The document discusses the complex relationship between attention-deficit/hyperactivity disorder (ADHD) and sleep. It notes that up to 50% of children with ADHD experience sleep problems like difficulties falling asleep or staying asleep. Sleep issues can both exacerbate ADHD symptoms and be exacerbated by them. ADHD medications can further disrupt sleep for some patients, though they may paradoxically improve it for others by reducing symptoms. The document recommends evaluating and treating any underlying sleep disorders before initiating ADHD medication.
Attention Deficit disorder with its etiology, types and pathophysiology clinical features, Diagnosis, Assessment, differential Diagnosis and treatment , Medical Treatment and prognosis
This document provides an overview of attention deficit hyperactivity disorder (ADHD). It begins with an introduction that describes ADHD as a common neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. It then discusses the types of ADHD (predominantly inattentive, predominantly hyperactive-impulsive, and combined type), prevalence rates, etiology, comorbidities, signs and symptoms, diagnosis, prognosis, and treatment options. Treatment involves medication, therapy like cognitive behavioral therapy, behavior therapy, and lifestyle modifications to help manage symptoms.
This paper discusses physiotherapy management for attention deficit hyperactivity disorder (ADHD). It defines ADHD and outlines its types, symptoms, comorbidities, and diagnostic criteria. It describes the pathophysiology involving dopamine and norepinephrine neurotransmitters. Management includes stimulant and non-stimulant medications as well as physiotherapy interventions targeting motor skills, sensory integration, strength, and lifestyle factors like diet and exercise. Physiotherapy is beneficial for both physical problems and improving social/attention skills for those with ADHD.
Are you feeling sleepy in daytimes? Check immediately the symptoms of excessive daytime sleepiness. It is one of the common sleep disorder problem .Prevent yourself from daytime sleepiness by following the tips and treatments suggest by the Sleep disorder specialist doctors.
ADHD is a neurodevelopmental disorder that affects attention, hyperactivity, and impulsivity. It is commonly diagnosed in childhood but often persists into adulthood. Symptoms are caused by genetic and environmental factors and treated through a combination of medication and behavioral therapy. Proper treatment and lifestyle management can help those with ADHD succeed academically and professionally.
Global Medical Cures™ | Attention Deficit Hyperactivity Disorder (ADHD) Global Medical Cures™
Global Medical Cures™ | Attention Deficit Hyperactivity Disorder (ADHD)
~10% of kids in the US are prescribed ADHD drugs and this trend is also growing worldwide. Find out more about ADHD in this booklet.
DISCLAIMER-
Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Attention Deficit disorder with its etiology, types and pathophysiology clinical features, Diagnosis, Assessment, differential Diagnosis and treatment , Medical Treatment and prognosis
This document provides an overview of attention deficit hyperactivity disorder (ADHD). It begins with an introduction that describes ADHD as a common neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. It then discusses the types of ADHD (predominantly inattentive, predominantly hyperactive-impulsive, and combined type), prevalence rates, etiology, comorbidities, signs and symptoms, diagnosis, prognosis, and treatment options. Treatment involves medication, therapy like cognitive behavioral therapy, behavior therapy, and lifestyle modifications to help manage symptoms.
This paper discusses physiotherapy management for attention deficit hyperactivity disorder (ADHD). It defines ADHD and outlines its types, symptoms, comorbidities, and diagnostic criteria. It describes the pathophysiology involving dopamine and norepinephrine neurotransmitters. Management includes stimulant and non-stimulant medications as well as physiotherapy interventions targeting motor skills, sensory integration, strength, and lifestyle factors like diet and exercise. Physiotherapy is beneficial for both physical problems and improving social/attention skills for those with ADHD.
Are you feeling sleepy in daytimes? Check immediately the symptoms of excessive daytime sleepiness. It is one of the common sleep disorder problem .Prevent yourself from daytime sleepiness by following the tips and treatments suggest by the Sleep disorder specialist doctors.
ADHD is a neurodevelopmental disorder that affects attention, hyperactivity, and impulsivity. It is commonly diagnosed in childhood but often persists into adulthood. Symptoms are caused by genetic and environmental factors and treated through a combination of medication and behavioral therapy. Proper treatment and lifestyle management can help those with ADHD succeed academically and professionally.
