CAN WE GET SOME SLEEP??????

I had a child who didn’t believe in sleep. Even as a tiny baby she slept eight hours a night period, no naps, and if anyone else was up, so was she.

I gave up on killing us both for no reason when she was about three and let he put herself to bed when she was tired. Poof, problem solved by magic. I don’t know if you will be as lucky but it’s worth a try. She tended to go to bed between 10PM and 11PM and had to use an alarm clock to get up at 7AM — so she has had her own alarm clock/radio since she started kindergarten at age 4 1/2, situation solved. By Grade 2 or 3 she started to arrange her life to get up half an hour early to finish off homework if she needed to, like me she found this the easiest way to make herself do distasteful tasks.

In her case and I suspect many others, the need for sleep just didn’t match the average in the official books. Most adults know the feeling of going to bed earlier than usual and then lying there tossing and turning half the night; well, I guess some kids get that feeling too if put to bed before their bodies and minds are actually ready. Going too early actually fights against a good sleep.

In her case lots of physical and mental activity was also a good thing , to work off the energy. She never had any medication.

As an adolescent she followed the usual pattern of needing more rest and being tired all the time.

I’m also in Canada. If you really want to try Strattera, it isn’t hard to go across the border, just expensive. I’d try modifying sleep patterns first, then think about it.

We use Seroquel, 25mg a night to help my son sleep. It doesn’t knock him out, but it helps him relax to the point where he can get to sleep and then it helps him to stay asleep so he doesn’t wake up in the middle of the night. I’m from the US and I don’t know if y’all have it, but that’s what has worked for us.

The first thing that I would want to change is him coming into your bed. If you haven’t already, I would build him a “nest” that he can sneak into if he is afraid.

In our case, the sleep issues were related to OCD. My daughter was obsessed with being away from me and had the compulsion to resist bed and also get up in the night. Overcoming this involved a long treatment plan on weaning myself away from her and rewarding her for good nights. We also get her away from us alot during the day to get her feeling more comfortable being away from us (exposure therapy). We also had to use cognitive behavioral therapy to ward off the obsessive thought that she must not be separated from me. She was getting sleep-deprived and acted like it so we knew that she needed more sleep.

Your son’s situation sounds a little different in that he appears to not need as much sleep as you. If this were the only issue, then I’d concentrate on getting him not to interfere with your sleep. I would try having him put himself to bed. He could earn tickets for good nights and then purchase a prize when he has earned enough tickets. He’ll need something to do quietly while everyone else is sleeping. Hopefully he’s a reader.

I do know that people with OCD do often have trouble going to sleep because of obsessive thoughts. You might want to ask him if he has a certain thought that keeps recycling back over and over again. If it is OCD then you can direct your treatment toward that. OCD is not allowed to take over our household. The treatment is to not be a slave to it but to resist it.

I would say that the Ped. needs to know that your ds is not able to shut off his brain at night so IT IS interferring with his life. It is affecting the entire family and you can not parent as well if you are sleep-deprived and resentful. If I understand your health system correctly you need to first contact your ped right? He needs to refer you on to someone else at this point. If you can find out why your ds is doing this you may be able to have more success treating it. Is is just that he doesn’t require as much sleep as you or are there additional compounding issues as well (such as OCD or other anxieties.)

How does he behave when he comes into your bed. Is is distressed, afraid or calm? Does he say that he is worried about something and you can not find a way to reason with him that there is a solution to the problem or that there isn’t a problem at all? A person with OCD can not be reassured easily, if at all. The treatment involves recognizing the “worry thoughts” as a recycling of thoughts that have been rejected over and over. It’s like they are thrown into the brain’s trash can and then they pop out and present themselves again. Once an individual understands that these are not legitimate thoughts, he can boss them back to the trash can over and over until they stay there. This is cognitive behavioral therapy. There is more to it than that but I’m not sure that this is your son’s problem so I’ll end and you can think if this sounds like what is going on.

Terry

I do not necessarily endorse this or any other medication in and of itself. That is a decision you will have to make after consultation with your dr.

http://www.news-medical.net/?id=2884

Treatment with Strattera makes children with ADHD fall asleep faster

Twice daily treatment with Strattera® (atomoxetine HCl), approved for the treatment of attention-deficit/hyperactivity disorder (ADHD), showed children with ADHD fell asleep faster (12.1 minutes relative to baseline versus 39.2 minutes relative to baseline, p<.001) compared to three-times daily treatment with methylphenidate, according to study results presented at the Associated Professional Sleep Societies meeting.
The results were based on comparisons before treatment and during treatment.

Parent and child diaries also showed that children on Strattera had less difficulty getting out of bed in the morning versus children taking methylphenidate. Additionally, parent diaries showed children on Strattera were less irritable compared to methylphenidate.

“Sleep difficulties related to methylphenidate therapy can represent a considerable source of concern for patients and families of children with ADHD,” said study author Judith Owens, M.D., MPH, Child and Family Psychiatry, Rhode Island Hospital, Providence, R.I. “The availability of an effective medication option that may help patients to fall asleep faster is useful in the treatment of ADHD.”

