The ADHD Family Newsletter – Week 7

ADHD and Sleep: Why Rest Is Essential for Your Child’s Success

A weekly guide for parents and teachers supporting children with ADHD

This Week’s Focus: The Sleep Foundation of Success

If ADHD is like running a marathon with a backpack full of rocks, then poor sleep is like running that same marathon after staying awake all night. Sleep isn’t just important for children with ADHD – it’s absolutely critical for their brain function, emotional regulation, and daily success.

The harsh reality: Many ADHD children are running on chronic sleep deprivation, making their already challenging symptoms significantly worse.

Meet Kamau: The Night Owl’s Struggle

Eight-year-old Kamau from Cape Town has a predictable pattern. By 7 PM, when his neurotypical sister is naturally winding down, Kamau seems to get a second wind. His mind races with ideas, his body fidgets, and falling asleep becomes an epic battle that often lasts until 10 or 11 PM.

The culprits making it worse:

• Screens: An hour of tablet games after supper has his brain buzzing with stimulation
• Medication timing: His stimulant medication, given at 8 AM, is still affecting his system at bedtime
• Anxiety and overthinking: His mind won’t stop processing the day’s events and tomorrow’s worries

When the 6:30 AM alarm rings, Kamau is a different child – irritable, unable to focus, emotionally explosive, and completely overwhelmed by tasks that might be manageable when he’s well-rested.

His teacher sees: A child who can’t pay attention, disrupts class, and seems defiant His parents see: Daily meltdowns, homework battles, and family stress What’s really happening: A sleep-deprived ADHD brain trying to function with depleted resources

The breakthrough came when the family prioritised sleep as medicine, not just a nice-to-have.

The ADHD-Sleep Connection: Why It’s So Complicated

The Vicious Cycle

ADHD and sleep problems create a self-perpetuating cycle:

ADHD symptoms make sleep difficult:

• Hyperactive minds that won’t “switch off”
• Screen overstimulation: Blue light and engaging content disrupting natural sleep signals
• Medication effects: Stimulants given too late in the day keeping brains alert past bedtime
• Anxiety and overthinking: Racing thoughts about school, friendships, and tomorrow’s challenges
• Impulsivity that leads to poor bedtime choices
• Difficulty with transitions, including the transition to sleep
• Emotional dysregulation that creates bedtime battles
• Executive function deficits that make sleep routines hard to follow

Poor sleep makes ADHD symptoms worse:

• Reduced attention and focus the next day
• Increased impulsivity and emotional reactivity
• Greater difficulty with executive functions
• Heightened sensitivity to stress and stimulation
• Reduced ability to cope with daily challenges

The Neurological Reality

Sleep and ADHD share common brain pathways:

• Both involve the prefrontal cortex (executive functions)
• Both are affected by dopamine and noradrenaline systems
• Both require regulation of arousal and attention
• Both impact emotional processing and memory consolidation

This overlap means that sleep problems in ADHD children aren’t just behavioural – they’re neurobiological.

Common ADHD Sleep Challenges

Sleep Onset Difficulties: The Racing Mind

What it looks like:

• Taking 1-3 hours to fall asleep despite being tired
• Mind racing with thoughts, worries, creative ideas, or screen images from earlier
• Anxiety about school performance, social situations, or tomorrow’s tasks
• Physical restlessness even when lying still
• Sensitivity to sounds, light, or textures that prevent sleep
• “Second wind” energy just when they should be winding down
• Replaying conversations or events from the day over and over

The ADHD brain explanation:

• Difficulty transitioning from “awake mode” to “sleep mode”
• Screen exposure disrupting melatonin production and creating mental stimulation
• Stimulant medication wearing off, causing rebound hyperactivity, or still being active if given too late
• Anxiety and worry creating a hypervigilant state that prevents sleep
• Hypervigilance that keeps the nervous system activated
• Poor internal clock regulation

Sleep Maintenance Problems: The Restless Sleeper

What it looks like:

• Frequent night wakings
• Restless, fidgety sleep with lots of movement
• Talking or calling out during sleep
• Difficulty getting back to sleep after waking
• Morning exhaustion despite being in bed for adequate hours

