Is it ADD, ADHD, or OSA?

October 28, 2021

Around 6.4 million children ages four to 17 have attention-deficit/hyperactivity disorder (ADHD). Symptoms include trouble concentrating on specific tasks and poor memory recall. These symptoms mirror obstructive sleep apnea (OSA), and it is no secret that poor sleeping habits can lead to exhaustion, poor learning, difficulty staying still, and more. This leads us to a current debate among medical professionals: Is it ADD, ADHD, or OSA?

This debate also applies to adults, as around 4 percent of individuals of all ages deal with symptoms of ADHD daily. While ADHD might be part of the problem, it’s worth exploring in further detail as our understanding of the human body, sleep, and airway increases.

Is it ADD, ADHD, or OSA? Let’s explore the similarities and differences to narrow down the possibilities.

ADD & ADHD

Attention-deficit disorder (ADD) and ADHD often begin in childhood, with most people diagnosed around age seven. These conditions are characterized by an inability to focus, poor behavior, outbursts, excessive energy, poor attention and memory recall, and more. They may lead to feelings of low self-esteem, troubled relationships, and reduced learning and development.

While symptoms are manageable with therapy and medication, these treatments don’t solve the root of the problem. But what is the heart of the problem? Is it truly an issue with mood and attention, or is it a result of poor sleeping habits? That is the question that many ADD and ADHD experts have sought to answer in recent years.

OSA

With more and more adults experiencing symptoms of ADD, ADHD, and OSA, it becomes difficult to identify the root of the problem without proper screening. Not getting enough sleep can make anyone irritable, moody, disruptive, or unproductive. That is why we need to go beyond the symptoms and look internally for signs of irregular breathing and OSA.

Signs of OSA include a high-vaulted palate, bruxism, orofacial pain, a scalloped tongue, and more. Dentists are in an excellent position to identify these elements during routine hygiene exams, ask patients about whether their sleep is restful or restless, and check in on their overall ability to function each day. If the patient expresses concern about attention and hyperactivity, it might be OSA in disguise. The key here is to consider all the details and treat the individual as a whole.

Separating OSA from ADD/ADHD

Dr. Ben Miraglia, a dentist and Vivos Integrated Provider (VIP) focusing on sleep and airway dentistry, discusses the connection between sleep-disordered breathing (SDB) and ADD and ADHD. He encourages healthcare providers to consider individuals with poor sleep and breathing and ask themselves how they might behave during the day. In other words, what are their daily symptoms? Now consider how many years that individual has likely struggled with these problems. It’s not just one or two nights of poor sleep. It’s a lifetime.

In the case of children, Dr. Miraglia shares, “You have had a poor quality of sleeping and breathing for years, and the parents have been struggling with so many different issues, not the least of which is the ADD/ADHD discussion.” In short, an individual who doesn’t get a good night’s sleep with good quality breathing will likely wake unrested. Put this individual in a classroom or office, and they will struggle to learn, cooperate with others, focus on a task, and operate effectively and efficiently. In the case of students, Dr. Miraglia shares that these individuals “have difficulty fitting into what is supposed to be a quiet, peaceful, and learning environment.”

All too often, poor behavior in the classroom results in a phone call home. And that phone call often concludes with a discussion about ADD and ADHD, as that is the current standard. Dr. Miraglia, summarizes,

They’re going to be diagnosed with ADD and ADHD, and our solutions are pharmaceutical. If we are given a pharmaceutical, it is usually in the form of a stimulant. And what that does to the child is it pushes them over the edge and brings them back to calm. So you take an exciting or hyperactive child, stimulate them more, and get them back to so-called calm, but it doesn’t make a better learning child. You’re not going to have a child who’s able to learn as well. So you now have a child sitting still in class because they might be a little more numb or relaxed or calm, but it doesn’t necessarily make them a better learner.

Current research shows that individuals who are sleep deprived showcase the same symptoms as individuals with ADD and ADHD, making it difficult to tell them apart. For this reason, medical professionals are now arguing that maybe ADD and ADHD have an underlying cause: OSA and poor sleep and breathing.

One case study example is Dr. Stephen Sheldon, a medical doctor with Lurie Children’s Hospital of Chicago. His research suggests the theory that ADHD and ADD do not exist: Instead, they are an outcome of SDB.

Another example is Dr. Karen Bonuck, a medical doctor with Albert Einstein College of Medicine. Her research includes the most extensive study to date with a pool of 11,000 children. These individuals were divided into two groups—those with SDB and those without—and analyzed them for seven years. The study concluded that individuals with SDB were 50 percent more likely to be diagnosed with ADD or ADHD and treated with medication. Additionally, these individuals had declining IQs, which is unnatural for young people.

Is it ADD, ADHD, or OSA? It can be hard to say just by looking at the signs and symptoms. That is why it is essential to view the patient as a whole, analyze their sleep and breathing patterns, and consider all factors before making a diagnosis, especially before prescribing medication. This will ensure we are tackling the root of the problem, creating a better and healthier life for the individual affected.

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