In children, sleep apnea and Attention Deficit Disorder can cause similar behavioral issues. It’s important to know which one you’re dealing with because each requires totally different forms of treatment. Let’s take a look at these; see how they’re similar, and also how they differ. We’ll also explore some treatment options.
We’ll start by defining the two.
As you probably already know, Sleep apnea (OSA) occurs when your airway closes off in your sleep, causing you to stop breathing.
OSA occurs in an estimated 25% of kids ages 2-8. With the most common cause of apnea being due to enlarged tonsils and adenoids. Also, under developed jaw and/or oral structures play a critical role as well.
Sleep apnea in kids can also lead to problems with learning and behavior. They can be hyperactive, have problems adjusting socially, and become anxious and depressed.
Other issues include:
- Hormonal/metabolic imbalances
- Stunted growth
- Irritability/mood swings
Also, you can have sleep apnea and not snore.
Now we’ll take a look at ADHD.
ADD stands for Attention Deficit Disorder; there are 3 forms of it.
1-Mainly inattentive. This is what think of when we hear the term ADD. Symptoms include:
- Failure to pay close attention to things
- Makes careless mistakes
- Doesn’t seem to listen when spoken to
- Tends to be unorganized
2-Mainly Hyperactive (ADHD), or ADD with a hyperactive component. Symptoms include:
- Excessive talking-Including interrupting others when they’re talking.
3-Combined-Inattentive, hyperactive and impulsive.
They have trouble focusing and/or paying attention, especially if they’re not interested. On the other hand, they can be super focused. They also tend to be creative, intuitive and full of energy.
ADD/ADHD develops in childhood. In fact, kids as young as 4 years old can be diagnosed. But whats a normal attention span for kids, vs the average attention span of one with ADHD? Also, girls with ADHD are less likely than boys to show cognitive, psychiatric, and functional impairment.
Refer to the following link for more information.
If a kid has sleep apnea but is misdiagnosed with ADHD. Do the meds resolve the behavior issues? Leaving the kid with untreated sleep apnea? And how long will this go on until sleep apnea is suspected?
signs of ADHD–You don’t have to be loud, or bouncing off the walls to have ADHD. Women of all ages sometimes have a form where they are “quiet and spacey”.
Notice the similarities in symptoms. Therefore, if you just focus on the behaviors, and not on their sleep, a misdiagnosis could easily happen.
Is Attention Deficit Disorder Really a Disorder?
There are many theories about the cause of ADD/ADHD. However, the strongest research reveals the following as most likely causes:
- Brain injury
- Exposure to environmental (e.g., lead) during pregnancy or at a young age
- Alcohol and tobacco use during pregnancy
- Premature delivery
- Low birth weight
Genetics plays a critical role. Also, brain scans show significant changes in brain structure. Therefore there are physical signs of Attention Deficit disorder; thus qualifying it as a disorder.
But does your child have ADD/ADHD or OSA? From a behavioral stand point, you can’t be sure. So let’s look at some things that can show us the difference.
Attention Deficit Disorder
The following link is an interactive self-test for women and girls to determine the likelihood you have ADHD.
However, there’s not really a test for ADHD. Your Doctor will look at things like your child’s behaviors, comparing them with other kids his/her age. The following criteria are used to determine the possibility of ADD/ADHD:
- Are in constant motion
- Squirm and fidget
- Do not seem to listen
- Have trouble playing quietly
- Often talk excessively
- Interrupt or intrude on others
- Are easily distracted
- Do not finish tasks
Additionally, a brain scan might also be ordered.
The following links will take you to questionnaires you can use to determine the likelihood you have sleep apnea.
Epworth Sleepiness Scale http://www.sleepmed.com.au/epworth-calculator.html
Berlin Sleep Questionnaire:
Snore score (Not an interactive link) http://sleepapnea.org/wp-content/uploads/2017/02/snore-score.pdf
Upper airway examination.
And of course, the ‘gold standard’ diagnostic tool is an in lab sleep study. However, in some cases, a study can be done right at your home. These tests are called Home Sleep Tests, or HST’s.
The nice thing about home testing is that you can sleep in your own bed in your own home. And they cost much less than an in lab study. However, they tend to under diagnose sleep apnea.
Attention Deficit Disorder
Meds-Ironically, stimulants such as Ritalin or Adderall are commonly prescribed for children with ADHD. However, as many as 30% of children either don’t respond to these meds, or they experience undesirable side effects. There are some non-stimulant medications that work, such as tricyclic antidepressants. But even these may have unwanted side effects.
However, there are complementary treatments that are showing promise. These include…
Biofeedback (Brain Training)-Sensors are attached to the child’s head and monitor brain waves. They’ll then play a computer game they control with their mind. this helps them focus.
Behavioral treatment-Works best when given by the parents and the child is 6 years old or younger.
Meditation, prayer, and Yoga have all shown some positive results.
Even something as simple as being outside in a place where there’s lots of greenery has been helpful to some.
For milder forms of ADHD-Eat healthy. Excercise. Minimize caffeine intake.
Fish Oil (Omega 3 fatty acid) can be ‘moderately effective’.
Removal of tonsils and adenoids is the most common way to treat pediatric sleep apnea, and can effectively eliminate OSA up to 90% of the time. If that’s not effective, then treatment with either CPAP, an oral appliance should be considered.
Positional therapy-Different methods to keep a person off their backs while they sleep. Weight management might not eliminate OSA, but can at least reduce its severity. And it just may be that using any combination of the above might bring the best results.
Also, OSA in children can resolve on its own. However, don’t rely on that, as the health risks are too great. Sleep apnea stresses your body, which leads to inflammation. And there’s a direct link with inflammation and disease. See http://sleepguyblog.com/__poor-quality-sleep-cause-disease/
Sleep Apnea and Attention Deficit Disorder can be easily confused in kids. This is because both can cause similar behavioral and cognitive issues. It’s absolutely essential that you as a parent know what to look for so that your child can receive proper treatment.
Please leave a comment, as you might have something to say that will help others.
Till next time…Blessings