ADHD? or Sleep Deprivation?

Sleeping boy with books
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An article in the New York Times highlights the fact that many children and adults are mistakenly diagnosed with ADHD, when their problems actually stem from lack of sleep.  Sleep deprivation produces the same symptoms: difficulty sustaining attention, forgetfulness, tendency to lose items, procrastination.  And though it seems counter-intuitive, children who are short of sleep often become hyperactive rather than lethargic.

It’s not just the amount of sleep that is important — children and adults also need a balance of the right kind of sleep, with an adequate amount of deep, delta-wave sleep. The dreaming, REM stage sleep is also important for learning, as it is the time when memories are consolidated, but it will not give the body and mind the needed period of sustained rest. 

Unfortunately, it’s a lot easier for a doctor to “diagnose” ADHD rather than identify sleep issues. The ADHD label can be attached based on a simple office visit and survey of symptoms. A sleep disorder, such as sleep apnea (associated with difficulty breathing at night), can only be diagnosed with a sleep study, which requires an overnight stay at a diagnostic center to monitor sleep patterns throughout the night.

Further, it’s easy to see how parents might mistakenly attribute their child’s restlessness at night to their daytime hyperactive behavior. That is, they may see the sleep problems as being a symptom of, rather than a cause of, the overall ADHD pattern of behaviors.

Here’s what makes thing even worse:  With a medical diagnosis of ADHD, the first response is typically a prescription for Ritalin or similar stimulants, or an alternative such as Strattera (a norepinephrine reuptake inhibitor).  Sleep problems or insomnia are common side-effects of Ritalin and Strattera. So the drugs often make the night time problem worse, but allow parents and teachers to believe that the daytime problems have been resolved, essentially creating a cycle that will perpetuate any sleep disorder.


Diagnosing the Wrong Deficit.  (New  York Times Sunday Review, April 27, 2013)