Sleep issues — primarily falling asleep and waking — are common in children with ADHD. These problems seem to be more severe in children who on stimulant medication, but are also seen in non-medicated children. Unfortunately, sleep deprivation exacerbates the symptoms of ADHD, causing increased hyperactivity, decrease in focus, and more defiant and difficult behavior.
I have noticed that many of the ADHD children I treat are prescribed melatonin to assist with difficulties in falling asleep. As mentioned previously, melatonin should be used only to re-establish sleep routines after they have been disturbed by travel, illness, or vacation schedules. Melatonin is considered safe by many as it is not a sedative, but a regulator of wake and sleep cycles. However, insufficient melatonin is not the reason ADHD children have difficulty falling asleep, and regular melatonin supplementation disturbs the body’s natural production of this useful neurotransmitter, one that has multiple essential functions in the body.
Optimizing “sleep hygiene” is the first approach to improving your child’s sleep habits. These are the environmental and habitual factors that are conducive to sleep.
Remove all electronic devices from your child’s room – including computers, televisions, blackberries or other phones, and video games. Video games, in particular, are terribly stimulating before bedtime, and make winding down to sleep very challenging. Do not allow your child to play video games in the hour before the bedtime routine begins. Generally, video game playing, which tends to be terribly attractive to many children with ADHD, should be limited as a reward for completing exercise or homework, or as scheduled social times with friends.
Regular exercise during the day is useful for sleep at night. However, exercise late in the day can be too stimulating. Do not allow your child to exercise in the two hours before bed. If this is unavoidable due to scheduled sport practices, give your child a warm bath with Epsom salts after the activity.
Stimulants in the diet such as sugar and caffeine can impede sleep. As a rule, your ADHD child should not be having any of these foods in their regular diet, and should never have a sugary treat or snack before bed and no chocolate after 4 or 5 pm.
Have a snack of foods high in tryptophan before bed – these include bananas, figs, dates, nuts, turkey, milk, yogurt. Tryptophan is a precursor to serotonin, which in turn effects melatonin production.
Maintain a consistent bedtime each night and a consistent wake up time each morning, including weekends. Also maintain a consistent bedtime routine. For younger children, a warm bath (with Epsom salts), a story and some quiet (lyric-free) music can help calm a child, enabling him/her to fall asleep quickly. “White noise” and relaxing sounds like CDs of the ocean can provide the child with a calming distraction. Older children may enjoy reading before bed, but for some children, reading is stimulating and it can be difficult to put an exciting book down.
A foot rub is a good way of encouraging a flow of energy away from the head and toward the feet. This is a nice addition to your bedtime routine.
Some children are worriers and the time before sleep is the time that they need to process their anxieties. Unfinished homework, scary movies, uncomfortable social situations, anxiety about the following day’s tests are the sorts of things that very sensitive ADHD children worry about in that quiet time before sleep. Allow a short reassuring discussion of these concerns as sleep may be impossible without the chance to unload the anxieties.
Of course, make sure the bedroom is comfortable and conducive to sleep. A room that is too warm can prevent sleep. Some children need a night-light to feel safe, but a dark room is best for deep sleep.
If your child finds waking difficult, open the shades or put on a soft light, as well as some music or a book on tape about 20 minutes before wake-up.
A so-called “delayed sleep” cycle is not uncommon in teens who cannot seem to fall asleep until very late. This is difficult for the ADHD teen who has to get up for school in the morning. A consistent schedule and calming routine is the best way to address this difficult problem.
Supplements and other Natural Sleep Aids
5HTP is created from the amino acid tryptophan, and in turn, helps in the production of serotonin. It is a useful supplement for depression and insomnia for some people. People taking anti-depressant medications should not take 5 HTP. Start with 100 mg before bed and increase gradually to 500 mg if needed. As with other amino acids, supplemental Magnesium and Vitamin B should also be taken.
GABA is a non-essential amino acid that works similarly to tranquilizers, easing the feeling of anxiety and creating a feeling of calm. Doses for children vary, depending on weight and reaction to the supplement. Generally doses are given in the range of 100- 250 mg three times daily. A single higher dose of 250 mg of GABA can be taken before bed if it is being used only for insomnia. GABA comes in a variety of forms, including a sub-lingual tablet that comes in 100 mg doses. This is especially useful for those with anxieties about falling asleep. Make sure you are also taking supplemental Magnesium and a B complex with GABA.
Magnesium – the wonder mineral! This calming mineral is necessary for all sorts of functions, including restful sleep. It is essential for those who have leg cramps at night, and helps with restless leg syndrome. Magnesium is best taken to bowel tolerance, but an initial starting dose of 100 mg before bed for children can improve sleep dramatically.