Global Medical Cures™ | Attention Deficit Hyperactivity Disorder (ADHD) Global Medical Cures™
Global Medical Cures™ | Attention Deficit Hyperactivity Disorder (ADHD)
~10% of kids in the US are prescribed ADHD drugs and this trend is also growing worldwide. Find out more about ADHD in this booklet.
DISCLAIMER-
Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder that impacts attention, focus, and impulse control. It has no single cure but can be managed through various treatment options like stimulant medications, non-stimulants, cognitive behavioral therapy, parenting skills training, and lifestyle modifications. An individualized treatment plan considers factors like a person's age, symptoms, and preferences to most effectively improve their quality of life.
Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders characterized by difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity. While the exact causes are unknown, genetics and environmental factors likely play a role. ADHD is diagnosed through a comprehensive evaluation by a licensed health professional considering behaviors, development, and environment over several months. Effective treatments include medications and psychotherapy to help manage symptoms.
ADHD is one of the most common childhood disorders characterized by difficulty paying attention, hyperactivity, and impulsivity. It is caused by a combination of genetic and environmental factors. Diagnosis involves ruling out other potential causes and determining that symptoms negatively impact daily functioning. Treatment typically involves stimulant medications, which can improve focus and reduce hyperactivity, as well as psychotherapy. While there is no cure for ADHD, treatment can effectively manage symptoms.
The document discusses sleep problems in older adults. It covers epidemiology of sleep problems, changes in sleep with aging, evaluation of sleep including screening questions, office evaluation and objective tests. Common sleep disorders like insomnia, sleep apnea, periodic limb movements and restless legs syndrome are discussed. Treatment options and management of sleep problems are also covered.
The document discusses strategies for establishing healthy routines to help children transition between day and night. It recommends starting the day with a consistent morning routine to set the child's circadian rhythm and regulate their sleep-wake cycle. The evening routine should wind down activities before bedtime. Individualizing the routines based on a child's needs, using positive reinforcement, and establishing logical sequences of activities can help motivate children and address issues with self-regulation. Perseverance and reviewing strategies if no progress is made are important to find an effective approach.
The document discusses insomnia, including its definition as difficulty falling or staying asleep, types such as chronic or short-term, common causes like stress or medications, symptoms like fatigue, and treatments including cognitive behavioral therapy, relaxation techniques, and sometimes prescription medications. Diagnosis involves keeping a sleep log and may include tests like a sleep study to evaluate nighttime sleep patterns.
ASSIGNMENTRespond to at least two of your colleagues by c.docxmckellarhastings
ASSIGNMENT:
Respond
to at least
two
of your colleagues by comparing the differential diagnostic features of the disorder you were assigned(
HYPERSOMNIA)
to the diagnostic features of the disorder your colleagues were assigned.
Note:
Support your responses with evidence-based literature with at least two references in each colleague’s response with proper citation in APA Format.
Colleagues
Respond # 1
The assigned sleep/wake disorder is Insomnia. According to Ruiz, Sadock, & Sadock (2014) insomnia is defined as difficulty initiating or maintaining sleep. It is currently considered as an independent condition where as in the past causes of the condition rather than symptoms were treated.
Diagnostic Criteria for Insomnia
According to American psychiatric association (2013), individuals need to meet criteria A to criteria H to diagnose insomnia. Criteria A requires one or more of the three symptoms such as difficulty in initiating sleep, difficulty in maintain sleep and early morning awakening with inability to return back to sleep which cause dissatisfaction with the sleep quantity or quality (American Psychiatric association 2013). The other criteria from B to H explains that the sleep disturbance causes impairment in social, occupational, educational, educational, behavioral or other important areas of functioning, disturbance occurs three nights per week and present for at least three months, it occurs despite adequate opportunity to sleep, insomnia do not caused by another sleep wake disorder, not attributable to physiological effect of a substance, and coexisting mental disorders or medical condition do not adequately explain insomnia (American psychiatric association 2013).
Psychotherapy Treatment
The psychological and behavioral therapies for insomnia according to Gabbard (2014) are sleep hygiene education, stimulus control therapy, sleep restriction, cognitive therapy, and relaxation therapies. Sleep focused cognitive-behavior therapy (SCBT) is a combination of various non pharmacological strategies and it is structured and time limited with a focus on sleep related issues (Gabbard 2014). It is for 6-8 weeks, once in each week. The treatment has shown benefit for up to six months after termination of SCBT (Gabbard 2014). However, there are some pitfalls with this treatment as it requires patient initiative, motivation and active participation in the treatment process, along with greater time commitment and limited availability of practitioners (Gabbard 2014).
