Reading & Other Learning Disabilities

From Reading & Other Learning Disabilities

A Blog by Dr. Gary G. Brannigan and Dr. Howard Margolis

Sleep, ADHD, and Learning Disabilities are Strange Bedfellows

So…

How Do My Child and I Get to Sleep?

Stephen M. Lange, Ph.D., Psychologist, Pine Ridge, SD

Sleep, Attention Deficit Hyperactivity Disorder (ADHD), and Learning Disabilities (LD) have complicated interrelationships. First, children and adults who do not have sleep that is long enough in duration and restful can demonstrate many of the symptoms of ADHD and LD. Fortunately, when their sleep improves, so do their symptoms. Second, individuals with ADHD, or LD, or both, can have difficulty falling asleep, staying asleep, and feeling rested in the morning. In fact, some of the brain chemistry that accounts for the cognitive symptoms of ADHD and LD also affect the onset of sleep and dreaming. Sleeplessness and fatigue exacerbate ADHD and LD symptoms for those who have these disorders, and learning to have better, longer, and more restful sleep can improve their achievement, behavior, and sense of well being.

When it comes to improving sleep, there are medical and behavioral approaches. People who have obstructed breathing when they sleep, called sleep apnea, need a medical approach that might include surgery, advice on weight loss (which can exacerbate sleep apnea), and/or the use of a device that delivers pressurized air through a face-mask, such as a C-PAP machine.

Medication approaches for insomnia are more suspect, and are seldom the first treatment choice. The class of medications called hypnotics, which includes Ambien, is addictive, and can disrupt how patients progress through the five stages of sleep, leaving them more tired than before. Finally, some hypnotics cause amnesia and when essentially blacked out, patients can behave in ways that are unhealthy or even dangerous. Even if hypnotics were unequivocally helpful, giving any teenager any addictive product is problematic in an era of rampant misuse and abuse of pharmaceuticals. Given these cautions, no medication should be started or stopped unless you first obtain medical advice.

Behavioral approaches are effective. If used correctly, they’re generally safe and healthy. Their primary drawbacks are that they take time to learn and sustained effort to apply. It is easy to become discouraged or impatient for results, which is what we who have ADHD or LD experience too often.

One way to conceptualize the most basic behavioral approaches to sleep—Sleep Hygiene—is to think about Sleep Destroyers and Sleep Heroes.

Sleep Destroyers

Sleep Destroyers include:

• Napping during the day: People who sleep like bats in the day, flit like bats in the night.
• Ingesting caffeine and sugar after dinner (like sodas and juice)
• Using alcohol and/or nicotine
• Arguing after dinner
• Using the bed for texting, phoning, chatting, computing—anything other than what beds are made for
• Exercising after dinner
• Eating salty or sweet snacks after dinner
• Sleeping late on weekends
• Making the bedroom too warm, too loud, too well lit, “too anything”

Sleep Heroes

Sleep Heroes include:

• Exercising moderately between breakfast and lunch. (Three cheers for recess!)
• Letting the sun’s rays touch your face (with sunscreen and other precautions as necessary) between breakfast and lunch (did I mention recess?)
• Eating three balanced meals and two healthy snacks
• Winding down and engaging in a quiet, relaxed activity as the sun sets
• Leaving bed and relaxing in a chair when falling asleep takes 20 or more minutes
• Showering or bathing before bed
• Sleeping in a slightly cool room
• Following a predictable nighttime sleep routine
• Journaling, praying, stretching, meditating, practicing yoga right before bedtime
• Telling yourself what you’re grateful for before bedtime
• Forgiving others and settling arguments early in the day
• Waking up the same time seven days a week
• Having a quiet house after sundown
• Avoiding video games or other stimulating activates right before bedtime
• Completing assignments, homework, checkbooks, and other worrisome tasks well before bedtime
• Avoiding the belief that you will never sleep
• Playing quiet or calming music after dark
• Creating a bedroom that is comfortable and relaxing

If these basic habits don’t work for you after a season of trying, I recommend that you consult a psychologist or other therapist who practices Behavioral Sleep Medicine. Often, psychologists or therapists with expertise in Behavioral Sleep Medicine can help solve more difficult problems. You can find a listing of such clinicians, including physicians, at the American Academy of Sleep Medicine’s website, http://www.aasmnet.org/PatientsPublic.aspx.

Goodnight!

Caution/Warning

This column does not offer medical advice. Further, every individual has different needs based on their individual physiology and psychology. Before considering using or stopping any medication or any medically-related intervention, readers need to consult a physician.

The Author

Stephen M. Lange, Ph.D., is a child and adolescent psychologist and parent of two. He is a very grateful adult with ADHD. He can be contacted at smlangephd@gmail.com.

Edited by Howard Margolis, Ed.D.   www.reading2008.com