It’s back to school time and that means parents are grappling with getting their children on a regular sleep routine. But for parents with children who have been diagnosed with ADHD, that’s no small task.

As many as 70% of children with ADHD experience problems with sleep. The issues include bedtime anxiety or resistance, insomnia and delayed sleep – meaning their sleep cycle has shifted and they aren’t tired at bedtime. 

Kristin Mock, MD, is a family practice physician at OSF HealthCare who specializes in ADHD and pediatric sleep issues. She sees patients whose behaviors are often linked to ADHD; but they could also be a result of a lack of sleep.

Unlike adults who have excessive sleepiness and fatigue, Dr. Mock says children with ADHD tend to have more behavioral issues such as acting out or temper tantrums. They have difficulties with behavior and focus and concentration, and they tend to get fidgety.

So that begs the question – is the issue ADHD or a sleep problem or a combination of both?

“If your child has ADHD, there is a high likelihood they have comorbid sleep dysfunction and mental health dysfunction,” says Dr. Mock. “We need to treat the whole of the child and make sure that we've looked at all of those reasons that people can have concentration deficits and treat all of that to give them the best potential.”

Dr. Mock adds that not getting enough sleep can cause or make ADHD symptoms worse. And that means improving a child’s sleep issues can help reduce symptoms.

“So, when the brain is tired, it tries to find ways to get it to stay awake. It will go from one task to the next. It will jump from here to there. It will stutter and sometimes forget things,” she says. “Children will get very fidgety to keep their brain awake. So, while your brain is trying to just get through to the next time it gets to sleep, it makes you not as effective.”

Dr. Mock says the most common referral to her clinic comes from teachers who inform parents that their child lacks focus in the classroom. “Then it's our job to figure out why,” she says.  “What’s really going on? Are they tired, do they have learning disabilities or do they learn differently?”

Mock says parents can help by discouraging any use of electronics once your child has gone to bed. That means there is no iPhone, iPad or TV in their bedroom and no texting, social media or video games, which will not go over well with many teens. Starting this behavioral change at younger ages makes this change easier. 

She also recommends encouraging children to go to bed and wake up at the same time every day. Most children require eight to 10 hours of sleep every night. Dr. Mock adds children need two weeks to gradually get back into a good sleep routine now that school has started.

It's also important to get a handle on your child’s medication. Some ADHD stimulants can make sleep worse so talk to your child’s care team about how they are affecting your child’s sleep. Dr. Mock adds that if your child snores, medical providers need to do more. Dr. Mock says their doctor should make a detailed sleep history or maybe make a referral to a sleep specialist.

“Parents need to pay attention to their children's sleep,” Dr. Mock says. “Physicians may not realize that the child is not sleeping well. And so, parents need to be able to tell their doctor, 'Hey, I'm concerned about the way my child is sleeping, or my child is snoring. Can we do more?'"

For more information on sleep disorders, visit OSF HealthCare. 

 

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For those who don’t enjoy sleeping with what looks like the equivalent of a MiG fighter pilot mask, there’s possible relief with new medication approved to treat sleep apnea.

Sleep apnea is a disorder in which the airway either closes off completely or becomes so narrowed that breathing repeatedly stops and starts during sleep, often causing brief awakenings that disrupt restful sleep. A common treatment includes wearing a CPAP, or continuous positive airway pressure, mask to deliver air pressure into the airways to keep them open.

But now there’s a new option. The FDA recently approved tirzepatide (Zepbound) for adults with obesity and moderate-to-severe obstructive sleep apnea (OSA). The drug is typically prescribed for type 2 diabetes and is among the class of drugs known as GLP-1 receptor agonists, meaning they work on hormones that control appetite and insulin levels and can help promote weight loss.

Sarah Zallek, MD, a neurologist and vice president and chief medical officer for OSF HealthCare St. Joseph Medical Center in Bloomington, Illinois, is also medical director of OSF Sleep in Peoria. Dr. Zallek calls the approval of Zepbound for treatment of sleep apnea a significant and important development. She points out there have been few new developments for the treatment of OSA, and this is the first medication.