Although patients had a greater decrease in the number of wake bouts (episodes of wakening) with methylphenidate (-1.3 for Strattera patients compared to baseline versus -4.4 for methylphenidate patients compared to baseline, p=.011), Strattera allowed patients to sleep longer relative to methylphenidate (-15.3 minutes compared to baseline vs.. -29.6 minutes compared to baseline, p=.016).

A total of 85 children were randomized to a double blind, cross over trial in which participants were treated with Strattera or methylphenidate for seven weeks and then alternated therapy. A portion of three patients’ data was removed as they had difficulty utilizing the monitors. After collecting baseline measures, children were treated with Strattera (mean dose 1.56 mg/kg) or methylphenidate (mean dose 1.12 mg/kg) for seven weeks each, separated by a washout period. Relative to baseline, the data indicated that methylphenidate increased time to sleep onset significantly more than Strattera -12.1 minutes for Strattera vs.. 39.2 minutes for methylphenidate, p<.001. For children and adolescents, maximum approved label dosing for Strattera is 1.4 mg/kg/day or 100 mg, whichever is less.

“When kids get the sleep they need, they may be less irritable. This may impact a variety of settings - at home, at school, and in social situations,” said A.J. Allen, M.D., Ph.D., Lilly Research Laboratories, Eli Lilly and Company.

If its OCD, anxiety, or ADHD that is preventing him from sleep, then something needs to be done. Has the Dr ever suggested a sleep study to determine if he has a sleep disorder? Has the Dr considered that the anxiety, and OCD and probably even some of his ADHD may be rooted in his inability to get a decent nights sleep?
My dd has always had a problem falling asleep, which in turn, ultimately led to a problem waking, and falling asleep during the day.
You can try adding a small amount of stimulant before bedtime that would help to quiet his brain down. For some it works, for my dd, it didn’t help, you may still have to deal with insomnia side effect of the stim. There are things like benedryl that can aid sleep, as well as using prescriptives such as clonidine (for the sleepiness side effect, but a low enough dose that b/p is not effected), and sleeping preparations. The problem with many sleep aids is that they will leave the user feeling sluggish in the morning. Melatonin did that to my dd, as well as cause some crazy, kind of scary dreams. What I’ve seen reported is that people using Melatonin can experience “vivid” dreams, what ever that means. There is another supplement that can aid sleep, although you don’t hear about it much. It’s called Valerian. It works great for my dd. I don’t use it all the time for her because initially I found so much conflicting or absence of information regarding it’s effect on the liver. It would seem that from what I’ve read more recently, it is only a problem for those with pre-existing liver involvement. It is something you might want to look at for more information. Just doing a google search for Valerian or Valerian Root will get you several hits, then I’d suggest that you run it past your Dr. If it works well, maybe just doing a periodic liver panel will be enough to watch for any side effects. But I would think that if your son has always had a problem with sleep, a sleep study is in order. My dd had one as a part of the evaluation for ADHD. We all felt it prudent to rule out a sleep disorder. Good luck

In general, I say ‘listen to TerryB’ — have a couple of friends with OCD and Terry has great advice…but what I really meant tosay is that no-one mentioned gravol as a sleep aid…it works, it’s safe, and lots of use in many situations says it is not a problem for long-term use…would only use this if Terry’s suggestions don’t apply, tho! A young friend with severe ADHD and a mixed up body clock uses this…Best wishes to you!!

Have you asked the Dr. about using benedryl?

I just remembered. Isn’t OCD a side-effect of Concerta in sensitive individuals? Sorry that I don’t have a chance to look it up.

Eliz, I’ll have to check out that Gravol myself for occasional use!

Roxie tells it like it is. Further professional input is needed.

Terry

As a general policy, I’d say use the least invasive approaches first and work up only as needed.

Step one is let him stay up longer until he is really tired and then put himself to bed. In my daughter’s case this solved 90% of the problem immediately.

Step two is behavioural adaptation as is suggested for adult insomniacs:
— avoid using the bed for daytime lounging or reading, keep a connection between bed and sleep.
— avoid sleeping during the day.
— lie down only when really tired; avoid developing the habit of not sleeping while in bed.
— if you can’t fall asleep, get up and do a quiet activity, read or write, until you can fall asleep; again avoid developing the habit of not sleeping while in bed
— avoid caffeine and other stimulants in the evening
— drink milk or other soothing drink before going to bed
— develop a routine that ends in sleep
— get rid of lights that shine in the eyes at night; move the bed if needed (personally I will not black out windows although some people do)
All of this is standard advice, and is probably at least a help with OCD as well.

Third step would be reward programs as suggested by others above.

Only after this non-invasive approach has been tried for a reasonable time, at least a couple of weeks, is it a good idea to go for medications. And then try the mildest approaches before pulling out the big guns . DEFINITELY see the doctor about medications, and discuss side effects and the interactions of drugs.

Terry has a good point, the Doc should also be considering the medication has a cause for the comorbid disorders, or at least as an exaserbant of them. Victoria also mentioned sleep hygiene. Additude Magazine not long ago had an article on this, you might want to do a search on sleep hypgiene for insomiacs, and/or you could check www.addititudemag.com and see if they archieve their articles over the internet. Good luck, I know how hard it is to deal with a non-sleeper, no one sleeps well.

