The Impact of Sleep: The Surprising Root Cause of Many of Our Students' Problems

​Misdiagnosed ADHD, Depression, and other Issues Can Often Actually be Attributed to Lack of Sleep

This Math Giraffe article was originally published in SnowDay Magazine for Creative Teachers, Issue 4. This is purely informational, and is not health advice. Consult a medical professional with any questions.

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​Did you know that children in China continue midday napping through elementary school, middle school, and even into adulthood?!  More sleep in children has been found to significantly improve happiness, control, and grit. Adversely, sleep deficiency can cause a number of problems, like chronic disease and behavioral problems. 

Some researchers are surprised to find that many of the diagnoses our children and teens are receiving can instead be attributed to extreme sleep deprivation based on their age and needs.

We can’t change our school day schedules overnight, but we can educate our students’ parents about the widespread impact of a good night’s sleep, as well as the negative impact of sleep deficiency.

Impact of Healthy Sleeping Habits

Every single person needs sleep every night to support their circadian rhythm, or sleep-wake cycle.  Studies have found that children’s mental and physical health are directly affected by sleep. Healthy and consistent sleep habits are associated with better language development, academic achievement, and socio-emotional and behavioral functioning in young children.  Other studies have shown that kids of all ages who regularly get an adequate amount of sleep have improved attention, behavior, learning, memory, and overall mental and physical health.

So, how do we help children develop healthy sleep habits?

First, students need the recommended number of hours of sleep per night.  Depending on their age, the numbers vary:
Infants under 1 year: 12-16 hours
Children 1-2 years old: 11-14 hours
Children 3-5 years old: 10-13 hours
Children 6-12 years old: 9-12 hours
Teenagers 13-18 years old: 8-10 hours

For teens who wake up at 6am to get on the bus, for example, this would mean getting to bed between 8 and 10pm. Is that the reality for most of your students? Not likely. But are parents and teens aware that it could be the root of their problems with weight, hormone imbalances, trouble focusing, or depression?

Beyond just the time spent in bed, it needs to be quality sleep.  It’s important for parents to consider bedtime routines.  Consistent bedtime routines are critical for younger children, (daily, positive interactions that end with the child sleeping).  Healthy bedtime routines should include things like brushing teeth and bathing, reading books together, and physical contact for younger children.  They may look different for older children and adolescents as they become more and more independent, but should still be happening. 

Parents of teens often drastically miscalculate the hours their child actually spends sleeping. They imagine them resting from the time they “clock out” for the day until the alarm goes off, but adolescents are frequently spending hours scrolling, reading, texting, or even just thinking while their caretakers assume they are asleep.

These reasons combine to cause a lot of confusion when a student starts to have trouble. Experts in pediatrics and in education both tend to look toward certain common explanations or diagnoses, when in fact, for many students, sleep should be the very first thing that is questioned.

​Diagnoses that Could be Explained by Sleep Deficiency

There are many diagnosed behaviors and conditions in classrooms that could be a result of sleep deficiency.  Not always, but oftentimes, students suffer from obesity or are misdiagnosed with ADHD or depression. Professionals will follow along with treatments accordingly when really, a lack of sleep might be the root cause.

The wonderful upside is that in cases where sleep is successfully identified as the root of the issue, the problem is easily solved. Working to get more rest is free of any negative side effects, and will have additional benefits for the whole child.

ADHD

Attention-Deficit/Hyperactive Disorder is prevalent in today’s schools.  Millions of children have been diagnosed with ADHD in the US, and the number has only risen over the years.  But, did you know that sleep deprivation and ADHD exhibit some of the  exact same symptoms?

The behaviors associated with ADHD interfere with a child’s social and intellectual development, which can lead to problems with relationships with other children and adults, at school and at home. But, ADHD might not always be the underlying cause.  

That’s right, many cases of ADHD are misdiagnosed, and forming healthy sleep habits could solve the problem.  Some symptoms ADHD and sleep deprivation have in common are inattention, hyperactivity, anxiety, agitation, nervousness, insomnia, and weight loss.

Often, when a child is acting out and we don’t see an obvious cause, doctors jump to an ADHD diagnosis.  Sometimes, though, the child is suffering from sleep-disordered breathing, causing disruption to sleep patterns.  At the NIH, they studied children with ADHD who were on medication, and fixed their sleep-disordered breathing.  Within just 6 months, 70% no longer showed ADHD symptoms and could be taken off medication.