Psychopharmacological Treatments
The pharmacological treatment of insomnia are hypnotics and the sleep medications according to Ruiz et al (2014) should not be prescribed for more than 2 weeks due to development of tolerance and withdrawal. According to Gabbard (2014) the FDA approved hypnotic agents are benzodiazepines, non-benzodiazepines, melatonin receptor agonists, and Histamine H1 receptor antagonists. For Treatment of insomnia character.
1) Attention deficit hyperactivity disorder (ADHD) is a brain disorder characterized by inattention, hyperactivity, and impulsivity that interferes with functioning.
2) While the specific causes are unknown, genetic and environmental factors like smoking during pregnancy may play a role. ADHD is associated with lower dopamine levels in the brain.
3) Diagnosis involves evaluating symptoms like poor attention, hyperactivity, and impulsivity based on reports from parents and teachers. Stimulant medications and behavioral therapy are commonly used to treat ADHD.
The document discusses signs and symptoms of ADHD in children, including difficulty focusing, being easily distracted, fidgeting, blurting out comments, and difficulty waiting their turn. It provides information on the causes of ADHD including genetics and environmental factors like smoking during pregnancy. It describes the three types of ADHD (inattentive, hyperactive-impulsive, combined) and treatments including stimulant medications, non-stimulant medications, behavioral therapies, and classroom accommodations.
ADHD is the most common neurobehavioral disorder in children characterized by inattention, hyperactivity, and impulsivity. It has no single cause but is linked to genetic and environmental factors like prenatal smoking. Treatment involves medication like stimulants which are effective for 75-90% of children, as well as behavioral therapies and lifestyle changes. A multimodal approach combining medication, parent/teacher training, and lifestyle modifications provides the most effective long-term management of ADHD symptoms.
This document presents information about sleep paralysis from a student. It discusses signs and symptoms like being unable to move upon waking or falling asleep and sometimes experiencing hallucinations. Causes are related to disruptions in REM sleep cycles where the body is paralyzed but the mind wakes up. Risk factors include conditions like narcolepsy, irregular sleep patterns, and family history. Prevention focuses on good sleep hygiene and managing stress or underlying conditions. Diagnosis may include checking for other issues like narcolepsy if it happens often. Treatment aims to address triggers or underlying causes through better sleep, stress management, or medications in some cases.
This document summarizes common childhood psychiatric disorders presented by doctors in Bangladesh. It discusses:
1. The increasing prevalence of psychiatric disorders in children worldwide and in Bangladesh based on epidemiological studies.
2. Common disorders seen in Bangladeshi children including anxiety disorders, ADHD, autism spectrum disorders, somatic symptom disorder, and elimination disorders.
3. The causes of rising psychiatric disorders in children such as modern life stresses, technology overuse, and family changes. Treatment approaches including behavioral therapy and pharmacotherapy are mentioned.
This document discusses Attention Deficit Hyperactivity Disorder (ADHD) and how the diagnostic criteria for ADHD has been updated in the DSM-5 to better characterize ADHD in adults. It notes that ADHD often continues from childhood into adulthood. The document then discusses common clinical histories seen in adults with ADHD, domains of impairment associated with ADHD, and the link between ADHD and addiction, noting people with ADHD are vulnerable to substance abuse to try and self-medicate their symptoms. It emphasizes the importance of treating both ADHD and any co-occurring addictions.
This document discusses learners with Attention Deficit Hyperactivity Disorder (ADHD). It begins by outlining some common myths and misconceptions about ADHD. The current clinical definition of ADHD from the DSM is then explained, which includes three subtypes. Professionals use medical examinations, clinical interviews, rating scales and observations to identify individuals with ADHD. The causes of ADHD are largely neurological, impacting areas of the brain involved in regulating behavior. Psychological and behavioral characteristics of those with ADHD include problems with behavioral inhibition, executive functions, time management, goal-directed behavior and social skills. Classroom instruction should provide structure, visual aids, clear routines and frequent shifts in activities. Medications like psychost
Case An elderly widow who just lost her spouse. Subjective.docxcowinhelen
Case: An elderly widow who just lost her spouse.
Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications:
• Metformin 500mg BID
• Januvia 100mg daily
• Losartan 100mg daily
• HCTZ 25mg daily
• Sertraline 100mg daily
Current weight: 88 kg
Current height: 64 inches
Temp: 98.6 degrees F
BP: 132/86
Insomnia is a disorder linked with difficulty in sleep quality, initiating or maintaining sleep, along with substantial distress and impairments of daytime functioning. Its prevalence ranges from 10 to 15% among the general population, with higher rates seen among females, divorced or separated individuals, those with loss of loved ones, and older people (Bollu & Kaur, 2019). Insomnia can simply be defined as a sleep disorder where the patient has trouble falling asleep or staying asleep. According to Krystal et al (2019), it is a common condition that is linked with noticeable deterioration in function and quality of life, mental and physical morbidity. The complaints of insomnia are present in 60–90% of patients with major depression, Complaints of disrupted sleep are very common in patients suffering from depression, (Wichniak, etal., 2017).
Questions you might ask the patient and rationale
The diagnosis and treatment of insomnia rely mainly on a thorough sleep history to address the precipitating factors as well as maladaptive behaviors resulting in poor sleep (Bollu & Kaur, 2019).
What is your sleep pattern including how many hours of sleep do you get at night prior to your husband’s demise and what it has been in the 10 months since his death? Does she perform certain rituals or do something special before she sleeps. This assesses if the insomnia started before or after the husband’s death. This provides a clue to insomnia that may be related to bereavement.
What time do you go to bed every night and what is your normal routine before going to bed? This is to check if the patient is doing something differently which has disrupted her normal routine and caused insomnia.
How often do you wake up to urinate at night? This question is asked to assess for nocturia due to diabetes that may lead to insomnia. Nocturia can prevent the patient from having a good night’s sleep. , changes in blood glucose levels at night causesto hypoglycemic and hyperglycemic episodes, nocturia and associated .
Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder that impacts attention, focus, and impulse control. It has no single cure but can be managed through various treatment options like stimulant medications, non-stimulants, cognitive behavioral therapy, parenting skills training, and lifestyle modifications. An individualized treatment plan considers factors like a person's age, symptoms, and preferences to most effectively improve their quality of life.
Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders characterized by difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity. While the exact causes are unknown, genetics and environmental factors likely play a role. ADHD is diagnosed through a comprehensive evaluation by a licensed health professional considering behaviors, development, and environment over several months. Effective treatments include medications and psychotherapy to help manage symptoms.
ADHD is one of the most common childhood disorders characterized by difficulty paying attention, hyperactivity, and impulsivity. It is caused by a combination of genetic and environmental factors. Diagnosis involves ruling out other potential causes and determining that symptoms negatively impact daily functioning. Treatment typically involves stimulant medications, which can improve focus and reduce hyperactivity, as well as psychotherapy. While there is no cure for ADHD, treatment can effectively manage symptoms.
The document discusses sleep problems in older adults. It covers epidemiology of sleep problems, changes in sleep with aging, evaluation of sleep including screening questions, office evaluation and objective tests. Common sleep disorders like insomnia, sleep apnea, periodic limb movements and restless legs syndrome are discussed. Treatment options and management of sleep problems are also covered.
The document discusses strategies for establishing healthy routines to help children transition between day and night. It recommends starting the day with a consistent morning routine to set the child's circadian rhythm and regulate their sleep-wake cycle. The evening routine should wind down activities before bedtime. Individualizing the routines based on a child's needs, using positive reinforcement, and establishing logical sequences of activities can help motivate children and address issues with self-regulation. Perseverance and reviewing strategies if no progress is made are important to find an effective approach.
The document discusses insomnia, including its definition as difficulty falling or staying asleep, types such as chronic or short-term, common causes like stress or medications, symptoms like fatigue, and treatments including cognitive behavioral therapy, relaxation techniques, and sometimes prescription medications. Diagnosis involves keeping a sleep log and may include tests like a sleep study to evaluate nighttime sleep patterns.
ASSIGNMENTRespond to at least two of your colleagues by c.docxmckellarhastings
ASSIGNMENT:
Respond
to at least
two
of your colleagues by comparing the differential diagnostic features of the disorder you were assigned(
HYPERSOMNIA)
to the diagnostic features of the disorder your colleagues were assigned.
Note:
Support your responses with evidence-based literature with at least two references in each colleague’s response with proper citation in APA Format.