1) Sleep disorders are very, very common in persons with ADHD. Your child definitely needs an evaluation, including a sleep study.
2) The sensation of not being able to “turn off” your brain, or having racing thoughts is a pretty classic anxiety symptom. One non-medication approach that might help is cognitive behavioral therapy, which offers specific things to do when racing thoughts occur.
3)IMHO, your doctor is way off base in saying take no action because grades are not being affected. Clearly, a 12 year old who is distressed enough to want to crawl into bed with his parents is suffering and needs help. There are anti-anxiety meds that might help in addition to CBT.

Not affecting grades is the *least* of your problems! Affecting the parents’ sanity and ability to support the children is pretty important, and in the long run the grades will be affected too along with everything else.

I have suffered from sleep deprivation, and it is *actively dangerous*. One test filmed for driver’s ed showed that a person who had missed a night’s sleep was as low in reaction time as a person who is legally drunk. There is no way to measure exactly but it is often suggested that sleep deprivation is responsible for a large proportion of auto crashes. Further, there are physical risks at work and at home, stress-induced illnesses, and then the problems of losing jobs and marriages cracking because your personality is affected. Yes, young strong parents can survive a few months with a newborn, but that’s an understood temporary situation. This isn’t a joke and it should be taken seriously.

Cognitive therapy would mesh right in with the anti-insomnia sleep hygeine that I was outlining, definitely something to find out about. Depending on how serious the problems are you might be able to do a lot for your son yourself.
The idea is, when your brain is racing and you can’t rest, the very worst thing to do is to stare at the ceiling and work yourself up into a vicious circle of being anxious about being anxious. Rather, get a good book and read about something else, take your mind to another place, until the body fatigue takes over naturally. If reading doesn’t work, perhaps looking at pictures or drawing or writing in a diary (as long as that doesn’t get compulsive or obsessing on the negative) or writing letters. A warm bath before bed can help too.
Avoid sweet foods as therapy even though they are relaxing, because you don’t want to trade insomnia for obesity or eating disorders. Also avoid late-night TV and computers which tend to stimulate the brain rather than relaxing.

At age 12, your son should be able to learn how to occupy himself pleasantly even if he can’t sleep, and let the family get some rest.
A problem that can come of this however is him staying up all night and not being able to go to school or stay awake once there, so there does need to be a strict lights-out time, which you enforce at your own final bedtime.
The lights-out time may be quite late, much later than your neighbours think is “right”, say perhaps midnight, but if it works for your son that’s his business and nobody else’s. Well-meaning neighbours and teachers telling people how they should feel and think cause immense amounts of trouble, so learn to brush them off if you haven’t already.

Usually when physical adolescence kicks in kids need a lot more rest, even mine did, so in a year or two things should be a bit easier.

Victoria,
I’m curious, you mentioned that you have suffered from sleep deprivation. If you don’t mind my asking, what was the general cause? I am asking because as I am reading your posts on this topic, many of the solutions you describe have only served to stimulate my dd’s brain more, making it even harder for her to fall asleep or at best, had really inconsistent and unpredictable results. I hate the idea of using medication on any kind of consistent basis for insomnia, and there is absolutely nothing temporary about her insomnia, it started at day 3 of life and has been an issue ever since. It would be nice to think that I could just leave her to her own devices, yes she can entertain herself at night, however, that has not been a very good approach. An active, impulsive ADHD mind can, and does, lead to trouble, even when they think they are doing something good.

Roxie has a good point. Some kids even at age 12 can’t be up alone. My nephew use to go down in the kitchen while mom slept and throw the kitchen knives into the linoleum. He didn’t think he was doing anything wrong and he was 14! He was just having fun. Yes, the knives were hidden after that.

Terry

Help us,
Let us know how you make out. This is a most interesting and relevant thread.
Terry

It really has been an interesting thread, probably b/c it hits so close to home in our family. The insomnia that so many ADHDer’s suffer is so challenging to deal with, it’s great to hear what others have tried. You just never know what might be the answer for you.

http://www.medscape.com/viewarticle/480681?src=mp

Insomnia and Psychiatric Disorders
Posted 06/21/2004

David N. Neubauer, MD

During the past several years, the relationship between insomnia and psychiatric disorders has come to be viewed as circular and synergistic. Psychiatric illnesses, particularly anxiety and mood disorders, have long been recognized as a frequent cause of insomnia symptoms. In some instances, this association is even formalized in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnostic criteria. Clinical experience shows that almost all patients with mood and anxiety disorders have sleep disturbances either chronically or during exacerbations of their psychiatric illnesses. However, it has become clear that insomnia also increases the risk of future relapse or the development of new onset anxiety, mood, and substance abuse disorders. This relationship can promote a downward spiral of symptom severity and quality of life for patients that further complicates treatment efforts. On the other hand, the close association of insomnia, depression, and anxiety symptoms can be viewed as an opportunity for targeted therapies that may provide significant benefits for patients.

