When the Throttle is Stuck: Sleep patterns among ADHD Children
I have written previously about the value of a good’s night’s sleep and what it takes to get one (see my Articles archived at www.simplesolutions4.com, “Counting Sheep” and “Never Underestimate the Power of a Good Night’s Sleep”). In this article, I would like to update you on addition research regarding insomnia and particularly the sleep difficulties related to children.
As with the previous articles on sleep, I write this article not only as a clinician-researcher psychologist, but as a parent. I will present a few summaries of empirical research and then let my hair down a little and tell you our experience as new parents of a sibling group that we adopted into our home last December. Let’s begin with brief summaries of some research.
Most of the interventions that I recommend come from my almost 30 years of clinical practice. A few come from personal life experience. Sleep is one of those that I can speak for myself. Particularly falling asleep. I can remember as a young teenager being frustrated, cranky, and in tears at 2 or 3 am because I could not fall asleep. This short article comes from both my clinical experience and my personal life. I know what its like to not fall asleep easily!
While the reasons one does not fall asleep easily may be diverse, basically reasons titrate to a few common scenarios. The first involves stress and anxiety. This one can go either way. Sometimes the body’s reaction to stress is exhaustion and hypersomnia (lots of sleep). Other times, the mental accelerations that characterize anxiety make it very difficult to fall asleep. This is when a person lays there rehearsing the day, trying to organize tomorrow, wondering where the money is coming from for the bills and wondering how Aunt Lucy on his mother’s side twice removed is doing! Everything is a mental spin and falling asleep entwines with the anxiety in such a way that keeps the systems going and the eyes open!
The second scenario is a bit more insidious. This scenario occurs when someone experiences chronic difficulties falling asleep. No particular stressors. No particular problems. The bills are paid and life deals no more than its usual cards in your direction.
Finally, a third scenario is common in ADHD children and is related more to biological factors. ADHD children (and adults) are noted for their fitful, restless sleep as if they are in some sort of WFC bout with the bed!
No matter the causes, there are a few simple solutions for sleep problems. Here they are:
1. Take a page from the Jungle Book. Disney’s animated movie, The Jungle Book, featured a wildly funny bear singing a song that had a line something to the effect of “forget about your troubles and you cares”. When you lay down at night, consciously lay your concerns on the floor beside you. Literally! Write them down on a sheet of paper and place them on the floor. Whenever you start to think about them remind yourself that your concerns and problems are on the floor where you can pick them up in the morning and tell yourself “I just can’t think about that right now!” If it is your child having difficulty falling asleep, go into their room and read them a bedtime story or give them a chance to vent their concerns. Do the same thing with their problems, writing them on a piece of paper and then leave the room with the piece of paper. Remind them that they can have the paper in the morning but in the meantime, they are not allowed to think about such things. This is powerful modeling that will follow your child for life.
2. Make the room as dark as possible. Many times we try to fall sleep using such things as late night TV, hall lights, etc. This actually works against your body’s natural sleep mechanisms. The same brain structure that is responsible for releasing substances in your brain that signal feelings of tiredness and sleep also works off light. It is called the Pineal gland and it releases melatonin. However, the Pineal gland also responds to light in an activating way and the bottom line is, light trumps melatonin! You won’t fall asleep if you’re thinking you’ll just watch the TV until you get sleepy. That may take a while. Note: if your child is afraid of the dark, lay down on the floor next to his/her bed and tell them a story. Make something up or tell them about when you were a kid. Kids love the time, get to know you better and it provides some time for the Pineal gland to kick in!
3. Use a MELATONIN supplement. I’ve already discussed the actions in the brain and the importance of Melatonin. It is what makes you fall asleep. Some brains have more than others. Babies and teens often have lots of melatonin. Elderly, ADHD brains and stressed out types generally have less. I prefer a liquid form of Melatonin such as the one marketed by Biometics (Order from www.mindofhope.com). It is micellized, goes easily under the tongue via a dropper provided with your order, has much higher absorption rates and since it is taken sublingually the absorption is much faster. It is an inexpensive way to enhance your ability to fall asleep. In my own case, I struggle tremendously to fall asleep without it!