Could this let some people ditch their CPAP machines? Dr. Zallek says if their sleep apnea is caused by obesity, potentially yes.

“So, if you’re wearing CPAP and you have weight-related sleep apnea, weight loss is a great idea. The approval of Zepbound (tirzepatide) is a new avenue for us to look for treating overweight or obesity and to treat sleep apnea.”

Dr. Zallek says for some people with weight-related apnea, losing about 10% or more of overall body weight can significantly reduce or eliminate the sleeping disorder.  However, she warns that with GLP-1 agonists, it’s important to maintain a healthy diet and exercise because the medication carries significant risk of muscle loss.

 “It's really important for people who are using GLP-1s to maintain adequate nutritional intake, particularly with high quality protein, and maintain exercise, so that they get muscle resistance exercise and build and maintain muscle.”

Treatment of sleep apnea with CPAP is still the gold standard. Dr. Zallek says if switching to Zepbound to address sleep apnea, a doctor should continue to monitor weight loss and then test again to see if a person’s airway has opened up.

“Keep using that treatment until you successfully lose weight and get rid of the sleep apnea. It's not time to stop the CPAP and switch to Zepbound, for example. To treat sleep apnea, it's time to continue what you're doing, approach weight loss and then see if the sleep apnea has resolved.”

Studies have shown that people who have lost weight with GLP-1 drugs, tend to regain the weight once they quit taking the medication. This is because GLP-1s mimic natural hormones that regulate blood sugar, slow digestion, and make you feel full. So, Dr. Zallek stresses the need for lifestyle changes regardless of the approach to treating sleep apnea.

Dr. Zallek is board certified in Lifestyle Medicine, which means she incorporates therapeutic lifestyle interventions to treat and reverse chronic conditions. That includes a whole-food, plant-predominant eating pattern, physical activity, restorative sleep, stress management, avoidance of risky substances and positive social connections.

It’s possible other GLP-1 drug makers for Wegovy, Ozempic or Mounjaro will seek similar approval for use as treatment of sleep apnea. But, Dr. Zallek says people also need to talk with their provider and weigh the side effects with the benefits. Some of the side effects of the GLP1s include nausea, vomiting, diarrhea, delayed gastric emptying, low blood sugar, fatigue, and more serious complications such as gallstone disease, and pancreatitis.

As they say in the ads, “Ask your doctor if it's right for you."

Dr. Sarah Zallek

If you see your cardiologist and they throw out the term “heart failure,” your heart might figuratively skip a beat. The heart is a vital organ, and if it’s failing, should I be counting my days?

While advanced heart failure will mean big life changes, Margy Goetten, APRN, a cardiology provider at OSF HealthCare, wants you to know that you can live with heart failure.

What to know about heart failure

Goetten says heart failure occurs when the organ can’t pump blood or relax like normal.

“New heart failure patients may experience shortness of breath. They might have difficulty when laying down. They can’t breathe. Leg swelling and fatigue are also common,” Goetten explains. “But if heart failure is well controlled, a lot of people don’t have symptoms.”

Milder cases of heart failure can be controlled by taking multiple medications – a cocktail of sorts that research has shown to help. Titrate medication, for example, helps with shortness of breath, Goetten says. Managing other health problems and not missing doctor’s appointments are also must-dos.

“It’s really symptom management,” Goetten says.

People with advanced heart failure, called end-stage, are “pretty sick,” Goetten says. She says they often require frequent trips to the hospital.

“Your symptoms are more severe. They come more frequently,” Goetten points out.  “If you miss medications, the symptoms can occur quickly within a day rather than missing medications for a couple days and showing symptoms,” Goetten says.

In addition to medication, end-stage heart failure patients might have a device – an Impella or a balloon pump – put in their heart to help it pump normally. Goetten often sees these people live a “new normal.” For example, they might cut back on long vacation trips in favor of “staycations” where they know their heart care team is just minutes away.

