The Correlation Between Sleep Deprivation & ADHD

As part of my 2025 goal of collaborating with more experts in their field, any of my sleep/breathing/airway/tongue tie content is collaborated with Dr. Hal Stewart, a holistic dentist and sleep breathing expert and teacher (also, my amazing dad and boss 🤪).

Important Note

This post is not intended to minimize any neurodivergent child. Many children suffer from “ADHD” merely as a symptom of a sleep breathing disorder (or vitamin deficiencies and other underlying root causes). There are also children who truly are neurodivergent, who’s smypoms are exacerbated because of the above. However, this is certainly not the case across the board. There are also children who are neurodivergent without any of the above, and that’s simply who they are. Which is wonderful and beautiful! But, for parents who have pause and would like to rule out all options before filling the prescription - there are indeed other considerations to rule out first. And, if at the end of the day, medication is still what is best that’s okay!

What is a Sleep Breathing Disorder

Research has discovered that many of these problems are often symptoms of a Sleep Breathing Disorder, which is a general term for a range of conditions that cause abnormal breathing during sleep - typically stemming from a very correctable  deformity and dysfunction of the oral and facial structure, directly effecting the airway.

There are many potential causes of sleep-breathing disorders like  obesity, enlarged tonsils/adenoids, tongue/lip ties, abnormalities of the jaw or tongue, neuromuscular deficits, just to name a few. It is best to seek out a properly trained professional if you suspect this could be the case. 

How Sleep Breathing Disorders Can Cause “ADHD”

When “ADHD” is a symptom of a sleep-related breathing disorder, what happens is the child (or adult) is not breathing properly, and therefore not sleeping properly. This puts their body in a constant state of sleep deprivation. The brain must over-stimulate the body in order to stay awake - thus the hyperactivity symptoms.

These individuals are often diagnosed with “ADHD,” and put on medication. Most times these mediations are stimulants - and the body is already overstimulating itself, so the fire is only being fueled, and a vicious cycle is created. 

Initially, medications may appear to work. However, over time, you may see dosages needing to slowly increase. And, ultimately, the underlying problem is not being solved. This can cause longterm health consequences in the future. 

A Few Things You Can Look for At Home

• Dark circles under the eyes 

• Blood shot eyes

• Crooked Teeth

• Swollen Tonsils/Adenoids

• Recessed/Stunted Chin (see photo below)

• Forward head posture (shoulders rolled forward - see photo below)

• Gummy smile (see photo below)

• Large tongue

• Snoring 

• Bruxism (teeth grinding)

• Do they have an elongated face/underdeveloped jaw?* 

• Do they wake up disheveled and looking like a tornado hit them/their bed while they slept?

• Are they, or did they, experience prolonged bedwetting?

• Are they, or did they, experience nursing/feeding issues?

• Are they tongue or lip tied?*

• Mouth breathing (watch your child during the day and while they sleep - their mouth should never be open while breathing!)

• ADD/ADHD

• Daytime sleepiness/fatigue

• Headaches

• Brain fog

• Frequent night wakings

• Restless leg syndrome 

*best diagnosed by a qualified professional

Mouth Breathing and Snoring

While there are certainly cases of sleep breathing disorders without mouth breathing or snoring, these are two of the most common signs. Outside of the occasional sickness or allergy they are NEVER NORMAL. 

Our nose is designed to prepare the air for the lungs. The nose warms, filters, accelerates, humidifies, and cleans the air, which leads to efficient oxygen exchange in the lungs. The mouth does none of this, and actually reduces oxygen absorption (4).

Nasal breathing also produces Nitric Oxide (1), an anti-inflammatory molecule that aids in immune function. Where as mouth breathing decreases immunity and causes inflammation throughout the body (2,3).

Think about hyperventilation…what happens when you hyperventilate? You rapidly breathe through your mouth and do not receive the proper exchange of oxygen, which results in a negative effect all over. When you are mouth breathing (day or night) the body is sent into a constant fight or flight mode, which puts your adrenal glands on max 24/7. 