One final note about Melatonin. Contrary to folklore, it is safe with children*. I discuss safety issues thoroughly in my book, Turbo Charged Childhood, on page 97.
* Ross, C. & Whitehouse, W. (2002). Melatonin treatment for sleep disorders in children with neurodevelopmental disorders: an observational study. Developmental Medicine & Child Neurology, 44, 339-44.
To reiterate from last month’s newsletter, most of the interventions that I recommend come from my almost 30 years of clinical practice. But some find their origins in my personal life. Sleep is one of those health factors that I can speak for personally! I can honestly say that this article is one of those times I can say I know whence I speak!, i.e., “I’ve lived this one, baby!” Last month I talked about falling asleep, this month I will take my cue from the humorous TV commercials that emphasize “never underestimate the value of a good night’s sleep!”
Perhaps in all of mental health, the most underestimated factor is sleep. Twenty-six years of clinical experience with individuals battling all kinds of mental duress and disorder have taught me that sleep as the number one flag for impending difficulties in mood, thought processing and behavior. You show me somebody who’s not sleeping well for several nights in a row, and I’ll show you somebody who is heading for trouble in some aspect of their psychological, behavioral and/or relational functioning.
So what does it take to get a good night’s sleep? Whether its stress or worry or part of an attention deficit issue, the answer to sleeping good throughout the night is fairly simple. Just take your cue from Granny: mine always told me to drink a glass of warm milk! Why? Because milk contains Calcium and Calcium, in tandem with Magnesium and Vitamin D, generate restful sleep! While you can use medication (I did and with limited benefit) there’s rarely a need to roll the dice on the medication’s side effects.
Why Calcium? Calcium is reabsorbed into the bones at night when we are supposed to be sleeping. If there is not sufficient dietary supply of calcium the body begins to look for it other places, e.g., muscles, joints, etc. This process makes for considerable restlessness and even cramps. The Calcium in conjunction with magnesium (a relaxant) relieve this process & you sleep much more restful.
When do you take Calcium? Calcium is most effective when taken at night prior to going to bed for reasons just mentioned.
Quirky Calcium. There is something of a catch to using a calcium supplement: it needs to be in the right form. Calcium is often marketed in a carbonate form. Studies have consistently demonstrated an inferior absorption of Calcium Carbonate even though many of the popular calcium supplements are, in fact, in carbonate form. The more absorbable form, ranging from 2 to 5 times, is the Citrate form. In addition, carbonate must be converted to citrate and the human body can only perform that process with about 500 mg per day. Given that the recommended Calcium Carbonate dose is 600 mg three times per day, do you see the problem? You got it! About 1200 mg doesn’t get absorbed and stays in the bathroom when you leave! I will leave it at that for right now and recommend that you read Chapter 10 of my new book Turbo Charged Childhood for a more detailed explanation of mechanics of calcium absorption. But let me add that I am also not in favor of the pill form. Again, I discuss the disadvantages of the pill form vs liquid in my book. Suffice it to say right now, I just don’t like the idea of paying 100% for a product that only delivers 20% of its content!
Calcium Quirk #2. Before I close, let me briefly describe yet another quirk, this one with the citrate form. Citrate is not the most stable compound known to man, i.e., it is subject to chemical reaction and breakdown shortly after production and may not be as potent when it finally runs its manufacturing and distribution routes and then sits on your shelf for 20-30 days! Some companies produce their Calcium supplement in the citrate form but sacrifice effectiveness due to this problem of the citrate being a somewhat unstable compound! I have found a way around all of these marketing/manufacturing problems associated with Calcium. I recommend (and use) the CalMag 100 manufactured by Biometics. It is shipped in a carbonate form (for maximum stability) and then converts to a citrate form (for maximum absorption) when you mix it in water right before you go to bed. For more information on this particular supplement go to www.mindofhope.com to order.
Calcium is directly related to our cycles of sleep. In one study, published in the European Neurology Journal, researchers found that calcium levels in the body are higher during some of the deepest levels of sleep, such as the rapid eye movement (REM) phase. The study concluded that disturbances in sleep, especially the absence of REM deep sleep or disturbed REM sleep, are related to a calcium deficiency. Restoration to the normal course of sleep was achieved following the normalization of the blood calcium level.