Epidemiology
An analysis of data from the large-scale Epidemiologic Catchment Area (ECA) project[1] demonstrates the relatively high percentage of individuals in the general population who suffer from significant insomnia symptoms and meet the criteria for mood, anxiety, or substance abuse disorders. In all, 10% of the sample met the stringent criteria for insomnia, and 40% of these insomnia sufferers met the criteria for at least 1 psychiatric disorder. Major depression or dysthymia was diagnosed in 23%; anxiety disorder was diagnosed in 24%; alcohol abuse was found in 7%; and drug abuse was discovered in 4%. Furthermore, if insomnia was present both at baseline and 1 year later, the risk of the individual having a new onset mood or anxiety disorder at the time of the follow-up interview increased significantly.

This general conclusion has been replicated in longitudinal studies with subjects ranging from adolescents to the elderly.[2,3] Indeed, any history of persistent insomnia augments the lifetime risk of major depression.[4] It is unclear whether the insomnia represents a prodrome, shared genetic vulnerability, or a causative process promoting depressive symptoms. Nevertheless, this association emphasizes the need for early recognition and treatment of insomnia, and an evaluation for potential psychiatric disorders.

Insomnia and Bipolar Disorder
In addition to major depression and dysthymic disorder, insomnia commonly occurs with bipolar disorder during depressive and manic episodes. Although some manic patients will describe a decreased need for sleep, others complain of being distressed by an inability to sleep. Sleep loss from any reason, including jet lag and work schedules, may contribute to the onset or progression of manic episodes in patients with bipolar disorder.[5,6] Early sleep-targeted interventions may prevent or limit exacerbations for these patients.

Anxiety Disorders
Among anxiety disorders, insomnia is particularly problematic for patients with panic disorder, posttraumatic stress disorder, generalized anxiety disorder, and social phobia. Most patients with panic disorder at times will experience distressing panic episodes that awaken them from sleep. This may lead to considerable anticipatory anxiety about going to sleep, which may lead to sleep insufficiency and more anxiety.[7] Patients with posttraumatic stress disorder frequently experience poor sleep quality and vivid nightmares.[8] The chronic anxiety of patients with generalized anxiety disorder often affects these patients throughout the night with resulting difficulty falling asleep and repeated awakenings. Patients with social phobia report significantly worse sleep quality and difficulty falling asleep as compared with healthy controls.[9]

Management of Insomnia in Patients With Psychiatric Comorbidities
Managing the insomnia complaints of patients with concurrent psychiatric disorders is a 2-pronged approach. Specific therapeutic interventions should address the primary psychiatric condition. These interventions may include psychotherapeutic, behavioral, and pharmacologic strategies. Optimizing the treatment of the underlying disorder ultimately should improve sleep.

Medications for patients with mood and anxiety disorders include an assortment of antidepressants, anxiolytics, and mood stabilizers. The selective serotonin reuptake inhibitor (SSRI) antidepressants and venlafaxine (a combination SSRI and norepinephrine reuptake inhibitor) often are effective for these patients, although they rarely improve insomnia symptoms rapidly. Furthermore, some patients will develop insomnia as a side effect from these medications.

A sedating antidepressant, such as amitriptyline, trazodone, or mirtazapine, may help with sleep, but also may cause residual sedation the following day. If trazodone is prescribed, further caution is advised regarding hypotension, priapism (men and women), and the potential contribution to the serotonin syndrome when combined with other serotonergic medications. Although selected medications work well for certain patients, there currently is no antidepressant that reliably and rapidly promotes improved nighttime sleep and daytime alertness.

General approaches to insomnia are those applicable to a broad range of patients and include sleep hygiene and behavioral interventions, cognitive behavioral therapy, and hypnotic medications. These approaches may be used concurrently with specific treatment strategies for the psychiatric disorders. There are several advantages to this 2-pronged approach. First, there is greater choice in selecting medications for the psychiatric symptoms, rather than restricting the options to sedating agents. There also can be flexibility in the dosage, timing, and duration of use of medications targeting different symptoms. Second, hypnotic medications may provide immediate relief and, subsequently, decreased distress and improved quality of life. A hypnotic can offset the stimulating effect of some antidepressants. Third, these general insomnia treatment approaches can directly address the perpetuating factors that reinforce chronic insomnia.

Currently available hypnotic agents include 5 benzodiazepines (estazolam, flurazepam, quazepam, temazepam, and triazolam) and 2, newer nonbenzodiazepine agents (zaleplon and zolpidem). All of these medications are positive allosteric modulators at the gamma-aminobutyric acid (GABA)-A receptor complex. The inhibitory GABA-A system functions through membrane hyperpolarization as negative chloride ions enter the cells. Benzodiazepine receptor agonists enhance this normal process. The traditional benzodiazepines appear to interact with most subunit configurations of the GABA-A receptor, whereas the newer agents are more selective for a particular configuration. This selectivity and the relatively short elimination half-lives of these nonbenzodiazepine hypnotics help explain the good efficacy, safety, and tolerance of these newer-generation agents.

