With our increasing demands on kids to sit still and pay attention, the rise of those who struggle with ADHD seems exponential. With the exception of a slight drop in 2016, rates of attention deficit hyperactivity disorder (ADHD) diagnoses have steadily risen since 2003. What researchers now believe is that not only is ADHD often over-diagnosed, but ADHD and sleep apnea are also linked and often misdiagnosed. Here’s what you need to know.

What’s the connection between ADHD and sleep apnea?

Sleep apnea affects an estimated 25 million people in the U.S. In children, the rate of sleep apnea is much more challenging to estimate. The approximate range of sleep apnea prevalence among children is between five and 10% .

Conversely, just over 6% of children in the U.S. are diagnosed with ADHD (the global rate of diagnosis is around 7%). Many parents opt for prescription treatment options for ADHD, with Adderall being the most common medication. In some cases, the treatment of ADHD with Adderall can further complicate the delineation between ADHD and sleep apnea as the brain deals with the additional stimulant from the medication.

But is it really ADHD or is it sleep apnea? The America Sleep Apnea Association believes that as many as 25% of kids diagnosed with ADHD may actually be suffering from sleep apnea. Another study in 2017 found that 75% of people suffering from ADHD also have sleep apnea, potentially due to the disruption in their regular sleep cycle.

Commenting on the connection between sleep apnea and ADHD in the study, Professor Andreas Reif from the University Hospital in Frankfurt, believes that:

“A disturbance of [sleep patterns] may indeed be a core mechanism in ADHD, which could also link ADHD to other mental illnesses such as depression or bipolar disorder…More research into the interconnections between ADHD and the ‘inner clock’ is thus very relevant to improve patients’ lives and to shed light on the disease mechanism of ADHD.”

A mistaken ADHD diagnosis makes sense largely due to the ways in which sleep apnea presents itself in kids as opposed to how adults experience the symptoms of sleep apnea. Adults who suffer from sleep apnea experience fatigue and sluggishness, but children respond much differently. Most parents are familiar with the overtired toddler and the full-on temper tantrum that follows. Sleep deprivation in children often appears as hyperactivity or excessive energy. They may feel restless and act out or become irritable and aggressive. These symptoms are similar to the checklist of symptoms for ADHD.

This hyperactivity is just one of a host of ADHD symptoms and the symptoms of sleep apnea in children.

What are the shared symptoms of ADHD and sleep apnea in children?

As with adults, children can experience some of the same symptoms of sleep apnea as adults. They may wake up feeling fatigued (or be very challenging to wake up at all). They may also complain of headaches in the morning, and their oral health may be poor due to teeth grinding (or bruxism) at night and a dry mouth from mouth breathing all night long.

The appearance of sleep apnea in children and adults during sleep is also similar – pauses in breath followed by a strangled or gasping intake of breath. However, this is where the similarities end. ADHD and sleep apnea in children have crossover symptoms that can result in a missed or mis-diagnosis. They include the following.

1. Poor school performance

One of the primary indicators of ADHD is poor school performance. It is challenging to get good grades when you cannot focus your attention long enough to learn.

Children with sleep apnea are three times more likely to earn “C’s” or lower in all classes.

2. Difficulty with focus

Just as with ADHD, children with sleep apnea have trouble focusing for long periods on the task at hand.

A full night of sleep – between 9 and thirteen hours a night for kids – helps with brain and body development. Over time, focus may become even more of an issue if sleep apnea persists.

3. Disruptive behavior

Just as children with ADHD cannot help themselves from blurting out in class or still their disruptive movement, so, too, do children with sleep apnea struggle with these behaviors.

Sleep apnea symptoms in children can include restless movement and lack of impulse control – much like ADHD.