Teens with ADHD need more sleep
Sleep issues are more common among teenagers with symptoms of ADHD. And although they need more sleep, they tend to get way less than they need.
We already know that sleep gets short shrift by adolescents generally, and that sleep problems among teenagers aren’t uncommon.
“On average, all teens get too little sleep, but adolescents with ADHD symptoms sleep even less than their age peers,” says Mari Hysing, a psychologist and researcher at Uni Research Health in Bergen. A new study that she led among 10,000 adolescents between the ages of 16 and 19 from Hordaland county in Norway was recently published in the journal Behavioral Sleep Medicine.
The study indicates a strong correlation between ADHD symptoms and sleep problems. Hysing believes that young people being treated for ADHD should also get help with sleep challenges.
Connecting ADHD symptoms and sleep issues
Previous studies show that five per cent of all young people struggle with symptoms of ADHD, which include concentration problems, impulsiveness and hyperactivity. A number of smaller studies have also shown that children and adults who have had an ADHD diagnosis have more sleep problems than others.
But until now no large population studies have been undertaken that show a correlation between ADHD symptoms and sleep problems.
The researchers were looking to determine whether young people who had not been diagnosed with ADHD, but who have many of the typical symptoms of the condition, were similarly affected by sleep problems.
“We wanted to see how sleep problems are distributed in the young population in general and if adolescents with concentration problems struggle more with sleep,” Hysing says.
The study shows that teens with concentration problems sleep on average one hour less per night than other youth.
Changing sleep habits
Teens naturally change their sleep patterns in adolescence. They fall asleep later, sleeping less than they did as children, and the difference in sleep duration between their weekends and weekdays is much greater.
This study confirmed earlier research results that people with ADHD are sleeping less than the recommended amount of sleep for their age, and less than they themselves say they need.
At the time of this 2012 study, nearly all of the 10,000 study participants were attending high school.
They were asked how much sleep they really needed, how much they actually slept and whether they had difficulty falling asleep. They also reported whether they had problems with poor concentration, inattention, impulsivity or hyperactivity.
Hysing said that researchers checked whether those who reported a lot of these symptoms had more sleep problems than the others.
Three hours short on sleep
Adolescents who score high on ADHD symptoms say they need about nine hours of sleep each night. But on average they only manage to sleep 5.5 hours on weeknights, resulting in a 3.5 hour sleep deficit.
Hysing notes that these estimates include the time it takes them to fall asleep and any time they’re awake during the night.
The gap between the need for sleep and actual sleep duration is smaller for adolescents in general, who reported that they need 8.5 hours of sleep per night, and usually only get 6.5 hours. Hysing finds it especially worrisome that teens with ADHD symptoms sleep less than others, since their need for sleep is even greater.
Depressive symptoms
Most young people sleep well once they fall asleep. But adolescents who reported that they had multiple ADHD symptoms also struggled with taking longer to fall asleep and waking up before they felt well rested.
“Difficulty falling asleep was the most prevalent issue in this group,” says Hysing.
Earlier studies show that too much use of computers, tablets and mobile phones just before bedtime destroys sleep for teens.
“But for these adolescents it isn’t specifically monitor use that makes them unable to fall asleep, but more often depressive thoughts, says Hysing.
Sleep problems and ADHD often coincide with depressive symptoms. “Painful thoughts explain some of the sleep problems, but not all,” she says.
The researchers also examined whether sleep problems could be due to the side effects of medication for ADHD symptoms, but they found no difference in sleep problems between those who used medications and those who did not.
Chicken or egg?
From prior research we know that sleep loss can lead to concentration problems even in otherwise healthy people.
So could it be that sleep problems can cause symptoms of ADHD?
Hysing assumes that the problem goes both ways. “It's hard to say what comes first. If you’re restless, it can be hard to relax enough to be able to fall asleep,” she says, “and it’s also likely that it works the other way. Sleep deficits can result in concentration problems and hyperactivity. It becomes a vicious circle.”
Another recent study indicates that continuous sleep disturbances are the most irritating factor and have the greatest impact on one’s mood.
Good sleep patterns can help
Difficulty keeping up with schoolwork and social problems can also be fallouts of sleep issues. If teens can develop a healthy sleep pattern, it will probably reduce those discomforts and problems, too.
A recent Swedish study showed that you remember better if you sleep long enough, and other studies support prioritizing good sleep patterns to increase concentration, Hysing says.
The researchers believe that addressing sleep problems should be part of the treatment plan for young ADHD patients. “Preventing sleep problems can relieve the symptoms and keep them from getting worse. It isn’t easy but it’s doable,” she says.
She recommends that teens with sleep challenges should first consult a nurse, psychologist or physician for assistance. Therapy works better than sleeping pills, according to another study.
Parents should be aware of how important enough sleep is and help their children get to bed early.
Being physically tired from exercise can be helpful, too, but “it depends on what time of day you exercise,” says Hysing. “From other studies, we know that being active or doing your workouts early in the day is good for sleep. But training in the evening can lead to it being more difficult to fall asleep,” she says.
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Read the Norwegian version of this article at forskning.no