In clinical practice, hypnotics often are prescribed concurrently with antidepressants for patients with mood and anxiety disorders. Pharmacokinetic and pharmacodynamic studies of fluoxetine and sertraline combined with zolpidem have been performed in healthy, nondepressed women.[10,11] These studies found no clinically significant interactions. Another trial evaluated the sleep of patients prescribed an SSRI concurrently with zolpidem or a placebo.[12] The study population included individuals successfully treated for depression with an SSRI, but who were complaining of persistent insomnia. The hypnotic-treated patients reported significantly improved sleep and daytime functioning.

New Agents
A variety of pharmacologic agents is being evaluated in clinical trials for the treatment of insomnia. These include new nonbenzodiazepine medications and modified-release preparations as well as melatonin agonists, presynaptic and postsynaptic GABA-A modulators, and corticotropin-releasing factor antagonists.

On the near horizon is eszopiclone, a moderately short-acting, nonbenzodiazepine agent derived from zolpiclone, which has been available outside the United States for several years. The newest development with the nonbenzodiazepine hypnotics is the modified-release formulation. The rationale behind the development of this formulation is that the immediate-release component promotes rapid sleep onset, whereas the extended-release component helps maintain sleep through the night. Ideally, short medication half-lives will allow a rapid decline of the sedating effects to prevent residual daytime effects. Formulations of this type are being evaluated for zaleplon and zolpidem. Indiplon is a new, very short half-life nonbenzodiazepine hypnotic that likely will be available in both immediate- and modified-release formulations.

Looking for Other Causes of Sleeplessness
Although it is important to identify and treat the insomnia symptoms that may result from psychiatric illnesses, it is equally important to evaluate psychiatric patients for other possible contributing causes of their sleep disturbances. These may include stimulating effects of psychotropic and other medications, medical disorders and underlying primary sleep disorders, circadian rhythm disorders, irregular schedules, and maladaptive habits and routines. Patients with sleep apnea can present solely with insomnia complaints. Restless legs syndrome and periodic limb movements, which can be exacerbated by most antidepressants, can cause difficulty falling asleep and repeated awakenings. Withdrawn or agoraphobic patients may spend excessive time at home, sleep at irregular times, and be deprived of the photoperiod that normally reinforces the sleep-wake cycle.

Although the clinical history is the cornerstone of the evaluation of sleep disturbances, patients’ descriptions of their sleep problems can be supplemented with a sleep log or diary maintained for at least several weeks. This may offer a more accurate representation of exactly when they are awake or sleeping (nighttime and daytime) as compared with their summary given at a clinic appointment. It also can be helpful when monitoring the effectiveness of treatment approaches. Consultation with a sleep medicine specialist and sleep laboratory testing may be appropriate for patients with excessive daytime sleepiness, when patients are suspected of having disorders, such as sleep apnea and narcolepsy, and when insomnia is persistent and not responsive to standard treatments.

The effective treatment of insomnia in patients with psychiatric disorders may require a constellation of strategies involving proper sleep habits, schedule manipulations, cognitive behavioral interventions, and adjustments of psychiatric medications. Hypnotic medications may play a valuable role for selected patients. Improving sleep can be an important catalyst to more general clinical recovery.

References
Ford DE, Kamerow DB. Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention? JAMA. 1989;262:1479-1484.
Breslau N, Roth T, Rosenthal L, Andreski P. Sleep disturbance and psychiatric disorders: a longitudinal epidemiological study of young adults. Biol Psychiatry. 1996;39:411-418. Abstract
Roberts RE, Shema SJ, Kaplan GA, Strawbridge WJ. Sleep complaints and depression in an aging cohort: a prospective perspective. Am J Psychiatry. 2000;157:81-88. Abstract
Ford DE, Cooper-Patrick L. Sleep disturbances and mood disorders: an epidemiologic perspective. Depress Anxiety. 2001;14:3-6. Abstract
Leibenluft E, Albert PS, Rosenthal NE, Wehr TA. Relationship between sleep and mood in patients with rapid-cycling bipolar disorder. Psychiatry Res. 1996;63:161-168. Abstract
Young DM. Psychiatric morbidity in travelers to Honolulu, Hawaii. Compr Psychiatry. 1995;36:224-228. Abstract
Uhde TW. Anxiety disorders. In: Principles and Practice of Sleep Medicine. Kryger MH, Roth T, Dement WC, eds. WB Saunders: Philadelphia, Pa; 2000.
Green B. Post-traumatic stress disorder: symptom profiles in men and women. Curr Med Res Opin. 2003;19:200-204. Abstract
Stein MB, Kroft CDL, Walter JR. Sleep impairment in patients with social phobia. Psychiatry Res. 1993;49:251-256. Abstract
Allard S, Sainati SM, Roth-Schechter BF. Coadministration of short-term zolpidem with sertraline in healthy women. J Clin Pharmacol. 1999;39:184-191. Abstract
Allard S, Sainati SM, Roth-Schechter BF, MacIntyre J. Minimal interaction between fluoxetine and multiple-dose zolpidem in healthy women. Drug Metab Dispos. 1998;26:617-622. Abstract
Asnis GM, Chakraburtty A, DuBoff EA, et al. Zolpidem for persistent insomnia in SSRI-treated depressed patients. J Clin Psychiatry. 1999;60:668-676. Abstract

David N. Neubauer, MD, Assistant Professor, Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland; Associate Director, Johns Hopkins Sleep Disorders Center, Baltimore, Maryland

Roxie — sorry, my computer posted by itself before I got to the third point.