The Child Mind Institute shares, although sleep disorders are rare in children, a lack of sleep (even if it’s not considered a sleep disorder) can cause or worsen ADHD symptoms.  So, if a student is diagnosed with ADHD, you may want to advise parents to pay attention to any sleep disturbances, and follow up with their physician.

It’s also worth noting that ADHD medication can play a role in sleep deficiency.  Children who take stimulant medication might experience symptoms, like deficient sleep.  If the child takes the stimulant too late in the day or if it keeps working too long, they might have trouble falling asleep. It’s worth bringing up any of these concerns with your doctor.

Obesity

As you probably know, obesity is prevalent in the US.  It affects about 17% of children and 35% of adults.  Obesity often leads to many other medical problems, like cardiovascular disease, diabetes, and hypertension.  Studies have also found it might cause sleep apnea in children.

Most people automatically jump to poor diets and exercise habits as the cause of this epidemic.  Although these definitely need to be considered, poor sleep patterns are often overlooked.  Most studies have shown a convincing association between a lack of quality sleep and increased weight gain in children.  Different factors determine quality sleep, such as the duration of sleep at night (Is the child getting the recommended number of hours of sleep per night?), or sleep patterns (Is the child following a strict bedtime?). 

As mentioned earlier, depending on their age, children and adolescents need a certain number of hours of sleep, and multiple reviews have determined there is a relationship between sleep duration and childhood obesity.  The underlying explanation(s) are still unknown though.  Some theorize it is because poor sleep can disrupt hormone production, which can lead to an increase in appetite.

Children and adolescents who suffer from obesity are at a higher risk for various sleep disorders.  Although researchers are still continuing to study this relationship, many believe this association involves metabolic and neuroendocrine/hormonal physiology and other factors.  These sleep disorders can be categorized into four functional categories, including insufficient sleep quantity, poor sleep quality, inappropriate timing of the sleep period, and primary disorders of excessive daytime sleepiness.  

Depression

It’s totally normal for a child or teen to feel down or irritable from time to time, but if it’s happening consistently there could be a deeper problem.  Depression can occur early in life and cause serious consequences later in life.  There are, of course, many different factors that can lead to depression or depressive symptoms.

Research has indicated that depression (in children and adults) is often linked to insomnia and other sleep problems.  Depression and lack of quality sleep also share common symptoms, like fatigue, loss of interest, and depressed mood.  Researchers have found that depression in children can be affected by the duration and quality of sleep they get each night.  

It is rare to see depressive symptoms in youth before puberty, but the rates increase drastically in adolescence.  Some argue that before puberty children’s sleep is “protected” against disruptions.  Young children are able to reach the deepest level of sleep, whereas adolescents often cannot.  Many suffering from depression, including children and adults, report “sleep complaints” like having trouble falling asleep, having difficulty waking up, etc.  These are considered subjective findings; there are also objective measures of research done through laboratory-based sleep studies that examine some of the physiological characteristics of sleep.  Some studies have found that children with subjective sleep complaints do not always correlate with objective measures.  This suggests a patient’s perception of their sleep may differ from objective measures.

Clearly, quality sleep and these chronic diseases have a complex relationship.  Many research reviews use the term bidirectional, functioning in two directions.  Children and adolescents diagnosed with ADHD, Obesity, or Depression might experience sleep deficiency because of their diagnosis.  It could also be the other way around, with sleep deficiency causing a misdiagnosis.  

Please consult with a doctor if you have any concerns.

​What you Can Do as a Teacher

Teachers can only do so much.  If you suspect any students are struggling due to sleep deficiency you certainly can’t go home with them and make them go to bed at a reasonable hour.  But, you can do what you do best... educate!

Educate parents and students (depending on their age) about good sleep hygiene.  Grab the parent handout below, fill in the blank (using the info on the sheet), and make copies to send home with students.

Download Student Sleep Handout

​More Ways to Help Your Teens

Read these next if you are a teacher (or parent) of teen students:

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Sources:

>>  CDC: Sleep in Middle and High School Students
>>  PubMed.NCBI: Attention-deficit/hyperactivity Disorder With Obstructive Sleep Apnea: A Treatment Outcome Study
>>  NCBI study: Sleep Disturbances in Pediatric Depression
>>  Harvard.edu: Sleep Deprivation and Obesity
>>  ScienceDaily: Children's Mental Health is Affected by Sleep Duration
>>  CDC: Data and Statistics about ADHD
>>  ClinMedJournals
>>  PubMed.gov: Obstructive Sleep-Disordered Breathing in Children