Colleagues
Respond # 1
The assigned sleep/wake disorder is Insomnia. According to Ruiz, Sadock, & Sadock (2014) insomnia is defined as difficulty initiating or maintaining sleep. It is currently considered as an independent condition where as in the past causes of the condition rather than symptoms were treated.
Diagnostic Criteria for Insomnia
According to American psychiatric association (2013), individuals need to meet criteria A to criteria H to diagnose insomnia. Criteria A requires one or more of the three symptoms such as difficulty in initiating sleep, difficulty in maintain sleep and early morning awakening with inability to return back to sleep which cause dissatisfaction with the sleep quantity or quality (American Psychiatric association 2013). The other criteria from B to H explains that the sleep disturbance causes impairment in social, occupational, educational, educational, behavioral or other important areas of functioning, disturbance occurs three nights per week and present for at least three months, it occurs despite adequate opportunity to sleep, insomnia do not caused by another sleep wake disorder, not attributable to physiological effect of a substance, and coexisting mental disorders or medical condition do not adequately explain insomnia (American psychiatric association 2013).
Psychotherapy Treatment
The psychological and behavioral therapies for insomnia according to Gabbard (2014) are sleep hygiene education, stimulus control therapy, sleep restriction, cognitive therapy, and relaxation therapies. Sleep focused cognitive-behavior therapy (SCBT) is a combination of various non pharmacological strategies and it is structured and time limited with a focus on sleep related issues (Gabbard 2014). It is for 6-8 weeks, once in each week. The treatment has shown benefit for up to six months after termination of SCBT (Gabbard 2014). However, there are some pitfalls with this treatment as it requires patient initiative, motivation and active participation in the treatment process, along with greater time commitment and limited availability of practitioners (Gabbard 2014).
Psychopharmacological Treatments
The pharmacological treatment of insomnia are hypnotics and the sleep medications according to Ruiz et al (2014) should not be prescribed for more than 2 weeks due to development of tolerance and withdrawal. According to Gabbard (2014) the FDA approved hypnotic agents are benzodiazepines, non-benzodiazepines, melatonin receptor agonists, and Histamine H1 receptor antagonists. For Treatment of insomnia character.
1) Attention deficit hyperactivity disorder (ADHD) is a brain disorder characterized by inattention, hyperactivity, and impulsivity that interferes with functioning.
2) While the specific causes are unknown, genetic and environmental factors like smoking during pregnancy may play a role. ADHD is associated with lower dopamine levels in the brain.
3) Diagnosis involves evaluating symptoms like poor attention, hyperactivity, and impulsivity based on reports from parents and teachers. Stimulant medications and behavioral therapy are commonly used to treat ADHD.
The document discusses signs and symptoms of ADHD in children, including difficulty focusing, being easily distracted, fidgeting, blurting out comments, and difficulty waiting their turn. It provides information on the causes of ADHD including genetics and environmental factors like smoking during pregnancy. It describes the three types of ADHD (inattentive, hyperactive-impulsive, combined) and treatments including stimulant medications, non-stimulant medications, behavioral therapies, and classroom accommodations.
ADHD is the most common neurobehavioral disorder in children characterized by inattention, hyperactivity, and impulsivity. It has no single cause but is linked to genetic and environmental factors like prenatal smoking. Treatment involves medication like stimulants which are effective for 75-90% of children, as well as behavioral therapies and lifestyle changes. A multimodal approach combining medication, parent/teacher training, and lifestyle modifications provides the most effective long-term management of ADHD symptoms.
This document presents information about sleep paralysis from a student. It discusses signs and symptoms like being unable to move upon waking or falling asleep and sometimes experiencing hallucinations. Causes are related to disruptions in REM sleep cycles where the body is paralyzed but the mind wakes up. Risk factors include conditions like narcolepsy, irregular sleep patterns, and family history. Prevention focuses on good sleep hygiene and managing stress or underlying conditions. Diagnosis may include checking for other issues like narcolepsy if it happens often. Treatment aims to address triggers or underlying causes through better sleep, stress management, or medications in some cases.
This document summarizes common childhood psychiatric disorders presented by doctors in Bangladesh. It discusses:
1. The increasing prevalence of psychiatric disorders in children worldwide and in Bangladesh based on epidemiological studies.