What’s happening:

• Lighter sleep phases mean easier awakening
• Physical restlessness continues even during sleep
• Anxiety or worry causing sleep fragmentation
• Possible sleep disorders (sleep apnoea, restless leg syndrome)

Morning Difficulties: The Impossible Wake-Up

What it looks like:

• Extreme difficulty waking up, even with multiple alarms
• Grogginess and irritability that lasts hours
• Appearing to be awake but not functional
• Emotional meltdowns immediately upon waking
• Needing excessive time to become alert and ready

The ADHD factor:

• Delayed sleep phase common in ADHD
• Poor sleep quality leading to inadequate rest
• Medication timing affecting wake cycles
• Executive function deficits making morning routines overwhelming

Age-Specific Sleep Challenges

Preschoolers (Ages 3-6): Establishing Foundations

Common issues:

• Resistance to nap transitions when they outgrow naps
• Bedtime battles becoming family-wide stress
• Night terrors or vivid dreams
• Early morning waking (4-5 AM starts)
• Difficulty with sleep routine consistency

What helps:

• Consistent bedtime routines starting early
• Physical activity earlier in the day, not close to bedtime
• Limiting stimulating activities 2 hours before bed
• Creating calm, predictable sleep environments
• Teaching self-soothing skills

School Age (Ages 7-12): Academic Impact

Common issues:

• Homework and activities pushing bedtime later
• Increased academic and social stresses affecting sleep
• Stimulant medication affecting appetite and sleep
• Growing independence challenging parental sleep oversight
• Sleep problems affecting school performance significantly

What helps:

• Prioritising sleep over excessive activities
• Creating homework schedules that don’t conflict with sleep
• Working with doctors on medication timing
• Teaching children about sleep’s importance for their success
• Maintaining family sleep rules and boundaries

Teenagers (Ages 13-18): The Perfect Storm

Common issues:

• Natural adolescent sleep phase delay conflicting with early school starts
• Increased academic pressures and social activities
• Technology and social media disrupting sleep
• Hormonal changes affecting sleep patterns
• Independence desires clashing with sleep needs

What helps:

• Understanding that teen sleep patterns are biologically different
• Negotiating reasonable but firm sleep boundaries
• Creating technology-free zones and times
• Educating teens about sleep’s impact on their goals
• Advocating for reasonable school start times when possible

The Hidden Costs of Poor Sleep in ADHD

Academic Impact

Poor sleep makes everything harder:

• Attention spans become even shorter
• Memory consolidation is impaired
• Problem-solving abilities decline
• Emotional regulation during school stress decreases
• Physical coordination and fine motor skills suffer

Research shows: Just one hour less sleep can reduce a child’s cognitive performance by two grade levels the next day.

Social and Emotional Consequences

Sleep-deprived ADHD children:

• Have more friendship conflicts
• Struggle with emotional regulation
• Show increased aggression or withdrawal
• Have difficulty reading social cues
• Experience more rejection sensitivity

Family System Stress

Poor sleep affects everyone:

• Parents lose sleep managing bedtime battles
• Siblings’ sleep is disrupted by noise and chaos
• Family mornings become stressful and rushed
• Everyone’s emotional regulation suffers
• Quality family time decreases due to exhaustion

Physical Health Impact

Chronic sleep deprivation in ADHD children leads to:

• Weakened immune systems and frequent illness
• Appetite regulation problems and potential weight issues
• Increased injury risk due to impaired coordination
• Growth hormone disruption
• Long-term cardiovascular health risks

Creating Sleep Success: Practical Strategies

The ADHD Sleep Environment

Bedroom optimisation:

• Cool temperature (around 18°C)
• Blackout curtains or eye masks
• White noise machines to mask disruptive sounds
• Comfortable, weighted blankets for some children
• Removing stimulating decorations or toys from the sleep space
• Ensuring comfortable mattress and pillows

Technology boundaries:

• No screens 1-2 hours before bedtime
• Charging devices outside the bedroom
• Blue light filters on necessary devices
• Using traditional alarm clocks instead of phones
• Creating physical separation between entertainment and sleep spaces

