Kids Who Can’t Sleep

The Sleep Issue: How to support a restful night’s sleep for your child

As a parent of 2 ADHD kids myself, sleep challenges can sometimes feel endless. When the rest of the world quiets down, my child’s brain seems to kick into high gear, and what should be a time of peace becomes a struggle. There is a mixture of empathy with my child and frustration. Can’t he just fall asleep?!

Sleep is crucial, not only for our kids’ well-being but also for our family’s balance, yet many neurodivergent kids, like those with ADHD, autism, or sensory processing sensitivities, face unique sleep challenges.

This article explores common sleep issues for neurodivergent kids, the impact of certain ADHD medications, melatonin use, as well as strategies parents can use to help their children achieve better rest.

NOTE: Consultation with a healthcare provider is essential to evaluate the child’s specific needs and any use of medication.

1. The Connection Between Neurodivergence and Sleep Issues

Sleep problems in neurodivergent(ND) children often stem from both biological and behavioural factors. Studies have shown that differences in brain structure, function, and neurotransmitter levels—especially dopamine and serotonin—can impact the sleep-wake cycle. These issues can be particularly pronounced in ND kids.

• ADHD and Sleep: Children with ADHD often experience delayed sleep onset and frequent night awakenings. This can be partly due to the restless and hyperactive symptoms associated with ADHD, which make winding down challenging.
• Autism Spectrum Disorder and Sleep: Children on the autism spectrum may face elevated anxiety, sensory sensitivities, and reduced melatonin production, all of which can impact sleep quality.
• Sensory Processing: Sensory sensitivities may make children highly attuned to sounds, textures, or light, hindering their ability to settle into a restful state.

2. ADHD Medications and Their Effect on Sleep

ADHD medications, particularly stimulants, can affect sleep, making it harder for some children to fall asleep. These stimulants—methylphenidate (e.g. Ritalin, Concerta) and amphetamine-based stimulants (e.g. Vyvanse)—increase dopamine and norepinephrine levels to improve focus but can also lead to wakefulness at night, especially if taken too late in the day (Kidwell et al., 2015).

3. Melatonin

Melatonin is a hormone produced naturally by the pineal gland in our brains. Its main job is to regulate our sleep-wake cycle. As it gets dark in the evening, melatonin levels rise, signalling to the body that it’s time to wind down and prepare for sleep. This is why melatonin is often called the “sleep hormone.” During the day, especially in bright light, melatonin levels drop, which helps us stay awake.

Neurodivergent children sometimes produce lower levels of melatonin naturally, or their bodies may release it at irregular times which is why paediatricians sometimes recommend it as a first-line option for sleep difficulties.

A bit more on melatonin:

1. Regulates Sleep Cycles: Melatonin helps reinforce the body’s natural sleep-wake rhythm. It helps to “cue” the body that it’s time to sleep, making it easier for kids to fall asleep at a regular time.
2. Works as a Sleep Aid: Melatonin supplements work similarly to the body’s natural hormone, giving the sleep cycle a “boost” that can help children feel drowsy and ready for bed, particularly if they struggle with a delayed sleep cycle. It’s commonly used to help kids who need to reset or regulate their sleep schedule.
3. Relatively Safe: Melatonin is often seen as a safer alternative to traditional sleep medications for children because it mimics a naturally occurring hormone.

4. Practical Strategies for Better Sleep

Several non-medication strategies can also help create a more sleep-supportive environment:

• Routine, Routine, Routine: A golden rule with ND kids! Establishing a calming, predictable bedtime routine can help signal that it’s time to wind down. This might include taking a warm bath, brushing teeth, reading a book, or using calming scents like lavender.
• Limit Screen Time: A tricky one in the afternoon, but the blue light from screens can delay sleep onset, so turning off devices at least an hour before bed can help.
• Weighted Blankets or toys: For children with sensory needs, a weighted blanket or teddy can provide a sense of security that promotes relaxation.
• Sleep-Friendly Environment: Create a quiet, dark, comfortable sleep environment. White noise machines, an audio book or blackout curtains may also help reduce sensory distractions.
• Daily Physical Activity: Regular exercise, like walking or swimming, can help regulate energy levels and promote better sleep.
• Mindfulness and Breathing: Simple mindfulness exercises (see our article HERE), like deep breathing or visualisation, can reduce anxiety before bed.
• Limit Caffeine and Sugar: Avoiding caffeine (coke, energy drinks, tea) and high-sugar foods in the afternoon and evening can help reduce energy spikes.

When to Seek Help

Sometimes, despite our best efforts, sleep struggles persist. If that happens, a healthcare provider, therapist, or sleep specialist can offer deeper insights. Cognitive-Behavioural Therapy (CBT) is one approach that has helped some neurodivergent kids manage sleep without long-term medication. Please remember to always seek professional advice.

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References

• Cohen, S., Conduit, R., Lockley, S. W., Rajaratnam, S. M., & Cornish, K. M. (2014). Sleep patterns and sleep disorders in children with autism spectrum disorders: A review and meta-synthesis. Sleep Medicine Reviews, 18(5), 447–458. https://doi.org/10.1016/j.smrv.2014.02.005
• Hvolby, A. (2015). Associations of sleep disturbance with ADHD: Implications for treatment. Frontiers in Psychology, 6, 728. https://doi.org/10.3389/fpsyg.2015.00728
• Kidwell, K. M., Van Dyk, T. R., Lundahl, A., & Nelson, T. D. (2015). Stimulant medications and sleep for youth with ADHD: A meta-analysis. Clinical Child and Family Psychology Review, 18(1), 18–35. https://doi.org/10.1007/s10567-014-0177-2
• Krull, K. R. (2023). Pharmacotherapy for attention deficit hyperactivity disorder in children and adolescents. UpToDate. https://www.uptodate.com
• Krystal, A. D., Durrence, H. H., Scharf, M., Jochelson, P., & Rogowski, R. (2010). Efficacy and safety of trazodone in the treatment of insomnia in patients with major depressive disorder. Sleep Medicine Reviews, 14(3), 221-231. https://doi.org/10.1016/j.smrv.2009.06.004
• Mazurek, M. O., & Petroski, G. F. (2015). Sleep problems in children with autism spectrum disorder: Examining the contributions of sensory over-responsivity and anxiety. Research in Autism Spectrum Disorders, 9, 50–57. https://doi.org/10.1016/j.rasd.2014.10.013
• Moore, A., Coulter, C., Roger, A., & Howard, D. (2017). The role of alpha-2 agonists in managing symptoms of attention-deficit hyperactivity disorder. Schizophrenia Bulletin, 43(Suppl 1), S126. https://doi.org/10.1093/schbul/sbw126
• Rossignol, D. A., & Frye, R. E. (2011). Melatonin in autism spectrum disorders. Journal of Neurological Sciences, 303(1-2), 1-10. https://doi.org/10.1016/j.jns.2011.08.014