2. Common disorders seen in Bangladeshi children including anxiety disorders, ADHD, autism spectrum disorders, somatic symptom disorder, and elimination disorders.
3. The causes of rising psychiatric disorders in children such as modern life stresses, technology overuse, and family changes. Treatment approaches including behavioral therapy and pharmacotherapy are mentioned.
This document discusses Attention Deficit Hyperactivity Disorder (ADHD) and how the diagnostic criteria for ADHD has been updated in the DSM-5 to better characterize ADHD in adults. It notes that ADHD often continues from childhood into adulthood. The document then discusses common clinical histories seen in adults with ADHD, domains of impairment associated with ADHD, and the link between ADHD and addiction, noting people with ADHD are vulnerable to substance abuse to try and self-medicate their symptoms. It emphasizes the importance of treating both ADHD and any co-occurring addictions.
This document discusses learners with Attention Deficit Hyperactivity Disorder (ADHD). It begins by outlining some common myths and misconceptions about ADHD. The current clinical definition of ADHD from the DSM is then explained, which includes three subtypes. Professionals use medical examinations, clinical interviews, rating scales and observations to identify individuals with ADHD. The causes of ADHD are largely neurological, impacting areas of the brain involved in regulating behavior. Psychological and behavioral characteristics of those with ADHD include problems with behavioral inhibition, executive functions, time management, goal-directed behavior and social skills. Classroom instruction should provide structure, visual aids, clear routines and frequent shifts in activities. Medications like psychost
Case An elderly widow who just lost her spouse. Subjective.docxcowinhelen
Case: An elderly widow who just lost her spouse.
Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications:
• Metformin 500mg BID
• Januvia 100mg daily
• Losartan 100mg daily
• HCTZ 25mg daily
• Sertraline 100mg daily
Current weight: 88 kg
Current height: 64 inches
Temp: 98.6 degrees F
BP: 132/86
Insomnia is a disorder linked with difficulty in sleep quality, initiating or maintaining sleep, along with substantial distress and impairments of daytime functioning. Its prevalence ranges from 10 to 15% among the general population, with higher rates seen among females, divorced or separated individuals, those with loss of loved ones, and older people (Bollu & Kaur, 2019). Insomnia can simply be defined as a sleep disorder where the patient has trouble falling asleep or staying asleep. According to Krystal et al (2019), it is a common condition that is linked with noticeable deterioration in function and quality of life, mental and physical morbidity. The complaints of insomnia are present in 60–90% of patients with major depression, Complaints of disrupted sleep are very common in patients suffering from depression, (Wichniak, etal., 2017).
Questions you might ask the patient and rationale
The diagnosis and treatment of insomnia rely mainly on a thorough sleep history to address the precipitating factors as well as maladaptive behaviors resulting in poor sleep (Bollu & Kaur, 2019).
What is your sleep pattern including how many hours of sleep do you get at night prior to your husband’s demise and what it has been in the 10 months since his death? Does she perform certain rituals or do something special before she sleeps. This assesses if the insomnia started before or after the husband’s death. This provides a clue to insomnia that may be related to bereavement.
What time do you go to bed every night and what is your normal routine before going to bed? This is to check if the patient is doing something differently which has disrupted her normal routine and caused insomnia.
How often do you wake up to urinate at night? This question is asked to assess for nocturia due to diabetes that may lead to insomnia. Nocturia can prevent the patient from having a good night’s sleep. , changes in blood glucose levels at night causesto hypoglycemic and hyperglycemic episodes, nocturia and associated .
2. Attention-Deficit/Hyperactivity Disorder
(ADHD) is a disorder that begins in childhood and encompasses
symptoms of inattention, hyperactivity, and impulsivity. These
symptoms interfere with functioning at school, at work, and in social
situations. ADHD is present in approximately 5% of children, and it is
more common in boys. For a majority of people the disorder continues
into adulthood, though careful managing can greatly improve quality of
life for people with ADHD
3. • What’s the Connection Between ADHD and Sleep?
• Common Sleep Disorders Commonly in People With ADHD
• Sleep Tips for Children and Adults With ADHD and Sleep Problems
4. The association of sleep with ADHD is multifaceted and complex.
Problems with sleep may be an intrinsic feature of ADHD, or may both exacerbate
and be exacerbated by the symptoms of the disorder.