Calming Herbs – There are a number of herbs that are useful for calming children to sleep. I often suggest that parents make their child a calming tea with herbs that have a gentle sedative effect for assisting with winding down into sleep. The combination I suggest includes valerian, passionflower, lavender, and St. John’s wort – generally in a formula of 30% valerian, 30% passionflower, 30% lavender, and 10% St. John’s wort. You will probably need to find a herbalist to make this combination for you. Chamomile tea is one that can also calm a child, but should be used judiciously, as it can have the adverse effect if used for a prolonged period – causing heightened anxiety and anger.
5HTP is an amino acid produced by the human body from the essential amino acid L-tryptophan which is found in dietary proteins. 5HTP occurs naturally in the body and is found in the seeds of the Griffonia Simplicifolia, a West African medicinal plant and the source of the supplement. 5HTP is a serotonin precursor and as such helps to reduce anxiety, depression and insomnia. Low serotonin levels can impair learning, the ability to focus and reason, as well as effecting mood and behavior. As a supplement, 5HTP is contraindicated for anyone taking antidepressant medication. Vitamin B6 is an essential complementary supplement to 5HTP as it is necessary for converting 5HTP into serotonin. Magnesium prolongs the benefits of 5-HPT. Dosages for this supplement vary. Children should start with 10-30 mg three times daily with meals, increasing if needed; adult doses are between 50-100 mg, with meals three times daily. Vivid dreams are a common side effect of 5HTP; if these are bothersome a lower dose should be taken later in the day. Nausea, vomiting, stomach cramps, decreased libido, tiredness, sleepiness are possible side effects. Taking regular breaks from this and other supplements is recommended.
GABA (Gama amino butyric acid) the calming amino acid
GABA is a non-essential amino acid that works similarly to tranquilizers, easing the feeling of anxiety and creating a feeling of calm. It is a sleep inducer and can help improve the quality of sleep. GABA is an inhibitory neurotransmitter; when there is adequate GABA present in the central nervous system it inhibits the firing of anxiety-related messages. There is a GABA receptor in every cell in the body, making it especially efficacious. A large percentage of children diagnosed with ADHD experience regular anxiety, stress and depression, symptoms that can respond well to GABA. GABA also increases the level of human growth hormone in the body, worth noting given the commonality of growth retardation in children with ADHD.
For ADHD, GABA should be taken three times daily on an empty stomach. Doses for children vary, depending on weight and reaction to the supplement. Generally doses are given in the range of 100- 250 mg three times daily. A single higher dose of 250 mg of GABA can be taken before bed if it is being used only for insomnia. GABA comes in a variety of forms, including a sub-lingual tablet.
L-Glutamine — the memory and concentration amino acid
Glutamine, the memory and concentration amino acid, along with GABA and glycine form the backbone of a supplementary combination amino acid approach to ADHD. Glutamine is the third most abundant amino acid in the body. It is readily available in most animal proteins. Beans have a high protein content which make them a good vegetarian source of glutamine. Glutamine provides an alternative source of energy for the brain when blood sugar levels are low. Glutamine is a precursor of GABA, and like GABA, functions as an inhibitory neurotransmitter, helping with mood stability, concentration, memory, and learning.
Low levels of glutamine are often found in children with ADHD who are tested for amino acids. Supplementation with this amino acid can provide marked improvements in children with ADHD, particularly in those with learning difficulties or intellectual impairments (usually in combination with Gingko Biloba and Vitamin B6). The usual dose of glutamine for children is 250-500 mg daily (depending on age and size), increasing gradually to a maximum dose of 3000 mg daily.
Glycine is a nonessential amino acid (readily made within the body as well as available in many foods), the third most important inhibitory neurotransmitter in the body after GABA and glutamine. Glycine has a simple chemical structure similar to glucose (blood sugar), is easily dissolved in water, and crosses the blood brain barrier readily. Supplementation with glycine (often in combination with GABA and glutamine) can calm aggression, reduce anxiety, and decrease the craving for sugar. Doses for children range between 500 to 2,000 mg daily, divided into three doses.
Taurine is an essential amino acid for children, (essential in this context means it must be provided by food or supplement, the body cannot make it on its own), conditionally essential for adults (who can synthesize it from other amino acids as long as sufficient amounts of B6 and zinc are available). Taurine is another inhibitory neurotransmitter similar to GABA with antioxidant, anti-convulsive, and anti-anxiety qualities. The body depletes taurine more rapidly when under excessive stress, physical or mental. This amino acid is especially useful for children with Downs Syndrome.
