The process of transitioning from a busy, active day, to settling in for sleep can be particularly difficult for youngsters with ADHD.
There are several things that can help:
Have a consistent routine:
- As much as possible, bedtime should be at the same time every night.
- The routine leading up to bedtime, for the last ½ to one hour before bedtime, should be the same. This can include a bath, story time, reading time, quiet play, drawing, etc.—whatever will work best in your home with your child.
- Anticipate procrastination! Make sure the routine includes going to the bathroom, brushing teeth, and (for those children who need a drink of water), a small drink.
Other tips include:
- Highly stimulating activities should be avoided in the last ½ hour of the day: this includes video games, horseplay and most TV programs.
- It may help to turn down the lights for the last ½ hour before bedtime—turn off the room light and turn on a lamp. The lower level of illumination helps the brain to get ready for sleep.
- It may help to have a system to reward the child in the morning if he is quiet in bed until he falls asleep.
- Not close to bedtime, but planned for earlier in the day: plenty of exercise during the day helps the child to sleep better at night. For the dark, dank days of an Oregon winter, consider some of the aerobic video games (such as Wii.)
Set up the bedroom to promote sleep:
- For several reasons, it is best that the child not have a TV in his bedroom.
- If possible, an ADHD child should be in his or her own bedroom.
- The choice of a night-light or not, door open or closed, depends upon the child’s needs.
- Try to minimize the noise coming from the rest of the house as the child is trying to fall asleep. It is particularly important that a TV in another part of the house is not going to disturb the child.
- Keep the bedroom a little on the cool side. We generally sleep better in a cool room, with appropriate blankets.
Many ADHD children have trouble slowing down their brain enough to fall asleep. Some helpful options are listed.
- Turn on music. A CD player is better than a radio. (Remember that every radio station is trying to make itself interesting to attract listeners. Interesting is not a good choice for an ADHD child trying to fall asleep.) Quiet instrumental music is probably the best for most children, but sometimes they surprise us. It doesn’t matter what they listen to, as long as it helps them settle to sleep.
- “White noise” is another option. An electric fan works well—if it’s too cool, have the fan blow against a wall.
- Books on tape can be very helpful for some children. Of course, they are likely to listen to the story—the first night. (Pick a night when they don’t have school the next day.) After that, keep playing the same book. Many children find the familiar voice and familiar story soothing and relaxing. (Every couple of weeks, on a Friday, you can change the book.)
When all else fails, medication may be the answer:
- Before you get to real medicine, you can try a bedtime drink of:
1 cup of warm milk
1 teaspoon of honey
1 teaspoon of real vanilla (not artificial vanilla)
- Another option is a low dose of caffeine. This doesn’t work for everyone, but some children settle down with this, just like they do for their stimulant medication. Options include a cup of tea or a half cup of coffee. Added milk and some sweetener (Stevia, a natural non-sugar sweetener is best, artificial sweeteners are OK, sugar is the last choice) will make it acceptable to the child palate. (Don’t use “pop”—too much sugar).
- Melatonin is a natural sleep hormone that can be purchased without a prescription. The usual dose is 3 mgs.
- Benadryl is an over-the-counter antihistamine that is pretty sedating for most children. The dose is 25 mgs for children from 30 – 50 lbs., and 25 – 50 mgs. for heavier children.
- There are a variety of prescription medications often used for sleep. We can discuss these if needed.
- Even though we usually say that stimulant medication will interfere with sleep, there are many ADHD children who need some of their stimulant close to bedtime in order to settle down enough to fall asleep. (The apparent trouble that some children have with sleep may be due to the rebound as the medication leaves their system, and not due to the stimulant effect of the medication.)
Nobody likes the idea of having to give an extra medication to a child to get them to sleep. However, consider the alternatives! Sleep deprivation will make anyone look ADHD, and if you already have ADHD, it can only get worse. Try everything else first. If it still doesn’t work, then medication is an option to discuss.