Prevention

Just as the tires on our car wear down with miles driven, our heart wears down with age. It’s inevitable. But healthy habits can help your heart hold up longer. Get on a diet and exercise plan to avoid obesity. Manage conditions such as diabetes, sleep apnea, high cholesterol and high blood pressure.

“Once those are under control, a lot of the symptoms seem to get better,” Goetten says.

Learn more

Read more about keeping your heart in top shape on the OSF HealthCare website.

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Most of us like the idea of turning back time, figuratively … but not so much literally. Some people relish the idea of turning back clocks one hour, marking an end to Daylight Saving Time (DST) which officially happens at 2 a.m. this Sunday. But, if given the option, a 2020 study reveals a majority of adults (66%) support the elimination of seasonal time changes in support of a national, fixed, year-round time. The American Association of Sleep Medicine (AASM) study included more than 2,000 US adults.

The ending of daylight saving time means that the sun will be out earlier in the morning and the evenings will get darker sooner. OSF HealthCare Clinical Director of Sleep Medicine Dr. Kaninika Verma says research shows most people don’t make good use of the extra hour of sleep in the fall, but simply stay up later and watch a little more TV, play on their computers, or in some cases drink more alcohol because bars stay open later.

She says light has a huge impact on our body's circadian rhythm, otherwise known as a sleep/wake cycle. So when that changes, it throws the body out of sync. When we "fall back," Dr. Verma says stress hormones start booting up the body's systems hours in advance of waking and when the clock changes, they are out of sync.

"You've got more stress hormones than what you're used to for that time period because you're starting to wake up or your alarm clock is going off when you think you should be sleeping a little bit longer. So that's why we see that bump in the number of heart attacks around that time," she says.  

In fact, many scientists see an increased risk for heart attack and stroke during the days following a time change. In addition, studies show that traffic fatalities have increased as much as six percent in the first few days following the return to daylight saving time in the spring. Because of this, the AASM recommends federal legislation be enacted to adopt a permanent standard time.

Meanwhile, Dr. Verma suggests preparing for the time change by going to bed 15 minutes later each of the four days leading up to the change.

"If you want to switch your clock, do it in 15 minute increments and don't expect it to happen overnight. You can't just go to bed an hour ahead and expect it to work. It's just not going to happen," she advises.

So, if you go to bed at 9 p.m., she suggests starting to go at 9:15 p.m., then 9:30 p.m., then 9:45 p.m. and finally 10 p.m. which will then be your usual 9 p.m. sleep time when you set your clock back over the weekend.

Dr. Verma says sleep is not a luxury. It is a vital sign and not getting enough sleep, or getting poor-quality sleep, increases the risk of high blood pressure, heart disease, obesity, and diabetes. Sleep deprivation also hurts the body's immune system so you can get sick more easily.

At Home Sleep Study

If you've been hesitant to do anything about your trouble sleeping, this might be an incentive. Dr. Verma says technology has advanced so many people can do an at-home sleep study to determine if a more advanced study in a sleep lab is needed. A patient who meets certain criteria can take equipment home to record critical measurements.

"It's looking at air flow from the nose; how much air you're moving. Bands around the chest to see if you're moving. An oximeter to see what oxygen levels are and also there is a snore mic so we know if someone's storing, we can hear the snoring too."

Regardless of the twice a year movement of the clock by one hour, lots of people have trouble getting to sleep or staying asleep. Between 50 and 70 million U.S. adults have some type of sleep or wakefulness disorder and the impact is affecting people’s quality of life.

Results from the world’s largest sleep study to date, involving 40,000 people from around the globe, found participants who slept four hours or less performed cognitively as if they were almost nine years older. Participants' reasoning and verbal abilities were two of the actions most strongly affected by sleep.

In addition to sleep apnea, OSF HealthCare Sleep Medicine doctors can evaluate conditions characterized by disturbances of sleep patterns and conditions such as restless leg syndrome or narcolepsy that can cause sleep abnormalities.

Many sleep disorders go undiagnosed and Dr. Verma points out that can affect not only your health, but personal relationships impacted by changes in mood, motivation and productivity. Learn more about sleep disorders to determine whether you should discuss sleep challenges with your primary care provider.