Tyrosine – the stress amino acid
Tyrosine, an amino acid used to make dopamine and norepenephrine, is conventionally used to help overcome depression, especially in medication resistant depression. In addition to reducing stress and providing mood stability, children given tyrosine display marked improvements in cognitive function including concentration, motivation and mental performance. In assisting the body’s natural storage of adrenaline, tyrosine helps the body cope physiologically with stress. Stress exhaustion causes a depletion of tyrosine — the brain requires additional tyrosine in times of stress. Children and teens struggling with depression, mood disorders, and stress can benefit from tyrosine supplementation.
This amino acid is popular for use in ADHD. It provides an excellent boost in cognitive function for people under circumstantial stress (e.g. examination periods), or for those with depressive tendencies and difficulties focusing on work. There are a few concerns about long-term use of tyrosine, namely, the increase in homocysteine levels. Vitamin B3 can help prevent the build-up of homocysteine and must be supplemented (along with other vitamin Bs in appropriate ratios) when using supplemental tyrosine. Additionally, tyrosine should not be used with pre-existing melanomas or with people on thyroid hormones (tyrosine can reduce the need for replacement hormones). Standard tyrosine dosage is 500 mg daily for children, up to 10,000mg daily for adults.
L-Thianine the feel-good amino acid
L-thianine is an amino acid found in green tea and some black teas. Research has indicated that regular consumption of L-theanine improves concentration and attention, lowers blood pressure, boosts the immune system, and reduces the occurrence of anxiety attacks. L-theanine produces a calming effect without drowsiness.
L-theanine easily crosses the blood-brain barrier and stimulates the production of alpha brain waves — those associated with a state of relaxation. The result is a state of calm with mental alertness. L-theanine also plays a role in stimulating the production of GABA (see above). It may also help regulate dopamine and serotonin, thereby impacting focus and mood.
While drinking green tea has numerous health benefits, L-thianine only represents 1-2% of the tea leave’s dry weight; so it would take a very large quantity of tea to constitute a physiological dose of L-thianine.
This amino acid is especially useful for children for whom focus and concentration are diminished largely due to anxiety. The dosage for children is between 50 and 100 mg (100-200 mg daily for adolescents).
DMAE is a central nervous system stimulant with an effect similar to a mild amphetamine, although it is not a drug, but a naturally occurring substance. Structurally, DMAE is similar to choline, but it crosses the blood-brain barrier more easily than choline. Similar to choline, DMAE works to increase the levels of the excitatory neurotransmitter acetylcholine. DMAE is also found in oily fish such as anchovies, and sardines.
DMAE is used as a supplement for a large number of issues including joint, skin, memory and mood. Studies for use of DMAE in ADHD have shown some promising results, particularly in reducing hyperactivity, aggression, and in improving concentration and attention spans. Because of the excitatory nature of this supplement, apathy, low energy, and other depressive tendencies respond well to DMAE. Because DMAE is an antioxidant, it helps fight environmental stressors caused by pollution, cigarette smoke, radiation, and other stressors. It can also help the body deal with dietary stressors, or dietary pollutants from unhealthy fats.
Some people find that this supplement causes restlessness, insomnia, irritability, even muscle spasms – generally symptoms of overstimulation. It is worth remembering that the conventional medical approach to treating ADHD is to use stimulant medications, often with side effects similar to those mentioned here. As with any medicine, natural or others, there is no one medicine that works for all, and finding one that works for each individual is essential.
Start taking low doses of DMAE – 50 mg twice daily for children, slowly increasing to up to a total dose of 500 mg daily. Teens can start at about 75-100 mg twice daily, increasing up to 700 mg daily if needed.
Melatonin: a warning
Melatonin is a neutrotransmitter made in the pineal gland that, among other things, helps regulate sleep/wakefulness cycles. Many children on ADHD medication suffer with restlessness and insomnia at bedtime and have been put on regular doses of melatonin. I am concerned about the use of this supplement over a long period of time, as it will eventually discourage the body from producing its own melatonin. Insufficiency of melatonin is not the cause of sleep disturbances in children with ADHD. Use of neurotransmitters in this way may produce problems in the future. We know that among other things, melatonin has high anti-cancer properties, and reducing melatonin production is something we should avoid if at all possible. Melatonin is an excellent product for regulating sleep after its cycle has been disturbed by travel, or schedule change, but should not be used as a long-term sleep aid.
See part 1 of this blog: Understanding Neurotransmitters, Amino Acids, and ADHD