The Wind-Down Routine: Making Sleep Inevitable

2 hours before bedtime:

• Finish homework and stimulating activities
• Begin dimming lights throughout the house
• Start quiet, calming activities
• Have final snack if needed (protein-rich, not sugary)

1 hour before bedtime:

• Begin formal bedtime routine
• Bath or shower with calming scents
• Quiet reading or gentle music
• Simple meditation or breathing exercises
• Physical affection and connection time

30 minutes before bedtime:

• In bedroom with minimal stimulation
• Final bathroom visit
• Brief gratitude or positive reflection
• Physical comfort measures (back rub, foot massage)
• Consistent goodnight ritual

Timing and Consistency

The power of routine:

• Same bedtime and wake time every day (yes, even weekends)
• Routine starts at the same time nightly
• Steps happen in the same order
• Everyone in the family respects sleep time
• Exceptions are rare and planned for

Finding the right bedtime:

• Work backwards from required wake time
• Allow for individual sleep needs (usually 9-11 hours for school-age children)
• Consider natural circadian rhythms
• Factor in time needed to fall asleep
• Adjust gradually (15 minutes earlier each night)

Nutrition and Sleep: The Connection

Foods That Help Sleep

Evening snacks that promote sleep:

• Turkey or chicken (tryptophan content)
• Bananas (natural melatonin and magnesium)
• Oatmeal with nuts (complex carbs and protein)
• Herbal teas like chamomile (caffeine-free)
• Small portions of cherries (natural melatonin)

Foods and Drinks to Avoid

Sleep disruptors:

• Caffeine in any form (chocolate, tea, soft drinks)
• Large meals close to bedtime
• Sugary snacks that cause energy spikes
• Excessive fluids that cause night waking
• Artificial colours and preservatives that may increase hyperactivity

Medication and Meal Timing

Working with stimulant medications:

• Coordinate with doctor about timing of last dose
• Ensure adequate nutrition during the day when appetite is suppressed
• Consider protein-rich evening meals to support neurotransmitter production
• Monitor how medication affects individual sleep patterns
• Discuss with doctor if sleep problems persist

Exercise and Sleep: The Physical Connection

The Right Kind of Physical Activity

Morning and afternoon exercise:

• Vigorous physical activity earlier in the day
• Outdoor time for natural light exposure
• Sports or structured physical activities
• Playground time that includes running and climbing
• Swimming or cycling for full-body exertion

Evening movement:

• Gentle stretching or yoga
• Walking the dog as family activity
• Slow dancing to calm music
• Simple massage or self-massage
• Progressive muscle relaxation exercises

Timing Matters

Exercise timing guidelines:

• Vigorous exercise should end at least 3 hours before bedtime
• Gentle movement can continue closer to bedtime
• Morning exercise helps regulate circadian rhythms
• Consistent daily activity is more important than intensity
• Some children need movement to help them wind down

When Sleep Problems Persist: Seeking Help

Red Flags for Professional Evaluation

See a doctor if your child has:

• Snoring, gasping, or breathing pauses during sleep
• Extreme difficulty falling asleep despite good sleep hygiene
• Frequent night waking that doesn’t improve with routine
• Daytime sleepiness despite adequate sleep opportunity
• Bedwetting that returns or persists beyond typical ages
• Sleepwalking or night terrors
• Restless leg movements or periodic limb movements

Sleep Disorders Common in ADHD

Sleep apnoea:

• More common in children with ADHD
• Can mimic or worsen ADHD symptoms
• Requires medical evaluation and treatment
• May involve enlarged tonsils or adenoids

Restless leg syndrome:

• Uncomfortable sensations in legs that worsen at bedtime
• Irresistible urge to move legs
• Can significantly delay sleep onset
• May respond to iron supplementation or medication

Delayed sleep phase syndrome:

• Natural sleep time much later than desired
• Extreme difficulty with early morning wake times
• May require light therapy or melatonin
• Common in teenagers with ADHD

Professional Help Options

Paediatric sleep specialists:

• Comprehensive sleep evaluations
• Sleep study recommendations if needed
• Medical treatment for sleep disorders
• Coordination with ADHD treatment team

Behavioural sleep interventions:

