Hi, looking for some advice on what to do about my sons sleep. He is soon to be 6 and diagnosed with ADHD last summer as well as sleep apnea.He has a lot of anxiety about going to sleep most nights. He is fearful of nightmares. After sleeping with my husband and I for 6 months (due to sheer exhaustion from all 3 of us getting up so frequently) we have recently put him and my 2 1/2 yr old son in the same room to hopefully help comfort him. Saftey in numbers right? Made the room super special for them and comforting. First 2 nights went great and now we are back to same behavior of very weepy and anxious to fall asleep and then waking very frequently due to bad dreams. We are treating the apnea with surgery coming up next week so am hopeful that will help with the being able to stay asleep portion but am really lost with what to do about his sleep anxiety. With us both working and him needing to also function this is so draining. We have talked about his bad dreams and how he is safe with mom and dad right next door, made room cozy and inviting. Little brother sleeping like a champ in bottom bunk.
He is currently taking Ritalin long lasting at 7:30am and then needs a short acting booster at 3pm to make it until 6:00ish.
To note he did have these same issues well before starting meds so dont think that is playing a role. We currently are seeing a pediatric neurologist for his medication management.
Any suggestions would be greatly appreciated!
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Thanks for posting your message. Our psychiatrist told us we could use Melatonin to help. We did that for a while then stopped. It helped a lot. I am no doctor but I doubt the medication is the cause.
There are a million tools to help with sleep: weighted blanket, white noise, control temperature in the room... you could also use melatonin until the surgery and then evaluate from there.
Unfortunately it's hard to say what could help, it can be so individual. But I do know how much it impacts daily functioning when they do not sleep.
Thank you for your reply! I should have mentioned we do melatonin at night as well but a relatively small dose now. I think I will bump it up to 7.5mg until after the surgery to see where he lands. He also has a soft weighted dinosaur blanket, special night lights and a fan for white noise..lol
I am wondering if the sleep anxiety isant really just part of generalized anxiety. I have noticed some general anxiety in him before meds and current. I would like to possibly get him into see a psychiatrist to manage all meds but feel really nervous to do it. I hear such awful stories of bad experiences and do not want to do anything that could set him back. I feel when I research ones in the area with every great review there is a bad one.
I think it may be due to general anxiety. My 7yr old has adhd and autism. He’s an anxious child. He always asks for his dad to sleep with him. We use 5mg of melatonin and works great. His developmental services doctor prescribed sertraline for his anxiety and it has helped tremendously he’s more functional and positive. Best of luck.
Yes I believe it is more of a generalized anxiety as well. He will have odd fears such as going into the bathroom or all of a sudden not wanting to be outside because there are bugs even though he loves playing outside. We talk about why he is fearful and why he should not be fearful and don't play into/feed into it. After awhile of encouraging him he can do hard things ( go to bathroom by myself) he is now over this but have a sense more will pop up in the future. Have also noticed at school is more anxious if he doesn't know exactly what is expected of him. If he is given picture guidance or an end plan he is much more relaxed. Puzzles are his favorite. Beginning/End are clear
Sounds just like my son! My son has this phobia of bees and he has never been stung. So sometimes he doesn’t want to walk through trails if he sees a bee he gets so scared. We talk about it and then he relaxes a bit but it’s all anxiety. He also gets anxious about school he needs to know everything that will go on in his day. I try my best to explain what he can expect for his day. When he recently started in-person learning 2xWeek I had teachers give him a tour of the school and class to help reduce his anxiety. It helped so much. My son gets overwhelmed when there’s crowds so I drop my son off 15min early at school before it gets busy and school supports this. My son hates loud noises too so he doesn’t enjoy things like going to see the globetrotters it was too loud for him.
I try to get my son to be more flexible. He has speech therapy at school and they go over having more flexibility. It has helped a lot for him to not be as rigid. The way I keep my son more flexible too is I set up surprises sometimes on the weekend I don’t tell him where we are going and then we will just show up to one of his many favorite places.
