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.
There are a large number of herbs that are effective in addressing ADHD symptoms. Herbal supplements are, by definition, entirely made from plant material. Many pharmaceutical medications are based on the active agents found in herbal medicines. Although natural, herbal medicine can be toxic, have severe side effects, and interact dangerously with prescription medications. It is best to check with an experienced herbalist or naturopath if you find that you are using herbs on a regular basis or for an extended period of time. Listed below are some of the more promising and clinically effective herbs for ADHD. There are many other herbs, from many different medicinal traditions, which may have calming, sedative, intellect boosting qualities that are not listed here. This is not to say that they do not have benefit. Generally, working with someone who is familiar with the herbs, including their safety and efficacy is best.
LEMON BALM, VALERIAN, PASSIONFLOWER, ST JOHN’S WORT – calming herbs
All of these herbs are commonly found in herbal combination formulas for ADHD. Lemon Balm is reputed to have impact on mental performance, enhancing attention, memory, and focus. Valerian and Passionfruit are considered to be mild herbal sedatives, often combined with each other and/or lemon balm to decrease nervousness, anxiety, and restlessness. Some people find these herbs useful for minimizing the “rebound” effect of medication wearing off in the late afternoon/evening. As calming herbs they can help with sleep difficulties, which are common for children who are medicated during the day. Some people like to make a gentle sedative tea for ADHD children at the end of the day – a good formula typically includes 30% passionflower, 30% lemon balm, 30% lavender flower, and 10% St. John’s Wort. You can ask a herbalist to make this combination for you. It can take awhile for the herbs to be effective – commit to trying this for at least a month before determining if it is effective for your child.
Chamomile tea before bed can be an excellent calming drink to help a high-strung child settle down to sleep. However, use of chamomile tea over time can have the adverse effect, causing heightened anxiety and anger. Use judiciously, and only occasionally.
Pycnogenol is a plant product made from the French maritime pine tree. It is a promising herb in the treatment of ADHD. This herb is a powerful antioxidant, acting as a cellular detoxifier and balancer of stress hormones. Children with ADHD have elevated levels of stress hormones that increase heart rate and blood pressure as well as causing hyperactivity, arousal, and irritability. By normalizing stress hormones, such as adrenaline and noradrenaline, pycnogenol can bring about a decrease of ADHD symptoms and an improvement in attention, concentration, and motor-visual coordination.
Ginkgo Biloba, a herb that has been used for centuries in traditional Chinese Medicine, has recently become popularized in the west for its purported memory-boosting and brain-power enhancing capabilities, and its use in slowing down the advancement of Alzheimer’s disease. Its use in ADHD is even newer, but has shown promise. Gingko Biloba seems to impact the brain by increasing blood flow to the nervous system. It is also an effective antioxidant, decreasing oxidative stress. These two functions together seem to improve cognitive function. Moreover, Gingko Biloba has been shown to have a positive effect on decreasing irritability and frustration. Oppositional and defiant behaviors as well as seemingly unrelated symptoms such as bed-wetting and auditory processing disorders also respond positively to this herb in some cases. Gingko Biloba may be a natural approximate to non-stimulant pharmaceutical medications for ADHD. It can be used effectively with the next mentioned herb, Ginseng, to boost memory, improve cognitive function, and address other symptoms commonly seen in ADHD.
Ginseng is another herbal remedy that comes to us from the Chinese medical tradition. It is well known to regulate energy levels, stimulate brain function, and improve sleep. There are certain features of this herb that make it especially promising for treating ADHD. There is evidence that Ginseng targets the dopamine pathways in the brain; deficiency in these pathways seems to be prevalent in ADHD. As mentioned earlier, dopamine can help regulate attention span, impulse control, and the ability to filter stimuli. Ginseng may also impact levels of norepinephrine – another neurotransmitter that, like dopamine, is often out of balance in the brains of those with ADHD. Imbalances in these neurotransmitters can lead to difficulties with complex cognitive processes. Many stimulant medications for ADHD work by boosting levels of dopamine and norepinephrine. It may be that Ginseng offers a non-pharmaceutical alternative similar to the conventional medicines used in treating ADHD. Finally, we know that Ginseng offers a degree of neuroprotection for the aging brain, impacting inflammation and neuron cell-death. This offers a promising alternative to the risks of life-long pharmaceutical medication for the treatment of ADHD.
There is a definite logic to giving your ADHD child natural stimulants such as coffee and tea, given that pharmaceutical stimulants are the primary conventional approach. Some parents find a cup of coffee or tea early in the day helps their ADHD child enormously. I would suggest that the gentle caffeine of green tea, coupled with the benefit of some additional l-thianine, makes this an ideal naturally stimulating drink for children with ADHD. Of course, carbonated energy drinks and pop with sugar, additives, artificial colorants, and phosphates are absolutely without any place in the diet of a child with ADHD. While establishing a dependency on caffeine may be something that concerns some parents, it is a habit that is easily broken and one that seems to have little negative consequence. This alternative to stimulants is one that works well for some children and is well worth trying.