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In the 2023 State of the Union Address, President Joe Biden renewed a call to cap the price of insulin for people with diabetes.

Five days later, the condition got nationwide attention again when singer Nick Jonas, a type 1 diabetic, starred in a Super Bowl commercial promoting a product that monitors your glucose level.

And a recent report from the U.S. Centers for Disease Control and Prevention predicted a rapid rise in cases of diabetes in young people over the next few decades.

It’s a good thing that influencers and medical professionals continue to preach diabetes awareness, says Uche Allanah, MD, an internal medicine physician with OSF HealthCare. That’s because if undiagnosed or untreated, diabetes can be fatal.

“It’s alarming,” Dr. Allanah says, referring to the number of patients she sees with symptoms or precursors of diabetes.

Prediabetes vs. diabetes

Diabetes is a disorder that affects how your body uses blood sugar, from which our blood cells get energy. Type 1 diabetes is when an autoimmune reaction stops your body from making insulin. Without insulin, blood sugar cannot move out of your bloodstream and into cells. With Type 2, your body still produces insulin but doesn’t use it efficiently. Gestational diabetes occurs in pregnant women. Diabetes symptoms include increased urination, increased thirst, increased hunger and unexplained weight loss.

Dr. Allanah says prediabetes describes when you are at risk for diabetes because your blood sugar is higher than normal. She says a blood test is necessary to diagnose prediabetes because you don’t present with symptoms. In fact, the American Medical Association says of the one in three U.S. adults with prediabetes, more than 80% don’t know they have it.

“It’s important to identify prediabetes because you can stall the development of diabetes and actually prevent a patient from becoming diabetic,” Dr. Allanah says.

Risk factors for prediabetes include obesity, sleep apnea and polycystic ovary syndrome in women. Providers also look at a person’s family history of the disease, and Dr. Allanah says certain groups -- African Americans, Hispanics and Latinos, Asian Americans and American Indians -- are at higher risk.

Dr. Allanah advises everyone to have regular checkups with their primary care provider to keep an eye on the risk factors you can control. Also, practice healthy habits from a young age.

“Eat right. Avoid processed food,” Dr. Allanah advises. “Exercise. A lot of people are sedentary, especially due to the pandemic. People who went to the gym no longer workout. Even now that the stay-at-home orders have been lifted, some people are just not back into their previous lifestyle.”

Dr. Allanah also says a prediabetes or diabetes diagnosis is a lot to handle. Some people may have to learn to safely give themselves shots. Others may have to constantly watch for low blood sugar to avoid fainting. Providers realize this and will be there to answer questions. But Dr. Allanah says it’s not uncommon for someone to see a mental health provider to talk about the emotional toll of the diagnosis.

Learn more

Learn more about diabetes care on the OSF HealthCare website.

Interview clips

Según la Academia Estadounidense de Medicina del Sueño (American Academy of Sleep Medicine, AASM), en Estados Unidos, cerca de 30 millones de adultos se ven afectados por la apnea obstructiva del sueño, y casi el 80 % de estos casos no tiene diagnóstico. 

La AASM lanzó una campaña de concienciación sobre esta afección, cuyo costo supera los $149 000 millones anuales, divididos en atención médica, pérdida de productividad laboral, y accidentes laborales y de tránsito.  

Juanbosco Ayala, doctor en medicina, trabaja como neumólogo en OSF HealthCare. El Dr. Ayala mantiene que el signo más común de la apnea del sueño es el cansancio generalizado durante el día. 

“Los pacientes se sienten muy cansados y no tienen energía al despertarse por la mañana”, indica. “Pueden sufrir dolor de cabeza matutino y sequedad en la boca, como también es posible que sus parejas manifiesten que han roncado o dejado de respirar en la mitad de la noche”. 

¿Otro signo común? Dormitar durante el día.  