Problems with sleep can, however, also lead to the development of ADHD or ADHD-
like symptoms, potentially resulting in misdiagnosis. The effects of restricted,
disordered or disturbed sleep can manifest as symptoms, behaviors or functional
impairments that are remarkably similar to those of ADHD .
The interrelationships are further complicated by the use of psychostimulant
medications to treat ADHD, which impair sleep in some patients but paradoxically
improve sleep in others via a calming effect. For these reasons, it has been
recommended that primary sleep disorders should be ruled out before initiating
ADHD medication .
Behavioral interventions targeted at improving sleep may benefit some patients
and should form part of the multimodal ADHD management plan recommended
for patients receiving pharmacotherapy .
5. • Psychiatric comorbidities are common in children with ADHD
• Psychiatric illnesses such as bipolar disorder, autism, post-traumatic stress
disorder and obsessive compulsive disorder often occur coincidently with ADHD,
and are also associated with sleep problems, which may both result from and
exacerbate comorbid psychiatric symptoms .
• Problems with sleep are likely to have adverse effects on health-related quality
of life for children with ADHD and their families and may also contribute to the
development of comorbid anxiety, depression or oppositional defiant disorder
• The interactions of comorbid disorders and associated medications with ADHD
and sleep disturbances are therefore important to consider when managing
patients.
6. The reciprocal nature of the relationships between ADHD and sleep may reflect the
functional and neuroanatomical overlap between brain regions involved in
attention, arousal and sleep regulation
7. • Sleep problems in children with ADHD are common and associated with poorer
child, caregiver, and family outcomes
• Up to 50% of parents of children with ADHD report difficulties with their
children's sleep, including difficulties initiating sleep (delayed onset sleep or
bedtime resistance) and maintaining sleep (frequent nocturnal awakenings or
restlessness).Daytime sleepiness, tiredness on waking, and nightmares are also
more common in children with ADHD than controls.
8. • Children with insufficient, fragmented, or poor-quality sleep have increased
impulsivity, hyperactivity, and aggressiveness as well as problems with mood,
academic performance, and neurocognitive functioning.
• Sleep problems in early childhood are a risk factor for future occurrence of ADHD
symptoms
9. Many ADHD symptoms are similar to symptoms of sleep deprivation.
In children, fatigue may present as being hyperactive and impulsive. Sometimes it
can be difficult to tell whether these issues are brought on by ADHD or by a lack of
sleep. This may lead to misdiagnoses or may allow sleep disorders to go
undetected. Experts therefore recommend screening patients for sleep problems
before prescribing medication for ADHD
10. Sleep problems in ADHD appear to differ depending on the type of ADHD.
Individuals with predominantly inattentive symptoms are more likely to have a later
bedtime, while those predominantly hyperactive-impulsive symptoms are more
likely to suffer from insomnia. Those with combined hyperactive-impulsive and
inattentive ADHD experience both poor sleep quality and a later bedtime.
11. Objective studies using polysomnography, an actigraph, and video
monitoring have shown that children with ADHD have:
• increased sleep latency,
• decreased rapid eye movement sleep percentages,
• and increased nocturnal activity.
• Other sleep problems identified include sleep-disordered breathing
(≤ 25%) and restless legs syndrome or periodic limb movement
disorder (≤ 36%).
12. What’s the Biology Behind the ADHD-Sleep Connection?
ADHD sleep problems may be a side effect of impaired arousal, alertness, and
regulation circuits in the brain. Other researchers believe that ADHD sleep
problems can be traced to a delayed circadian rhythm with a later onset
of melatonin production.
13. Effects of ADHD medications on sleep
ADHD medications are known to affect sleep in many individuals, and guidelines
recommend that sleep is carefully assessed before starting ADHD pharmacotherapy .
Pharmacotherapy with stimulants:
The effects of stimulants on sleep in patients with ADHD differ from patient to patient .
The sympathomimetic action of stimulants promotes wakefulness in most people.
While there is evidence that stimulants are associated with disrupted or disturbed sleep in
patients with ADHD , clinical experience also indicates that stimulants produce paradoxical
effects , whereby alleviation of symptoms can calm patients and promote sleep .
Furthermore, because of the potential for symptom rebound as blood drug concentrations
wane , an additional dose of a short-acting stimulant, or the use of a formulation with an
increased duration of action, may prevent sleep disturbances resulting from worsening of
hyperactivity or behavioral difficulties at bedtime .