Mouth Breathing: Primate Study

Two fascinating studies by Dr. Egil Harvold, published in the American Journal of Orthodontics and Dentofacial Orthopedics, observed young monkeys with plugged noses forcing them to adapt by mouth breathing.

This study found that ALL the monkeys who mouth breathed developed crooked teeth and poor jaws & facial development. Specifically, mouth breathing led to “a lowering of the chin, a steeper mandibular plane angle, and an increase in the gonial angle.” Their faces become long and narrow, with the jaw prominent and the chin recessed. 

Possible Causes of Chronic Mouth Breathing

An improperly functioning tongue/jaw due a tongue tie or weakened tongue

• A tongue tie is a physical issue from birth, and very easily treatable. A weakened tongue and underdeveloped jaw is something that develops overtime due to a lack of proper strengthening and development, possibly due to a childhood diet of only soft foods, extended pacifier/bottle/sippy cup use, and thumb sucking, to name a few (1,2,3)

• This is the most common, and can often times lead to the following other causes...

Sinus Polyps

Enlarged Tonsils and Adenoids  

Underdeveloped Jaw

Asthma 

Allergies

Deviated Septum

Sources:

• 1 Caruso S, Nota A, Darvizeh A, Severino M, Gatto R, Tecco S. Poor oral habits and malocclusions after usage of orthodontic pacifiers: an observational study on 3-5 years old children. BMC Pediatr. 2019 Aug 22;19(1):294. doi: 10.1186/s12887-019-1668-3. PMID: 31438904; PMCID: PMC6706895.

• 2 Page DC. Breastfeeding is early functional jaw orthopedics (an introduction). Funct Orthod. 2001 Fall;18(3):24-7. PMID: 11799699.

• 3 Wagner Y, Heinrich-Weltzien R. Occlusal characteristics in 3-year-old children--results of a birth cohort study. BMC Oral Health. 2015 Aug 7;15:94. doi: 10.1186/s12903-015-0080-0. PMID: 26251128; PMCID: PMC4528377.

Mouth Breathing: Possible Interventions

Treatment will vary depending on age and severity. If caught early during childhood, the treatment is often much more simple. Early correction for optimal child development will typically involve a TEAM approach of an airway centered & trained dentist, an ENT specialist, speech/myo therapist, body worker, and possibly orthodontist. 

Possible treatments could include:

• Tongue/Lip tie release 

• Tonsillectomy 

• Orthodontic/Palate Expansion

• Myofunctional Therapy

• Surgery in extreme cases

These are possible “band aids” that relieve symptoms in the interim, but do not solve the underlying problem:

• CPAP machine (typically more so for adults)

• Mouth Taping (recommended to consult provider first)

• Mandibular Advacement Devices (MADs)

What to Look for in Tongue and Lip Tie Providers: CLICK HERE

Sleep Hygiene Practices

Magnesium

view some of my favorite magnesiums here

Magnesium is an essential nutrient for overall health and wellness, and most Americans are deficient. 

Research has shown a possible correlation between magnesium and sleep quality (1). Magnesium may also ease symptoms of stress, anxiety, and muscle tension, which can improve sleep.

• Magnesium may help to control the chemical messengers (neurotransmitters) in the brain, resulting in a calming effect on the body.

• Magnesium may help to manage your stress response system and cortisol levels. Low levels of magnesium in the body can increase stress, and high levels of physical or mental stress can lower magnesium.

• Magnesium is an essential nutrient for muscle function, and helps muscle tissue to relax. A deficiency in magnesium can increase muscle tension. 

GABA

If you struggle with anxiety, Gaba is a natural anxiety supplement that can, in turn, aid in better sleep. Gaba (gamma-aminobutyric acid) is a natural chemical produced by the brain, and is a valuable anti-anxiety neurotransmitter.

When we experience stress, the adrenal glands are triggered to produce hormones that trigger what we know as “flight or fight” responses. Gaba counteracts these natural stimulants by relaxing the brain.