“Ya sea que estén hablando como estamos haciendo nosotros ahora, participando en una reunión o mirando una película, los pacientes se quedan dormidos. Es el cansancio excesivo lo que los lleva a quedarse dormidos con tanta facilidad. Hay pacientes que incluso pueden quedarse dormidos mientras conducen. Llegan a una señal de ‘Pare’ y, durante esos dos segundos en los que no prestan atención, se quedan dormidos”, manifiesta el Dr. Ayala.  

Además, indicó que el tratamiento más común para la apnea del sueño es una máquina que ejerce una presión positiva continua en las vías respiratorias (continuous positive airway pressure, C-PAP).  

“Existe una máscara facial completa que cubre la nariz y la boca. Aunque hay pacientes que solo con una mascarilla nasal resuelven el problema”, sostiene Ayala.  

Según informaron recientemente los médicos de OSF HealthCare, los malos hábitos de sueño pueden tener consecuencias a largo plazo en nuestras vidas. El Dr. Ayala dice que lo mismo sucede con la apnea del sueño.  

“Las consecuencias a largo plazo suelen afectar el corazón o los pulmones. Específicamente, la hipertensión crónica y la hipertensión pulmonar pueden ser afecciones a largo plazo que surjan a partir de una apnea del sueño no tratada”, menciona el Dr. Ayala. “Además, existe un alto riesgo de padecer ataques cardíacos o accidentes cerebrovasculares”. 

El Dr. Ayala indica que, según ciertos datos, la apnea del sueño también podría dar lugar a un deterioro cognitivo. Explica que la apnea del sueño suele observarse en personas con sobrepeso, pero casi todas las personas pueden padecerla. 

“Hay una parte de la población que está en forma, y no necesariamente tiene sobrepeso, y padece apnea del sueño”, afirma el Dr. Ayala. “En ocasiones, no abordar el tema es lo que impide tratar esta afección”. 

El Dr. Ayala manifiesta que lo mejor que puede hacer si sospecha que sufre apnea del sueño es acudir a un médico. Un proveedor de OSF HealthCare puede evaluarlo y elaborar un plan de tratamiento para seguir adelante. 

Video Interview Clips

Nearly 30 million adults in the United States are affected by obstructive sleep apnea and almost 80% of these cases are undiagnosed, according to the American Academy of Sleep Medicine (AASM).

The AASM has launched an awareness campaign for this condition, which costs more than $149 billion annually in health care costs, lost work productivity and workplace and motor vehicle accidents.

Juanbosco Ayala, MD, is a pulmonologist with OSF HealthCare. He says the most common sign of sleep apnea is an overall tiredness throughout the day.

“Patients feel very tired and don’t feel energized after waking up in the morning,” Dr. Ayala says. “They may have morning headaches, a dry mouth, and they may be told by their significant other that they snore or stop breathing in the middle of the night.”

Another common sign? Dozing off during the day.

“Whether it’s talking like we are, in a meeting, or watching a movie. It’s this excessive tiredness that leads to falling asleep quite easily. There are even patients who will fall asleep while driving. They get to a stop sign and for those two seconds they’re not paying attention, they’ll doze off,” Dr. Ayala says.

The most common treatment of sleep apnea, Dr. Ayala says, is the C-PAP machine.

“There’s a full face mask that encompasses a mask over the nose and mouth. There are patients that do well with just a nasal mask,” Dr. Ayala says.

As recently reported by doctors at OSF HealthCare, bad sleeping habits can have long-term consequences to our lives. Dr. Ayala says the same goes for sleep apnea.

“Long-term consequences typically involve either the heart or the lungs. Specifically long-standing hypertension and an entity called pulmonary hypertension can be something we see long-term from untreated sleep apnea,” Dr. Ayala says. “There’s also a significant risk for heart attacks and strokes.”

Dr. Ayala says some data suggests sleep apnea could also lead to cognitive impairment. He says sleep apnea is normally seen in overweight patients, but can be found in almost anyone.

“There is a subset of the population that is fit, not necessarily overweight, and they have sleep apnea,” Dr. Ayala says. “Sometimes not thinking about it leads to impediments in treatment.”