Yes! Bee's are the number one fear. Also has never been stung. We have been giving him a little squirt gun when we are outside so if he feels anxious over a bug he just gives it a little spray and moves on. That is such a great idea for school to drop off a bit early. My son is the SAME. When we go to karate class if we show up a minute or two before he won't go out on the mat but if we get there 10 minutes early and it's just one or two kids he will go find his x to sit on.
He will be starting kindergarten this fall so it will be a good idea for me to ask the school if we can do a bit of an early drop off. It never clicked to me before that it was the crowd. I always thought that the hard preschool drop off for so long was due to separation but now it totally makes sense.
I also think its an awesome idea to do suprise outings on the weekend. What a great way to keep them guessing/being flexible but still having fun!
Yes surprises are fun and keeps them flexible. Also getting them to try new foods even if they don’t like some of them makes them more flexible just teach him to say, I don’t like it but I’m glad I tried it.
For kindergarten my son had a very difficult time it took him 4 months to adjust. He was overwhelmed with a new school, teacher, more structure, and more kids in the playground “70 kids running around”. So my son had a shark space in the class where he could take a sensory break if he was overwhelmed or class got too noisy for him. They had noise canceling headphones for him when he was irritated by loud noises in the class and this helped a lot. I think it would be great for your son to get a tour of his kindergarten class and meet his teacher before he starts kinder. I asked his kinder teacher and the inclusion specialist at school to do a small peer group for play time during recess to help my son not be overwhelmed at recess because he would freak out and start to run around and bump kids because he didn’t know what else to do to express his anxiety and being too overwhelmed. His recess peer group helped so much to keep him focused on playing with a smaller group of kids. Please look into having your son evaluated for taking sertraline/Zoloft for anxiety it will help him so much I have two boys at home with high anxiety so the 3 yr old and the 7 yr old both take sertraline and it does make a big difference they are more functional. My 7yr old is on adhd meds too nonstimulant “guanfacine 3mg” this has helped reduce hyperactivity and improved focus. I didn’t get my 7yr old on adhd meds till around the end of kindergarten since It took time to do all his evaluations. I hated to get him on meds but he wasn’t learning at school because he was too hyperactive and I didn’t want his education to suffer so I went ahead and tried the meds and now he’s catching up. Reading is a challenge for him but we are still working on it and I have included after school tutoring twice a week to give him one-on-one instruction for math, reading, and writing.
It may be a little challenging at first trying to get the right adhd meds then adding sertraline but be patient it will all get stabilized. The key is to get your son evaluated for any accommodations he may need or extra supports at school this way the school doesn’t look at him like a trouble child and have more compassion for your son and give him all the supports he needs.
Thankfully he already has an IEP in place at school. We were able to meet with the special ed person who will assign him his teacher. Thankfully she was extremely warm and receptive to hear our input and suggestions. We know he will have his "cozy corner" if he feels over stimulated and needs a place to go but will mention having some noise cancelling headphones on hand. We live just down the street so are able to walk by the school frequently. I know there is a meet and greet before school starts but think your idea of meeting with the teacher individually and exploring the classroom in a quiet enviroment is a good idea as well. My plan this summer is to bring him to the playground area many times so that is a very familiar place . I was also hesitant to put him on a stimulant but saw his self confidence plummet due to his frustration with not being able to do simple tasks such as writing his name. After 6 months of being on Ritalin he can now write sentences (when told the letters) and all his numbers. Reading is also his biggest struggle but from what I have been reading that is pretty typical for these kiddos. Ranked superior in visual processing skills though! Lol all those puzzles!
We have a follow up in June with his neurologist so will be definitely bringing up the anxiety concern and see if she has referrals for who to see.
Your are doing great! A whole lot more prepared than I was. My son wasn’t diagnosed till he started kindergarten. It was a difficult year for him and me. He has a neurologist that treats him for absence seizures. The fact that your son has an IEP already is a plus! He will do just fine just keep staying involved to keep his services in line at school and all will be fine. He is still little but as he matures and grows he will
learn tools to manage his anxiety. In the mean time try a weighted stuffy or stuffed animal, fidget toys he can carry in his hands to help work through anxieties, stress ball. Also try massaging pressure points
That’s great. My 3 yr old just had his eeg test last week. It’s an important job helps determine if children are having seizures. Glad to hear through your job you’re helping kids get the treatment they need to be healthy and get seizures under control. 👍
It really is a very interesting and rewarding job. I love working with kids and making the study into something fun vs. scary. Absence seizures are interesting in how differently they can present from each child. Thankfully most grow out of them
We have been using Clonidine for sleep (.05mg) for our 5 year old. It's a blood pressure medication that helps make a person feel more physically relaxed, and has drowsiness as a side effect. The quality of my son's sleep has greatly improved. He is far less restless at night.