No, definitely not having the child up alone. I was suggesting a final lights-out at the same time the parents go to bed. And yes, try to avoid having kids roam the house at night. Absolutely, no question. I was speaking more of late evening when the parents are still up, not the middle of the night.

I found that my daughter needed about the same amount of sleep that I did, around eight to nine hours. Attempts to force her to bed earlier just led to a vicious circle of wakefulness and frustration and in the long run much *less* rest for everyone. I left her to get into her PJ’s when *she* felt tired, and lo and behold that happened naturally around ten or eleven at night.

The fact that we didn’t have a TV in the house until she was nine years old probably was a help there. I would recommend if you try this not to have a TV or computer in the child’s bedroom, or else to install a power switch on them from your own room, no joke.

I found with my daughter that if she had lots of physical activity to use up her energy during the day and she went to bed relaxed when she felt ready, then she would stay asleep and more or less in one place until morning.

I think this may be the place for the stewed prunes story. I went for some years to a summer camp around here and then worked one summer as a counsellor. One breakfast, our table got a bowl of something brown. I looked at it and said “Oh, stewed prunes”. So I slopped a couple into my bowl and passed it around. Most of the girls took some — we all swam in cold water twice a day and we were always hungry — we finished breakfast and did the dishes as usual, and I went off with the other counsellors. To my surprise they were all talking about the stewed prunes. Apparently they thought we were forced to eat them once a week as a laxative. They were all talking about how awful they were, how they had to choke them down, how they forced every girl to take at least two, how they had to sit there for hours to force the girls to choke them down … I had a sudden insight that I had by pure accident fallen into the ideal approach, to just continue as normal without even thinking of making a fuss. The complete lack of fuss meant the kids could make a choice without it being a major issue and an embarrassment, and most of them chose to eat what was available.

This was the approach that worked best with my daughter nine times out of ten. The tenth time I had to go to World War 3 (the family is known for our determined characters). But most of the time if I simply let her alone, she did very well. She would also often take positive suggestions. Of course this approach has to be combined with common sense and watchfulness!! I am the *last* person to recommend letting children run rampant over you. And be prepared for WW3 as needed, just save it for life-threatening emergencies.

On the sleep issue, this meant forcing her to get moving and go to school in the morning (that is life-threatening and she was a dawdler), driving her around to every sports activity possible, staying at home quietly reading/listening to radio most evenings, and letting her fall asleep naturally when she really needed to.

If your child gets worked up doing various activities in the evening, perhaps you could brainstorm alternate timings — for a simple example, start reading earlier so you can finish the book before midnight; tape exciting TV shows to watch over breakfast, etc.

Victoria
Thanks for your response. I hate to sound like the eternal pessimist, but we have done, and are doing what you outlined. My dd, now 15, has always been active. She was a gynmnast, working out 4-5 days a week, 3-4 hours a day. She is now a dancer, she gets up at 6:30 for a 2 hour work out, last week was dance camp, 10-3, in addition to the am workout, this week is off, then she starts classes in the am and pm. During the school year, she is leaving for school at 6:30am, practices 4-5 days a week for 2 1/2 hours after school, then was also attending classes 3 nights a week at her dance school. You would think this girl would be tired. With the exception of my husband, who works late hours, the rest of us are in bed between 9 and 10pm. My dd is allowed to listen to music quietly in the evening. There is no computer or TV in her room, it’s not an option in our house for anyone. We only have 2 TV’s, and one computer. The kids are allowed to use an old lap top of my husbands in their rooms which only has word processing capabilities, all games have been taken off, there is no internet access. I try to get her started in her nighttime routine by 9pm. I’ll admit, I am exhausted by this time, during the school year I am getting up at 5:15, in the summer there is some flexibility in these evening times.
After reading guests posted medscape article, I am just wondering if our problem is that my dd’s insomnia is not more so rooted in her ADHD, but maybe there is some anxiety that I’m just not recognizing. Maybe she is able to compensate for it so it’s not so appearant or something. But it is possible that her sleep issues may be rooted primarily there. Unfortunately, my dd isn’t concerned about her sleep habits, even though she is sleepy during the day and it often takes me raising my voice after several attempts to get her up before she actually does.
Your stewed prunes analogy is an excellent one. That theory has worked for me in the past, although I can’t say that I really ever thought about it, I’ve probably took that position more for selfish reasons. With 4 kids, it’s hard to make all happy, so I just pick one avenue and go for it. Either they like it or they don’t, I can’t control that, but that is the program.