Dr. Ayala says the best thing you can do if you suspect you have sleep apnea is to see a health care provider. An OSF HealthCare provider can evaluate you and create a treatment plan moving forward.

Video Interview Clips

Television host Carson Daly is the latest celebrity to try what some call sleep divorce. Couples who sleep in the same bed but are not getting that coveted seven to eight hours of shut eye will slumber with some degree of separation: in the same bed but with separate blankets, in separate beds in the same room or in separate rooms.

Daly called the move the “best thing” for his marriage during a summer episode of the Today Show.

“We both, admittedly, slept better apart,” he said.

The concept is one worth exploring for couples who are kept up by snoring, restlessness, differences in sleep schedule or other nighttime issues, says Nadeem Ahmed, MD, a pulmonologist at OSF HealthCare in Alton, Illinois.

But let’s get one thing straight.

“I don’t like the term ‘sleep divorce’ because it tends to blame other people. It’s not a good word. It brings anxiety,” Dr. Ahmed says.

“I like to use ‘sleep alliance.’ They’re working together. They’re working things out. They want to make sure it’s healthy for both bed partners and the sleep disturbances don’t affect the other partner’s life,” he says.

Have the discussion

Dr. Ahmed says he encounters sleep issues, like snoring, in his practice “almost every day,” and many people are shy about it.

Every case is different. Dr. Ahmed says couples should first talk out their sleep issues and try to find a solution. The partners could try sleeping in separate beds during the week and in the same bed on the weekend so intimacy is not completely lost. Some mattresses have different firmness, temperature and slant on each side, which can help.

If needed, the partners should talk to a pulmonologist or psychologist.

“A lot of psychologists will do similar things that a physician will do. It’s just the comfort level of the person,” Dr. Ahmed explains. “Sometimes they don’t want to go to a medical doctor for the sleep problem. They would rather talk to a psychologist.”

“The idea is to discuss it with some type of professional,” he says.

Dr. Ahmed adds that sleeping separately should be a short-term solution.

“Tell your bed partner this is an issue, and we need to address it. As opposed to just getting mad or feeling crummy or sleepy the next day,” Dr. Ahmed says, “Because it can affect your job, like if you’re a machine operator or have to drive a truck.”

A major cause

Dr. Ahmed says a big cause of the restlessness that leads to sleep alliance discussions is sleep apnea, when people stop breathing during sleep. This can lead to loud snoring or body movement in bed and crabbiness or grogginess the next day.

Dr. Ahmed says there are two types of sleep apnea: obstructive and central. Obstructive sleep apnea is a product of obesity. Central sleep apnea is associated with neurological deficits like a stroke.

“[Sleep apnea] is not fatal because our brains are hard-wired to let you go to a certain time, and then it triggers you to take a breath,” Dr. Ahmed explains.

But, if the condition is left untreated, there is a litany of possible issues: hypertension, cardiac arrhythmia, diabetes, dementia, headaches and frequent urination.

Diagnosis of sleep apnea would involve a sleep study, either in your home or at a hospital.

Treatment options include a mask and machine combination known as a CPAP or BiPAP, a mouth guard or a small device that’s implanted in your body in outpatient surgery. All those options aim to help you breathe normally and sleep peacefully.

“Along with that, we have to stress lifestyle changes,” to rid oneself of sleep apnea, Dr. Ahmed adds. “Eating healthy. Losing weight. Getting exercise.”

Over-the-counter options for better sleep include melatonin, an eye mask, earplugs, thick window curtains, a plush mattress and sheets and a white noise device like a smart speaker. Don’t eat or drink, aside from water, a couple hours before bedtime, Dr. Ahmed also advises.

Learn more

Learn more about healthy sleep on the OSF HealthCare website. If you’re having sleep problems, especially if it’s impacting your daytime life, talk to your primary care provider, a pulmonologist or a behavioral health provider.

Interview clips

Previous coverage

TikTok trend deemed dangerous
Catch your ZZZs
Getting a wake-up call
Chronic fatigue is nothing to sleep on
Slumber hours slump
OSF HealthCare blog entries on sleep