything to fall back into place, right?

Sometimes returning from vacation brings even more sleep challenges. Many kids revolt once they return from vacation – tantrums at bedtime, night waking, early rising, and more. Why do they torture us after we took them on such a lovely trip?

Kids crave routine and regularity. Even on a short vacation, they come to expect that whatever the sleeping situation was there will continue. So when they get home and find that they can’t share a room or a bed with the family, or that they have to go to bed earlier, they have something to say about it.

Here are 5 tips to help you transition back to your home sleeping routine:

  1. Articulate the rules. The adults in the house need to be on the same page so everyone can enforce the rules and routine. Explain to your kids (even the little ones can understand) that vacation was a special treat, and now that you are home, you are going to return to our house rules. Write down the rules and routine to remind the older kids.

  2. Clear your schedule. For the first several days after you return from vacation, try not to plan any activities late in the day. Keep it simple and stay close to home. Then you can make sure your evening routine is calm, unrushed, and the kids get to bed on time. Your kids may be overtired from less than ideal sleep on vacation, so consider an earlier bedtime for the first week you are home.

  3. Reinforce the routine. Chances are that your routine while on vacation was different from your normal routine at home. When you return, remind your kids of their bedtime routine and stick to it strictly the first week or two after vacation. With younger children who still make, make sure their daytime schedule is back on track and naps are at the right times. Use positive language not just about vacation, but also about how nice it is to be home. “Isn’t it great to be back in your own bed with your animals?” Give small rewards to congratulate your children when they get it right.

  4. Give extra attention. While not strictly linked to sleep issues, I think that kids get used to having more of our attention when we are on vacation. Once we return home, to our jobs and our daily lives, we may not be spending as much quality time with the little ones as we were while away. So kids may seek that extra time with us during the night or at bedtime. To keep from creating bad nighttime habits, try to pay a little extra attention to the kids in the daytime if possible. Or plan some special time for the weekend and discuss that with your child during the week.

  5. Expect some setbacks. Try to manage your own expectations. As your kids adjust to life at home again, they may wake during the night or very early in the morning. If you are suffering from jet lag, assume your kids are suffering even more. While these disruptions may be frustrating, it is normal and kids take a few days to a couple of weeks get back on track.

 

Vacation Update: Smooth Sailing

I last blogged before my family left for a one-week beach vacation with extended family. I wasn’t worried about my kids’ sleep, but I will admit I was stressed. Travel is always a challenge, and it’s always unpredictable. Change can be hard for kids, and for some adults, too. So how did we fare? It wasn’t perfect, but it was pretty darn good. Continue reading…

Dads: Nighttime Warriors

This week, as I continued to think about the role fathers play in helping babies sleep, I asked my friends and clients, “What is the one thing your partner does that you find most helpful?” The response was overwhelming. Mothers of infants and young children told us that the most valuable contribution fathers make is getting the baby back to sleep during the night.

Our personal experience and our experience as sleep consultants has demonstrated that when dads respond to baby’s cries during the night, the whole family gets back to sleep more quickly. So we wondered, why are dads so great at getting babies to sleep during the night. We have a few ideas.

  1. Dads don’t have boobs. That’s right, I said it. Dads don’t have the goods…i.e. milk. If Mom is breastfeeding, the baby can smell it when she gets near. And many breastfeeding mothers experience let-down when they hear crying. So if Mom responds during the night, chances are baby is going to want to eat. Once your baby is old enough to sleep through the night and you have stopped night feeding, best to send Dad in to help soothe the baby back to sleep and keep milk out of the equation.

  2. Dads don’t have crazy hormones. Debbie told me the story about how when her daughter would cry during the night, she would sit in bed squeezing her husband’s hand on the verge of tears herself until the baby settled down again. Woman deal with hormone changes during and after pregnancy, and for some women, hearing her baby cry, especially during the night, can trigger emotional and physical reactions. In response, we often want to go to our babies and hold them, rock them, physically bond with them. This is a perfectly natural response, but it can interfere with the baby’s sleep, her ability to learn self-soothing skills, and it interrupts Mom’s sleep. Dad, on the other hand, seems less affected by these physiological responses to baby’s cries, so he can go in with minimal disruption and quickly settle the baby back to sleep, and then get right back to sleep himself.

  3. Dads are problem solvers. Please don’t call me sexist…I’m actually more of a problem-solver myself. What I mean here is that dads typically approach night waking in a very tactical sense. “What is the problem and how can I fix it?” During sleep time, the ability to quickly assess the situation, address the problem, and get out is critical so that the entire family can get back to sleep. While many dads we know are also very nurturing and do a great job of soothing (see last week’s post), during the night, speed is king.

Some clients who stay at home with their babies tell us that they are reticent to have their husbands get up during the night when they have to be at work during the day. On days when Dad has a critical meeting or presentation or business trip, then let him sleep the night before. But sometimes, having a well-rested mom is just as important. So on days when Dad can deal with being a little more tired, ask him to have a try.

To avoid sleepy arguments during the night, before you turn in for bed agree who is “on duty” for the night shift and what your strategy will be (e.g. let the baby cry for 20 minutes to see if he can soothe himself back to sleep, then go in to check). And be sure to let Dad know that dealing with baby during the night is the most helpful thing he can do for you!

Have a Happy Fathers’ Day!