• Sleep hygiene education
• Cognitive behavioural therapy for insomnia
• Relaxation training
• Family-based sleep interventions

Melatonin and ADHD: What Parents Need to Know

Understanding Melatonin

What it is:

• Natural hormone that regulates sleep-wake cycles
• Available as over-the-counter supplement
• Can help with sleep onset difficulties
• Not a sedative but helps signal bedtime to the brain

How it helps ADHD children:

• Addresses delayed sleep phase common in ADHD
• Helps establish consistent sleep timing
• Can reduce bedtime battles
• May improve overall sleep quality

Using Melatonin Safely

Important considerations:

• Consult with doctor before starting
• Start with lowest effective dose
• Give 30-60 minutes before desired bedtime
• Use consistently, not just on difficult nights
• Combine with good sleep hygiene, not replace it
• Monitor for side effects or changes in effectiveness

When melatonin might help:

• Difficulty falling asleep despite good routines
• Delayed sleep phase that interferes with daily functioning
• Temporary disruptions (travel, schedule changes)
• As part of comprehensive sleep improvement plan

Sleep and Academic Performance: The School Connection

Advocating for Your Sleep-Deprived Child

Working with teachers:

• Explain how sleep affects your child’s ADHD symptoms
• Share information about sleep problems and academic impact
• Request understanding during periods of sleep difficulty
• Discuss accommodations for sleep-related challenges

School start time considerations:

• Advocate for reasonable school start times when possible
• Understand your child’s natural rhythm vs school demands
• Work with school on strategies for difficult mornings
• Consider transportation options that allow more sleep

Homework and Sleep Balance

Prioritising sleep over homework completion:

• Set firm homework cut-off times
• Communicate with teachers about sleep prioritisation
• Focus on quality work during available time
• Advocate for reasonable homework loads
• Remember that sleep is more important for learning than excessive homework

Family Sleep Success Stories

The Transformation Timeline

Week 1-2: Establishing new routines (expect resistance) Week 3-4: Beginning to see improvements in sleep onset Week 5-6: Noticing daytime improvements in mood and attention Week 7-8: Family stress decreasing, routines becoming natural Month 3+: Sustained improvements in multiple areas of functioning

What Success Looks Like

Sleep improvements:

• Falling asleep within 30 minutes
• Sleeping through the night most nights
• Waking up more easily
• Better mood and energy in mornings

Daytime improvements:

• Better attention and focus at school
• Fewer emotional meltdowns
• Improved social interactions
• Better family relationships
• Reduced need for behaviour interventions

A Message from Dr Flett About Sleep and ADHD

In my practice, I see sleep as one of the most underestimated interventions for ADHD children. Parents often focus intensively on medication, therapy, and school accommodations whilst overlooking the foundation that makes all other interventions more effective: adequate, quality sleep.

Here’s what every ADHD family needs to understand: Sleep isn’t a luxury – it’s medicine. A well-rested ADHD brain functions dramatically better than a sleep-deprived one. Often, addressing sleep problems can reduce ADHD symptoms by 30-40%, making other interventions more effective.

The challenge is that ADHD makes good sleep difficult, creating a vicious cycle. But with consistent effort and the right strategies, this cycle can be broken. I’ve seen families transform when they prioritise sleep as seriously as they prioritise medication or therapy.

Don’t underestimate how much sleep problems are affecting your entire family system. When the ADHD child sleeps better, everyone’s stress decreases, family relationships improve, and daily life becomes more manageable.

Sometimes sleep problems indicate underlying medical conditions that need professional evaluation. Don’t struggle alone if basic sleep hygiene isn’t working – seek help from paediatric sleep specialists when needed.

Remember: Every hour of sleep your child gains is an investment in their success, happiness, and your family’s wellbeing.

Contact Dr John Flett

Location: 8 Village Road, Kloof, Durban
Phone: 031 1000 474
Online: Zoom consultations available for schools and educators

Dr Flett can help evaluate sleep problems in ADHD children and coordinate comprehensive treatment approaches that address both sleep and ADHD symptoms.

Next week: “ADHD and Nutrition: Fueling Your Child’s Brain for Success”