14. How Do ADHD Sleep Problems Affect Daily Life?
• Children and adults with ADHD plus a sleep disorder often report more severe
ADHD symptoms and a lower quality of life. They may also be more likely to suffer
from depression, anxiety, hyperactivity, inattention and difficulty processing
information.
• Daytime sleepiness can have serious effects on school and work. People may
judge a person with ADHD for sleeping at inappropriate times, without realizing
that it is part of their condition and very difficult to avoid.
• Not sleeping well at night can also cause daytime fatigue. Individuals with ADHD-
related sleep deprivation may feel grumpy, irritable, restless, or tired, or they may
have trouble paying attention at school or at work. Sometimes, these symptoms
may be mistaken for a mood disorder. In turn, anxiety and behavioral difficulties
have been linked to a higher incidence of sleep problems for children with ADHD.
15. Recommended strategies for managing sleep disturbances during treatment
with ADHD medications
Monitoring: insomnia associated with stimulants may attenuate after 1–2 months (Lecendreux and
Cortese 2007)
Considering if it is possible to stop the medication
Implementing sleep hygiene/behavioral measures
Reviewing the possible causes of sleep problems
Treating RLS
Adding small, short-acting stimulant doses in the early evening (if rebound effect occurs)
Reducing stimulant dose
Switching to an alternative class of stimulant
Switching to an alternative stimulant formulation
Considering use of a non-stimulant (e.g., atomoxetine)
Considering melatonin treatment
Monitoring: insomnia associated with stimulants may attenuate after 1–2 months (Lecendreux and
Cortese 2007
Considering if it is possible to stop the medication
Implementing sleep hygiene/behavioral measures
Reviewing the possible causes of sleep problems
Treating RLS
Adding small, short-acting stimulant doses in the early evening (if rebound effect occurs)
Reducing stimulant dose
Switching to an alternative class of stimulant
Switching to an alternative stimulant formulation
Considering use of a non-stimulant (e.g., atomoxetine)
Considering melatonin treatment
16. Sleep Tips for Children and Adults With ADHD and Sleep
Problems
• Cut out sugar and caffeine within a few hours of bedtime
• Avoid screen time for an hour before bed
• Avoid doing stimulating activities and projects that require hyperfocusing in the evening
• Make the bed a stress-free zone reserved for sleep
• Get enough exercise and sunlight during the day
• Develop a bedtime routine that you enjoy, such as rereading a favorite book, spending
time with pets, or taking a warm bath
• Keep the bedroom dark, cool, and quiet, using a white noise machine if necessary to
block out intrusive noises
• Go to bed and wake up at the same time every day, choosing a time that is realistic and
age-appropriate to get the recommended sleep for your age group
17. Sleep hygiene
Healthy sleep practices include the following:
a regular sleep/wake schedule; adequate opportunity for sleep; calming and
structured bedtime routines;
avoidance of caffeine, large amounts of liquids, naps, exercise and alerting activities
(e.g., use of electronic devices) soon before bedtime;
sleeping only in bed and using the bed only for sleeping; and attention to
environmental factors such as bedroom furniture, lighting and temperature.
18. Conceptual model of the modes of interaction between ADHD and
sleep. ADHD attention-deficit/hyperactivity disorder
19. Conclusions
ADHD is commonly associated with specific sleep disorders.
The relationship between ADHD and sleep problems is complex and bidirectional,
and is modulated by interactions with ADHD medications and by psychiatric
comorbidities and associated medications. Understanding these associations and
relationships is important when assessing and managing patients with ADHD. As
recommended in current guidelines, primary sleep disorders (specifically SDB/OSA
and PLMD/RLS) should be ruled out before diagnosing or treating ADHD. Obesity
and psychiatric comorbidities (e.g., anxiety and depression) can also lead to sleep
problems, and need to be identified and treated appropriately. The multifaceted
effects of stimulant pharmacotherapy on sleep in patients with ADHD are
particularly important for clinicians to understand when evaluating treatment
options for patients. Stimulant medications may disrupt or improve sleep in
different patients, depending not only on the nature of the patient’s illness, but
also on the drug dose, class, formulation and duration of efficacy. Effective
management of sleep problems associated with ADHD and its treatment may not
only alleviate sleep-related symptoms, but also improve quality of life in parents of
children with disruptive bedtime behavior or insomnia.