You might ask you physician if it would be an option given the sleep apnea. Have you also done a sleep study?
Thank you. Yes we have done the sleep study which determined all his teeth grinding was due to apnea events. He is having his adenoid and tonsils removed on Monday. I am hoping that will help with the staying asleep part but more than likely will still need to do something for the anxiety about going to sleep in his room. Did your kiddos pediatrician recommend the clonidine or another doctor?
We give a small dose of Clonidine (0.05mg) 30 minutes before bedtime, per the Psychiatrist we are working with. It's completely out of his system by morning. He wakes up bright eyed and bushy tailed and ready for school.
I am sorry you’re going through this. My teen daughter has adhd and social anxiety disorder. She too was always anxious before bed and slept terribly. Her psychologist said anxiety is often worst at bedtime. Sigh. She was sleep deprived for (I’m not exaggerating) YEARS. We tried everything. And I mean everything. We finally had a sleep study done and it determined nothing. Her sleep disturbance is all anxiety.
Antidepressants helped immensely with calming her from completely freaking out at bedtime (her thoughts still race though) and it did nothing for sleep. She would lay in bed for hours on end not able to fall asleep until 3-4am. She sees a pediatric psychiatrist which is what I recommend. Since we exhausted everything we could do (cool room / melatonin / magnesium / soft music / essential oils / screen-free before bed (kindle) / supplements / lavender pillow / CBT / neurobiofeedback / sleep study, etc) he finally prescribed sleep meds at 14 years of age. The first prescription didn’t even work and it’s what they give patients to fall asleep before surgery! We then moved to Trazodone and it WORKED!
For your situation I don’t know how young they will prescribe sleep medication but it is worth asking a professional. I strongly recommend a pediatric psychiatrist. There will always be negative reviews unless a doctor is God. Our doctor had a few bad reviews and he is amazing. Those reviews were the exception and only a couple. What is the ratio of good reviews to bad reviews? Look at it that way. Pedi Psychiatrists deal with all these adhd/anxiety/sleep issues all day long and know more than doctors who don’t manage these conditions full time. There is an answer out there. Just keep digging. I hope the surgery helps some!
Oh my. I got tired for you just listening to what you and your daughter had to go through for years! I am so glad you finally found something that worked for her. My niece who has anxiety also takes Trazodone at bed time and made a world of difference for her. Last night I went from giving him 2.5mg melatonin to 7 and it took about an hour but then he fell asleep and stayed asleep all night. Could definetely be a fluke but hopefully will do for a bit until we can get through the surgery/healing from that. You make a lot of sense in that there will always be negative reviews most likely. Its easier to ignore them when your searching for a nail salon vs someone who is prescribing meds for your child 😩 BUT I do know its important that we do this. Especially since more than likely we are dealing with some minor/moderate anxiety during the day time as well and will need to address this sooner than later.
Thank you for your helpful thoughts
My teen had sleep problems since 5 yrs old. Recently the child psychiatrist recommended a box light to help reset his circadian rhythm which so far has worked great. He never went to bed before 1am now he is able to with light therapy fall asleep by 11pm and wake up own his own now at 8:30am. Normally if I don’t wake him up he would normally sleep until 11am. You may want to check into light box. Science behind light therapy is very interesting. There is plenty of products out there, we got a light glasses looks like google glasses instead do the outdated light box. Our son’s psychiatrist personally uses this himself to boost energy and help with sleep.
Melatonin in low dose (3 - 5 MG) is good, consult your Psychiatrist or doctor before starting it. I would check into a different med than Ritalin, Vyvanse is good. Research meds though before deciding on one specific one, learn the side effects etc. Every child, person is different. .1 mg of Clonidine helps with sleep in little ones also. Be sure to keep track of his blood pressures, pulse rates, eating habits, weight etc while using ADHD meds as they are stimulants. Anxiety stems from fear, try to help the therapist discover his fears causing his anxieties!
