Dear Patients, 

October is ADHD Awareness Month and the team at Smile Starters Pediatric Dentistry would like to share this article with all our families. Here at Smile Starters, we like to make sure that not only do our pa-tients have healthy teeth, but they have healthy minds and bodies too! Studies show that Attention Deficit/Hyperactivity Disorder is highly correlated with quality of sleep and sleep can be affected by certain soft tissues in the mouth. We hope you enjoy this article!

Dr. Cristina B Georgescu and Dr. Eileen Dano Calamia

Our son's Sleep Disorder was misdiagnosed as ADHD & a "behavior problem"

by Becky (Your Modern Family)

Let me start at the beginning before diving right into ADHD and sleep apnea... E is our youngest son, and he was the BEST baby. He slept all night long (which was something I was NOT used to!) He never woke, not even in the middle of the night. He was happy all of the time. Over the next few months, E started waking more often. I had not changed his bed-time routine at all, yet he was not able to stay asleep at night. He was also falling asleep extremely fast at night when it was time for bed. The excessive daytime sleepiness (well, evening sleepiness) should have been a clue. Fast forward about five years... he was still waking at night. Still coming into our room every night (around the same time). Still tired in the mornings (and so grumpy when he woke up.) E had gone from a happy baby to a very unhappy, unpredictable, grumpy, hot-tem-pered child. He was now VERY quick to lose his temper, quick to get angry, and then quick to feel embarrassed when he realized that he had acted that way. His behavior issues were growing. E was that child that family members joked about as being a "hot head". He was the one that made us timid to go out anywhere just in case he had a meltdown. Why was he acting this way? What on earth had we done differently? Nothing. We had raised them the same, yet he reacted to things in a completely different way than his older siblings. Someone suggested that maybe he had ADHD or a behavior disorder. I thought about it and thought that maybe he was showing symptoms of ADHD. Finally, when I didn't know what else to do — I took him to see a therapist. I asked "Does my child have ADHD? I don't know what else it could be?" Immediately, she suggested seeing a Neurologist to rule out any issues. She suspected that the Hand, Foot & Mouth were to blame. I had always wondered about it, as well, so I called that day and made an appointment.

That started us on a very long journey to find out the truth.

After many appointments and questions: Does he seem to have symptoms of atten-tion deficit hyperactivity disorder, does he seem to have restless legs at night (lean-ing towards restless legs syndrome), does he have high blood pressure or any learning disabilities?

When we went over his history and talked about any risk factors, the doctor ordered a sleep study. Then the day came when our doctor called us in for an appointment to discuss the results.

Our son had Central Sleep Apnea, "CSA", and it was presenting as ADHD be-cause of how it was changing his attitude and behavior.

"Central sleep apnea (CSA) is a pause in breathing during sleep, usually without snoring or gasping. Everyone experiences central apneas occasionally. However, if it occurs too frequently or for long periods of time, it can cause a decrease in the oxygen levels in the body and disrupt sleep." —Children's

What are the signs and symptons of CSA?

This was not SLEEP apnea as we knew it. It was not a blockage. It was not the same as obstruc-tive sleep apnea. This was CENTRAL sleep apnea, caused by his brain telling him that he was drowning, pretty much, and making him get out of his REM sleep to 'wake up and take a breath'. This type of sleep apnea is often related to congestive heart failure and puts our son at a higher risk for breathing problems related to a heart condition. So they sent him for more tests to rule out any of these further complications. He did not have a heart condition or restless leg syndrome (rls.) Now we needed to fix his breathing patterns to help him so he sleeps through the night ... every night.

What the doctor told us next explained the grumpiness, moodiness, temper tantrums, etc... in 11 little words:

"He is waking up 8 times every hour, all night long."

Often times, one of these wake-ups would lead to a 1-2 hour time of being awake. This is why the symptoms of sleep apnea often resemble the symptoms of ADHD. They are tired, grumpy, moody and anxious due to lack of sleep. A child waking at night is not rested enough to think or act the way that a rested child would think or act. This is why they show that ADHD misdiagnosed is happening more & more.

Our poor sweet baby boy was barely sleeping.

So... we looked into solutions for his sleep disorder.

He had many tests done because often times central sleep apnea is linked to a heart problem. Everything else came back normal and now we just had to help him. We started him on a CPAP machine to help him. It took months to get it right, but once we did, he was back. Our sweet, happy, selfless, caring E was back. That was three years ago. To say that his life changed is an understatement. He went from being the one that was unpredictable to being a child that you could rely on. He went from one that you hated to disappoint, because you knew how we would react, to being a child who could take things with a grain of salt. Don't get me wrong... he still had to unlearn the behaviors that he was used to (five years of "losing it" about things can change the way you handle things), but now he had the sleep that he needed and he could react in a calm way. All parents. If you have a child, I'm going to tell you something you need to know that you have probably never heard. And please share this. There is a huge red flag in the picture I am sharing with this story. Do you see it? CHILDREN SHOULD NOT BREATHE THROUGH THEIR MOUTHS. Not while awake, not while asleep. Never.

Symptoms that your child may have a sleep disorder:

If your child...

So what can you do?

According to Sleep Review Magazine: "Dentist Michael Fulbright, DDS, sleep apnea in children is a big problem, particularly when it goes undiagnosed or is misdiagnosed entirely. "These days, many children are being diagnosed with ADHD (attention deficit hyperactivity disorder). Some of them are acting out in school and getting in trouble. Well-meaning doctors may misdi-agnose some of these children and prescribe Ritalin for ADHD, when really the cause of their behavioral problems may be sleep apnea," he says in a release. I highly suggest being 100% sure that your child has ADHD before starting any medication. Have the doctors do a sleep study to be on the safe side. I wish we had done ours years ago.