Misdiagnosis: ADHD may really be a Sleep Disorder!

Jahbulon wrote:One symptom of sleep deprivation is hyperactivity (the symptoms of ADD/ADHD).

The rest, you know.

In children, yes.

49er wrote:

Todzo wrote:

SleepingUgly wrote:
The majority of children with ADHD symptoms do not have SDB; only a small proportion do (although I wouldn't be surprised if there is a high incidence of ADHD-like symptoms in kids with significant SDB). Of course the possibility of a sleep disorder, as well as other disorders, should be explored prior to concluding that it's ADHD (what I call "primary ADHD", as in not caused by another disorder).

Citation?

Todzo,

I have seen a 30 to 35% figure quoted regarding kids with SDB being misdiagnosed as having ADHD. Unfortunately, there is no information on where it came from.

49er

That supports my guess noted above: There may be an impressive percentage of kids with SDB who have ADHD-type symptoms. However, of those with ADHD symptoms, it's going to be a much smaller percent whose symptoms are solely due to SDB.

Interesting
I have ADHD but no sleep disorder that I'm aware of :p

49er wrote:I am confused as to which panel member you are referring to. It is the 2nd guy, Timothy Wilkens, who talks about ADHD and sleep disorders. He said, inadequate amount of sleep is also related to diminished attention, focus, academic performance, and occupational performance, as well as a number of mood symptoms.2 If the ADHD symptomatology is related to sleep apnea or duration of sleep, treatment should provide immediate reversal of ADHD symptoms.""

Well, that isn't true with adults. I am not sure how he can assume that is true with kids since they also could have gone years without treatment.

I haven't listened to this or read the link (no time now), although this is a topic I know something about. I would agree that, in both children and adults, if the attentional difficulties are due solely to SDB, if the SDB is treated optimally, the attentional difficulties should disappear. As for the fall-out from years of inattention, academic underachievement, etc., that is another story.

Regarding the first guy, Dr. Barkley, who seemed to be linking ADHD to LD, uh, if you have learning disabilities for example that affect your processing abilities, what looks like ADHD issues isn't. The key is if your LD issues are accommodated, your ADHD problems should disappear. Sorry, that is a hot button issue of mine as I know people who are midiagnosed as having ADHD and put on meds when it turns out they had LD.

Again, I didn't read/listen to the link, but I have read quite a bit of what Dr. Barkley has written. There is a high comorbidity of ADHD and learning disorders. That doesn't mean that every person with ADHD has an LD or that every person who has an LD also has ADHD. They can be difficult to tease out, and I'm sure there are lots of misdiagnoses along the way. If this was an issue for someone, I would recommend they see a psychologist, not a psychiatrist. Psychiatrists don't do the sort of testing that would differentially diagnose an LD vs. ADHD.

sleepstar wrote:Interesting
I have ADHD but no sleep disorder that I'm aware of :p

When was your last full Polysomnogram with esophageal pressure sensor?

sleepstar wrote:Interesting
I have ADHD but no sleep disorder that I'm aware of :p

How do you know: Narcolepsy is 90% undiagnosed in both the US and UK?

I'm guessing she was kidding... Why would she be on a cpap forum if she had no sleep disorder?

Nope, no sleep apnea.
I joined because I work in sleep and wanted to give advice if I could

And definitely no narcolepsy. Even if I did, I'm on the treatment for it anyway, lol.

Jahbulon wrote:

sleepstar wrote:Interesting
I have ADHD but no sleep disorder that I'm aware of :p

How do you know: Narcolepsy is 90% undiagnosed in both the US and UK?

because I know the symptoms inside out, and I don't have any

ADHD may be a sleep disorder, but it can also be related to gut disorders.

It runs in my family. 12 years ago, I went to a grain-free, starch-free, sugar-free, gum-free and whole bunch of other-free diet. My gut issues had been steadily getting worse over the years. The diet solved the gut issues. I never noticed a change in my behavior... but my husband did, and told me, "I like SCD. It's nice to have the woman I married back."

SleepingUgly wrote:In that case, my guess would be that he didn't have true "periodic limb movements", but rather muscle contractions associated with respiratory events. Great news!

Neither RLS or PLMD were ever formally diagnosed by any professional. What I find interesting is that the jumpy legs before he goes to sleep remain but the kicking after he goes to sleep have stopped on CPAP.

SleepingUgly wrote:

Jahbulon wrote:One symptom of sleep deprivation is hyperactivity (the symptoms of ADD/ADHD). [ . . . ].

In children, yes.

All of us: irritability, inability to pay attention, focusing on the things we like, such as television or playing with the computer, to the exclusion of tasks we need to complete, such as cleaning or school homework ("hyperactivity").

If that is not so, why else do we sleep?

The traditional difference between US and UK medical conclusions is that the US medical establishment claims hyperactivity (the symptoms of ADD/ADHD) can exist alone, with no other cause; while the British claim hyperactivity always has some other cause, such as Narcolepsy; and therefore, ADD/ADHD does not exist as an independent free standing diagnosis.

This has been transliterated into false claims that hyperactivity does not exist or does not exist in adults. Have a look at the behavior of young men after taking too much of the sedative known as alcohol and then claim hyperactivity does not exist.

SleepingUgly wrote:There is a high comorbidity of periodic limb movements and ADHD. It's not known why. One theory is that they are both dopamine issues. No one knows.

Indeed. Dopamine suppressing (anti-psychotic) drugs precipitate PLMS.

There is also high comorbidity of sleep disorders in general: the fact that you have OSA means you are more likely to have Narcolepsy.

SleepingUgly wrote:

PreemieNrsTiffy wrote: once he falls asleep (on the CPAP) his limb movements stop. I can't tell you what a blessing this is as his bed partner, as well as the lack of snoring.

In that case, my guess would be that he didn't have true "periodic limb movements", but rather muscle contractions associated with respiratory events. Great news!

Disagree: OSA causes limb movements during sleep; the limb movements approaching sleep may well benefit from therapy, such as low dose Codeine.

Jahbulon, you seem to be disagreeing with me on a couple of points (which is fine), mainly through unconventional use of terms.

"Hyperactivity" does not = inattention, irritability, focusing on the TV, etc. That's just not what "hyperactivity" means either in lay use of the term or in diagnosis of ADHD.

"Periodic limb movements" also has a specific definition (don't ask me what), and is not the same as leg movements. There can be leg contractions related to respiratory events, which some labs may score as limb movements (they will be picked up by the leg sensors), but they disappear when the SDB is treated. That is not what I would call a separate and "primary" diagnosis of "periodic limb movements". Of course it's not always 100% clear which it is, until it disappears with treatment.