Yes his dr defintely knows that we give melatonin and has said that it is safe. She suggested starting at the lowest of 2.5 and then going up if needed. We also keep a weight chart for him to monitor that. Why do you say not ritalin? He showed signs of anxiety both during the day and before bed long before we started the ritalin. We tried concerta and he had awful side effect. Climbing the walls practically. So far feel like ritalin is doing a good job with focus and getting through school day much better but we are missing the emotional regulation aspect still.
Ritalin just has a lot of negative associated with it from when it came out in the 80s to present. There are newer, safer meds for these little ones out there now. Ritalin does work for some. It is whatever you are most comfortable with and does the best for your little guy. Emotional regulation is where parents come in.... I suggest Love and Logic, Strengthening Families and Nurtured Heart Approach parenting classes. Research Executive Function, Impulsive behaviors in children with ADHD. chadd.org/for-parents/overv... and chadd.org/parent-to-parent/... Have you had him tested for coexisting conditions?
Yes I agree. I just recently started following/reading/watching all things adhd dude on YouTube. If you have not checked him out he is great. Very easy to understand and talks a lot about emotional regulation and executive function skills. He is offering a parent class soon and I plan to take it.Starting the med journey is definetely a compelx one. He is doing pretty well on Ritalin as of now. Has made a lot of progress but as time goes on and if he gets a diagnosis with anxiety disorder am open to hearing of other options. He has not been tested yet but plan to bring it up on our follow up appt in June.
The biggest tool that helped me for decades is a white noise machine that has multiple sounds. I simply use white noise but others use other sounds such as a babbling brook or rainfall or any number of repetitive sounds. Hopefully one of them will be the most soothing for your child. Whenever I take a trip I take the white noise machine with me. Everyday at home I use it throughout the night and when taking a nap. Again, a life changer for me. Hope this helps.
I have had exactly the same experience with two children. In terms of analysis and treatment, you need to split the ADHD from the Sleep Apnea and treat the Sleep Apnea first. Kids with Sleep Apnea will wake dozens of times a night. If they are in the midst of a dream at that time then their dreams do become extremely vivid. Both our kids has their tonsils and adenoids removed around the age of 4 (the surgery is called an Adenotonsillectomy).
It is important to understand the surgery is not a miracle overnight cure. Yes they will immediately breathe more clearly at night. However they will also, possibly for the first time in years, experience REM sleep. Our ENT referred to this as "REM rebound". For our kids, the REM rebound resulted in night terrors, vivid dreams and even sleep walking for both our kids. However, 6 weeks post surgery these effects disappeared and both slept like babies.
Now on the the ADHD. Yes ADHD can affect sleep and dosing times are important. Melatonin can help. One of our kids is helped greatly by Brain.Fm but it has, so far, shown no benefit for our youngest.
Talk to your paediatrician about talking half or quarter of a short acting tablet at 3pm instead of a whole tablet. Ritalin has a half-life. Thus later doeses do build upon what is already in the system. See this link medscape.com/content/2003/0...
Thus a 10mg short acting at say 3pm will push the curve back up to its peak and delay sleep by several hours. We have found 2.5mg at around 3pm is enough delay the decline of Ritalin in the blood plasma. My eldest is on Ritalin LA 30mg. If he has a 10mg short acting at 3pm then he wont sleep until 1am. If he has 2.5mg then he can get his homework done and be asleep by 8pm.
Thank you for the heads up on what possibly to expect after the surgery. My son had night terrors for a few months at age 3 so I atleast know what those look like and how to handle them. Hopefully that will not be the case though. I'm not sure the afternoon 10mg booster is really affecting his ability to fall asleep. The afternoon dose seems completely out of his system by 6:30pm. Also, he is behaving exactly how he did pre ritalin. Not hyper just anxious about being in the bedroom without mom or dad.
Laatnight we upped his melatonin a bit and he fell asleep in an hr and was able to stay asleep. We will see if this continues and how he lands after surgery!
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