TerryB
What ever happened with your nephew, did he settle in to a decent/acceptable nighttime routine? That would be pretty scary to find marks, or worse yet, knives, in the lenolium! I remember when my dd was about 3 and I woke to find the butcher knife and some food out. She had been up to get something to eat during the night. I put them higher, she climbed higher. I had to find I real good hiding spot for all knives after that. After that she learned how to run the VCR and would watch Disney movies or exercise with Barbie. What a sight at 4am! I can laugh now

Roxie,

At 15 you are fighting the teenage clock, as well as any other clock you have always had to deal with. Teenagers, with or without ADHD, do not go to bed at 9 or 10 easily regardless of what time they have to get up. I have read studies showing that they are simply programmed to stay up later. Schools have begun to recognize this and are starting (in some places) high school later.

I fight to get my 13 year old to bed by 9:30 or 10 and she is not ADHD.

Beth

Thanks for so many suggestions. I guess this has been such a popular tread because so many of us struggle with similiar sleep issues. My first step will be to return to our Ped and have our son assessed for a sleep disorder, anxiety disorder etc , but I really feel this is adhd related. Our son has always had issues around falling asleep. He might be stressing about what someone said or did in school or thinking about a movie he wants to see. Basically almost anything at all can keep his mind racing, BUT isn’t that a adhd mind. We had tried letting him turn his own light off and fall asleep whenever he was tired but this does not help our interrupted sleep issue, because when his precious mind needs an answer it needs one NOW! Thanks for so many wonderful suggestions and until our next PED app’t I will give some of them a try.
Help Us

Help us
Please come back and let us know how things are going. I’ll be most interested if you find something that helps. The racing mind is what my dd tells me keeps her awake at night also. She can be dead tired, but once she tries to lay down, she has trouble falling asleep. I think that is why the background noise will sometimes help, I just wish we could find something more consistent, but that may just be an unreachable goal for us. Good luck!

There are several things it may be but my 2 best guesses would be a sleep disorder caused by the use of Concerta.

The other more likely cause is hormonal changes that happens with 12 year old boys.

Actually another cause of insomnia could be nutritional. Food allergies, low calcium levels, low B-vitamins, maybe he is drinking something with caffiene too late in the day.

Turkey makes me sleep like a rock. Turkey contains the amino acid L-tryptophane.

Roxie,
I just found out what my sister did with her son that would through the kitchen knives at the kitchen floor when he couldn’t sleep. She stopped going to sleep until she was sure that he was asleep. After the kids got on the school bus she would go back to sleep. She wasn’t working outside of the house at the time.
Terry

I’ve dealt with a lot of insomnia myself—primarily related to hormones. I found that a dietary supplement called Myocalm PM, manufactured by Metagenics, worked beautifully. It’s calcium and magnesium with valerian root. I took it regularly to get my sleep cycle back in order and then began to taper off. Now, I only take it when I’m revved up about something. My son who does not have ADHD but who recently broke his leg and has had lots of sleep problems related to that injury has used the Myocalm PM and had great success. We also swear by Dr. Amen’s recipe of warm milk with sugar and real vanilla.

I remember when my ADHD son was 3. He hadn’t slept through the night in months and months. He’d get up 4 or 5 times a night and wander into our room. I had a baby, too, and was a walking basket case. Finally one night I bribed him with a pack of candy. (Those were the days when candy never touched my first-born’s lips.) He eagerly took the bribe, slept through the night, and kept doing it for years. We’ve laughed about that so many times. I’m not recommending the candy bribe, but generally speaking, if I can re-direct his ADHD brain, he’s off and running on a new track.

Good luck!

One of my sons was this way. Does your son like to read or listen to music? We kept tapes in our son’s room of soothing soft music - he’d put them on and often fall asleep or back asleep while listening to them. The old glass of warm milk (if you can stand it) can help - the digestion of warm milk requires the body to also produce natural chemicals inviting of sleep. Any food that’s eaten helps sleep as the body redirects blood from the brain to the stomack for digestion - the reason why many people feel sleepy after eating.

As a child I would read myself back to sleep and as a restless adult I often put the tv on a timer and fall asleep watching it.

I wouldn’t hesitate to tell your son that if there’s a true emergency he should certainly wake you up but he cannot wake you up simply because he’s up. Explain that he can’t wander the house but should stay in his room and in his bed. Counting sheep or day glow stars you put on his ceiling might be worth a try. Learning to fall back asleep is a healthy life skill well needed in your sleep deprived adult years and this is an opportunity for your son to learn that skill now.

Just now getting caught up on all of my reading? How did this story end up?

