Sleep apnea causes people to temporarily stop breathing while asleep, which can lead to chronic sleep deprivation. In children, symptoms of sleep deprivation can look similar to those of attention-deficit/hyperactivity disorder (ADHD).

Some children, and even some adults, have been misdiagnosed with ADHD when the real culprit is sleep apnea. The opposite is also true — some people struggle to treat their sleep disorder because the root cause is actually ADHD. It can be tough to untangle the two conditions because each one can worsen the other.

In this guide, we’ll explain the subtle differences to look for and how to confirm a diagnosis of sleep apnea or ADHD.

How Common Is It To Have Sleep Apnea and ADHD?

Researchers estimate 1.2 percent to 9.5 percent of children have sleep apnea, and around 5 percent of children have ADHD. It’s very common for these conditions to overlap, as about 95 percent of children with sleep apnea also have ADHD.

Other sleep-related issues are also common among children with ADHD, including:

• Hyperarousal — Feeling too alert to fall asleep
• Restless legs syndrome
• Delayed sleep phase syndrome — Having trouble falling asleep until late at night
• Epileptiform discharges — Surges of electrical activity in the brain during sleep

The link between sleep apnea and ADHD in adults hasn’t been extensively studied, so it’s unclear how many adults have both conditions.

What Are the Risk Factors for Developing Sleep Apnea and ADHD?

Because most children with sleep apnea also have signs of ADHD, we’ll focus on the risk factors for pediatric obstructive sleep apnea.

• Older children may be more likely to have ADHD and sleep apnea, possibly due to developmental delays caused by lower levels of oxygen in the brain.
• Large adenoids and tonsils (structures inside the throat) significantly increase the risk of OSA, as does obesity.
• Other possible risk factors for OSA include premature birth, asthma, low socioeconomic status, and abnormal bone structure in the face and head.
• Males may be more affected by ADHD than females, according to a study in the journal Children.

Do Sleep Apnea and ADHD Share Common Symptoms?

In sleep apnea, airways become blocked when muscles in the throat become too relaxed (obstructive sleep apnea) or the brain doesn’t tell the breathing muscles to work (central sleep apnea).

In contrast, attention-deficit/hyperactivity disorder is a neurodevelopmental disorder.

While the causes of these conditions are very different, some ADHD and sleep apnea symptoms overlap.

Sleep apnea and other forms of sleep-disordered breathing can lead to sleep deprivation, but sleep-deprived children don’t necessarily act sleepy. Sometimes sleep deprivation manifests as:

• Hyperactivity
• Impulsivity
• Mood swings
• Irritability
• Difficulty concentrating

These are all common signs of ADHD.

Untreated sleep apnea in children may cause growth and developmental delays.

ADHD is also linked to some cognitive developmental delays, meaning differences in how children think, learn, focus, and process information.

What Are Some Signs That Your Child May Have the Wrong Diagnosis?

If your child has been diagnosed with ADHD but hasn’t been evaluated for a sleep disorder, their treatment may not address the root cause of their symptoms.

Sleep Disorder Symptoms

When your child is asleep, watch for the following symptoms of a sleep disorder:

• Breathing through the mouth
• Breathing with odd pauses
• Frequently changing positions
• Sleeping with the head tilted back
• Grinding teeth
• Sleepwalking
• Talking in their sleep
• Gasping or choking
• Snoring (even light snoring)
• Excessive sweating
• Bed-wetting

When they wake up, check for these signs:

• Drenched pajamas (indicates night sweats)
• Difficulty waking up
• Morning headaches
• Dark under-eye circles

Your child may continue to show symptoms of sleep deprivation throughout the day, including:

• Either drowsiness or hyperactivity
• Poor concentration or inattention
• Irritable mood
• Impulsive behavior
• Mood swings
• Behavioral and/or academic problems at school

ADHD Symptoms

Maybe you’ve already addressed sleep apnea but certain symptoms persist. Your child may benefit from ADHD screening if you notice the following signs:

• Not wanting to go to bed
• Difficulty falling asleep
• Waking up in the middle of the night
• Trouble waking up in the morning
• Daytime sleepiness

Many people with ADHD have a sleep disorder called delayed sleep phase syndrome (DSPS). People with DSPS have an internal clock (also called a circadian rhythm) naturally wired for going to bed and getting up at later times. Because most schools and jobs start early in the morning, it can be difficult to get enough hours of sleep.

It’s possible for some people to gradually shift their body’s internal clock toward earlier sleep and wake times. However, people with DSPS may struggle with this.

DSPS is easy to confuse with bedtime procrastination, insomnia, or accidentally staying up late due to poor time management skills.

How Do You Get an Accurate Diagnosis?

Consult with a sleep specialist or an airway dentist to rule out sleep apnea or another sleep disorder as a cause of your child’s ADHD-like symptoms.

Typically, these professionals:

• Ask some questions about your child’s health history and symptoms
• Examine your child’s mouth and throat
• Take some 3D scans of their airways

Your child may also need to wear a small device for an at-home sleep study.

In contrast, diagnosing ADHD is relatively simple. A behavioral health professional will ask questions about your child’s health history and symptoms. They may also talk directly to your child and to other people in their life.

According to the latest diagnostic criteria, all of the following conditions must be true for an ADHD diagnosis:

• Symptoms started before age 12.
• Symptoms occur in at least two settings.
• Symptoms disrupt relationships and daily activities.
• The child experiences at least six symptoms of ADHD.
• Another condition isn’t causing the symptoms.

Because it’s critical to rule out other possible causes of ADHD symptoms, consider going to a sleep or airway specialist before seeking behavioral health support.

How Can You Effectively Manage Both Conditions?

In children, surgically removing the adenoids and tonsils can open up the airways and may improve sleep apnea and other forms of sleep-disordered breathing. Surgery may also help treat ADHD in children with OSA.

If your child isn’t a good candidate for surgery, there are other ways you can manage sleep apnea. When sleep quality improves, ADHD symptoms may also improve.

Sleep Apnea Treatments

Typically, sleep apnea is managed with a continuous positive airway pressure (CPAP) machine. It blows a gentle stream of air through a mask worn around the nose and mouth. This keeps the airways open during sleep. People get longer, deeper, and more restful sleep because they’re not waking up from a lack of air.

Pediatric CPAP machines are designed to fit over a child’s face. However, CPAP machines can feel uncomfortable at first, even for adults. Find a well-fitting mask and gradually work up to a full night’s use.

Other sleep apnea treatment options include:

• Wearing a mouthpiece
• Addressing other risk factors, like obesity
• Having jaw or nasal surgery

ADHD Treatments

ADHD is often managed through a combination of lifestyle changes, skills training, and medications. Certain ADHD medications can make sleep problems worse, so it’s important to be aware of the potential side effects.

Cognitive behavioral therapy, which focuses on identifying and changing unhelpful behaviors, can also help people with ADHD get a better night’s sleep.

It can take some trial and error to find a good solution.

Join the Conversation

On MySleepApneaTeam, people share their experiences with sleep apnea, get advice, and find support from others who understand.

Have you or your child been diagnosed with attention-deficit/hyperactivity disorder and sleep apnea? Let others know in the comments below.