Wake-Up Call

Long- and short-term effects of sleep disorders go beyond just feeling groggy


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Mistaken Identity

Is it ADHD, or could it be a sleep disorder?

By Alexa Stanard

Six-year-old Yousef Mohammed was having trouble focusing in school. The Detroit resident sometimes lacked the energy to finish his assignments, and he also had a bad temper, getting upset quickly.

“His teacher said he was a very smart student,” says his 20-year-old sister, Zahra. “When he had the energy, he was doing very well.” Yousef also had trouble breathing at night, sometimes stopping breathing altogether and then choking on his breath. When he was 4 years old his mother, Sawsan Marae, took him to a specialist, who told her the problem might resolve itself.

That didn’t happen, so Marae took him to Children’s Hospital of Michigan to be evaluated. Yousef took a sleep test, which revealed severe sleep apnea — just 70 percent of the available oxygen was reaching his brain. 

In an age of increasing diagnoses of attention deficit hyperactivity disorder (ADHD) and other mental and behavioral disorders in kids, sleep problems are a growing area of interest. That’s because the symptoms of sleep deprivation in kids — hyperactivity, trouble focusing, moodiness, temper — look a lot like the symptoms of ADHD and other disorders. 

In fact, a host of studies are demonstrating a correlation between sleep problems and diagnoses of ADHD. A study of 11,000 British children, published in the journal Pediatrics, found that kids with sleep issues like snoring, mouth breathing, and apnea were 40 percent to 100 percent more likely to develop behavioral problems resembling ADHD.

The causes of poor sleep in children are multiple, says Dr. Ibrahim Abdulhamid, clinical director of the Children’s Hospital of Michigan Pediatric Sleep Center. 

Sleep apnea is one of the most common disorders, appearing in about 2 percent of otherwise healthy children. Apnea is typically caused by enlarged tonsils and adenoids, and can be tricky to spot. Though it’s associated with snoring, children with even severe sleep apnea may not snore or do so very lightly.

“These children present with snoring, or with mouth breathing, restless sleeping, sweating at night, sleeping with the neck extended,” Abdulhamid says. They may choke or cough, or wake up crying and then resettle.

“They can be irritable, moody, hyperactive, aggressive — the cognitive performance at school will not be good,” he says. “You’ll be surprised how this behavior improves after adenoids and tonsils are taken out.”

Indeed, a 2013 study of 464 children by the National Institutes of Health found that removing the tonsils and adenoids in school-age children with sleep apnea improved behavior and quality of life.

In September, Yousef had surgery to remove his adenoids. The change was immediate. “He’s been doing way better,” Zahra says. “His participation in class has been noticed by his teacher, and he received an award for improvement. He has way more energy, and he’s getting interested in joining sports.” 

Physiological disorders like apnea aren’t the only causes of poor sleep. Toddlers who resist going to sleep or wake up during the night may be chronically under-rested. A loss of as little as 30 minutes of needed sleep can manifest in hyperactivity and poor focus. 

In teens, poor sleep quality can look more like it does in adults, with fatigue and sluggishness replacing hyperactivity. But the poor focus and irritability are often still present. 

“One of the most common sleep problems in teenagers is delayed sleep phase syndrome,” Abdulhamid says. “Teenagers have problems falling asleep — their brain doesn’t shut down until later in the night versus adults. It gets worse with phones, gadgets, iPad ... they maintain arousal. The other precipitating problem is use of caffeine.”

Chirece Webb’s son, Brian, was sluggish and “borderline lazy” as he moved into his teen years. His school performance was poor. At 14, he started snoring loudly. 

“I thought maybe it was a growth spurt, or because of his weight,” Chirece says. (Brian was 6 feet 1 inch and weighed about 250 pounds.) “Then he would get sick a lot, with colds and strep throat — he kept getting it. And he would get tonsillitis, which was when the snoring really kicked up. It was horrible.” 

Chirece decided to take Brian, now 16, for a sleep study. The study found he stopped breathing so often during the night that he was referred for emergency surgery to remove his uvula, tonsils, and adenoids.

Since the surgery, Chirece says, Brian “has tons of energy. He’s doing so well. He wants to go everywhere, get more involved. He’s lost weight, and his confidence level went up. 

“Sleep is the key to everything,” she says. 

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