I am new here but saw your Post about your son. Our son WAS on Concerta over the summer. He was so overly anxiuos and he would get up at 1 am and cry his eyes out for two-three hours because he was so anxious and couldnt sleep. Then we saw him withdraw from his friends and his activities. The good side was that he could focus on his summer homeowkr alot better and he wasnt as antsy when he did it…the negative side was that he wasnt not the same little boy we always knew him to be…happy, smiling, funny, silly and on the go. He completely pulled inward and it was heart wrenching.
We were told that soft music at night would help and it did. Our son is 9 1/2. Not sure of a 12 yr old would get benefit from this but ask him. Or get him one of those machines that make sounds of the ocean or rain. Our son also has that on the radio that plays the soft music all night. The white wash noise helps them to relax and focus.
Currently he is not on meds. We were advised to take him off and try something else. We tried Ritalin after school becuase it only lasts four hours and we saw NO CHANGE. The next step for us is ADDERAL XL. We are reluctant to begin this med as we have heard horrible things about it. The Pediatrician told us to tell Neuro to try Straterra. Again, we are nervous to put him on anything.
Good luck with your son. KNow that your not alone. Hang in there!
-D

It is an ongoing affair helping these kids get to sleep. Both of my “ADHD-type” kids used to dislike sleeping - they both said is was “such a waste of time”! We lay down to read with them until around 11 or 12 years old, and would even lay there until they fell asleep if needed. However, night waking was still an issue.

We had some good results with reward programs for staying in bed. We actually used sleeping in our room one night a week as a reward for our youngest staying in his room. Have a chart where the successful days are recorded and a certain number of checks or stickers results in the reward, whether it is a movie, a trip to the ice cream parlor, or whatever you come up with. Naturally, you want to use time with a parent as the primary reward, since that is what he is giving up by not joining you in your room. I have also had a lot of luck with “betting” that they won’t do things I actually want them to do. This makes it more of a game, more fun for both you and him. Of course, you have to act very frustrated or disgruntled when he “wins” the bet - this will really tickle his oppositional little heart!

We also used a homeopathic medicine called “Calm Forte”, and have had success with a calcium-magnesium formula and with a Stash herbal tea called “Sandman PM”, which has Kava-Kava, in addition to Camomile and a lot of other herbs. Oh, and a king-sized bed for those nights when it isn’t worth the struggle!

That’s about all we have used. It’s not like there aren’t still sleep issues, but it makes it a lot easier. The good news is, you are very close to the age when it will start to be “uncool” to sleep with your parents, so you only have a year or two at most to worry about it.

Remember: herbal medications can have side effects. Here is an interesting article regarding the use of kava kava as a medication to treat anxiety. It details (with good links) the benefits and risks of kava kava.

http://www.vanderbilt.edu/AnS/psychology/health_psychology/kava.htm

Hey,
I can so relate .. My two with ADHD (11 & 7) don’t like sleep much either and my 2 year old , once he hears anything he’s up ‘till 6 AM.
I read several good ideas in the replies.. please remember to ask your MD before starting any of the herbal meds. I wanted to start my son once on primrose oil and other things and was lucky that someone was there to tell me NOT to mix with Ritalin he was taking.
Anyway, you could try a reward system for staying in bed (Choose a few other items and make a reward chart to track behaivior over time: week etc) also you can give alternatives to coming to your bed, what would he be allowed to do? Reading in bed or listening to stories? maybe that will help keep his mind quiet enough to be able to rest again after a while.. good luck

I have to say that Benedryl knocks out even my wild oldest daughter, but I only give it to her when she is having severe allergies, and then only at night, and when we are out of her Clarinex.

By the way, Hello to you all! Hope everyone is well, especially you, victoria, JenM, Roxie, ElizabethTo, and TerryB! I haven’t fallen off of the planet, but my computer is now and has been dead for several months now. I hope to be in touch very soon. I have lots to tell. Right now, I am working as Night Manager at a midtown Manhattan hotel, and do have work to do, but thought I’d drop a quick line.

Take care!
:)

I have been wondering how you were doing — VERY WELL, I hope! Obviously you have had a VERY busy last few months…but it sounds like you have ticked many things off the ‘goals’ list you had last spring…well done!

Best to you through the holidays, and I hope to see you posting when you can…I am here in ‘fits and spurts’. Take care!

Hi LizzyBee! Hope your holidays are fabulous too! :D Yes, I’ve been EXTREMELY busy, but it’s all good. You ladies are not gonna believe this, but I am actually seeing someone… He’s someone I used to work with here in NY back in 1989, and we were very good friends back then, but it’s a lot different now. I think maybe we both grew up? Anyway, I don’t mean to veer off topic, but thought I’d throw that in, since I haven’t had a chance to be online much at all.

I have tried both valerian root and kava kava myself, for my own anxiety and insomnia. I have to say, neither one of them did much for me, but of course that doesn’t mean they don’t work for other people. I have read and heard that they can do wonders for these ailments.

One word of warning, though: I read somewhere (probably on the internet) that kava can cause liver damage, but it’s never been proven one way or the other. I do know that kava is banned in some European countries for this reason.

The FDA recently issued a list of herbal medications that consumers should be cautious about. Kava was on that list. A good rule of thumb is that if the herbal compound improves a medical condition, it is functioning as a drug and you should regard it as such. You can buy all kinds of prescription drugs on the internet without a real prescription, but I bet most folks here would think that was foolhardy. They’d look to their doctor first for advice and for a prescription if one was needed. Take that same approach about herbal and other supplements and keep your children and yourself safe!

We use Melatonin from our local GNC to help our child sleep at night. It was recommended by a friend and then our Neurologist gave us the thumbs up to use it. Just one sublingual under the tounge and my child gets a good nights sleep.