Gaba is mostly used as an anti-anxiety remedy, but it has many other benefits like helping with inflammation issues, PMS relief, and other chronic pain issues. 

*Drugs such as alprazolam (Xanax) and diazepam (Valium) work by increasing the amount of GABA in the brain.

Source Naturals GABA supplement

XYMOGEN Magnesium + GABA

Mouth Taping

As mentioned above, mouth breathing is never normal. If done properly and safely (everyone's situation is going to differ), it can be a beneficial temporary band-aid (a CPAP can also be a beneficial band-aid).

Mouth taping is simply laying a piece of tape over your lips to keep your mouth closed while you sleep. It encourages nasal breathing which is linked to a myriad of health benefits, and protects you from the health risks associated with mouth breathing. 

Clear Nasal Passages

A clear nasal passage is important for sleep as it promotes nasal breathing. Things like deviated septums, nasal polyps, and the like require more medical care. However, if blocked nasal passages are due to the occasional allergy or sickness xylitol and and/or saline can do wonders. 

Red Light

Circadian rhythms are not affected by red light, making it one of the best lights to use at night. Research has shown that red light exposure can improve sleep (2) and increase melatonin.

Reducing all other lights and switching to red light at least 60 minutes before bed will signal and prep your body for sleep.

Blocking Blue Light

The light receptors in the eyes that affect the circadian rhythm are especially sensitive to blue light (3). Blue light suppresses melatonin and causes the body to maintain alertness. If you are regularly viewing blue light at night your body will be convinced that it is still daytime, which can disrupt the circadian rhythm and decrease sleep quality. 

It is best to avoid electronics an hour before bed. However, if electronics are a must, then consider reducing the blue light settings on your device and/or wear blue light blocking glasses.

Sources:

• 1 Arab A, Rafie N, Amani R, Shirani F. The Role of Magnesium in Sleep Health: a Systematic Review of Available Literature. Biol Trace Elem Res. 2023 Jan;201(1):121-128. doi: 10.1007/s12011-022-03162-1. Epub 2022 Feb 19. PMID: 35184264.

• 2 Zhao, J., Tian, Y., Nie, J., Xu, J., & Liu, D. (2012). Red light and the sleep quality and endurance performance of Chinese female basketball players. Journal of Athletic Training. 2012 Nov-Dec;47(6):673-8.

• 3 Goldstein, C. A. (2022, May 20). Overview of circadian sleep-wake rhythm disorders In A. D. Benca (Ed.)., Retrieved April 28, 2023

Other ADHD Considerations

Zinc

Studies have shown that a significant amount of people with an ADHD diagnosis are deficient in zinc (1). Zinc is a crucial mineral that plays a role in neurotransmitter regulation and overall brain function. There is also research showing if you take zinc along with ADHD medication, then the amount of medication can many times be reduced by 40%. 

Iron

One study showed that patients with iron deficiency anemia had significantly higher WURS scores compared to the controls (2).

Vitamin D

Another study showed 78.4% of children with ADHD deficient in vitamin D compared to 48% of children without ADHD (3).

Magnesium

Most Americans are deficient in Magnesium, which is vital for the overall function of our bodies. It provides a calming effect, can improve sleep, and can help reduce agitation. One study showed that 12 weeks of a combination of omega-3 and omega-6 fatty acids, magnesium, and zinc resulted in a reduction in ADD/ADHD symptoms, emotional problems, and impulsivity assessed by SNAP-IV (4).

Heavy Metals

An overload of heavy metals has also been associated with ADHD symptoms due to interference with neural signaling (5). Lead, specifically, has been extensively researched when it comes to ADHD and can impact children’s neural development even at low levels (6).

Sources:

• 1 Arnold LE, Disilvestro RA, Bozzolo D, Bozzolo H, Crowl L, Fernandez S, Ramadan Y, Thompson S, Mo X, Abdel-Rasoul M, Joseph E. Zinc for attention-deficit/hyperactivity disorder: placebo-controlled double-blind pilot trial alone and combined with amphetamine. J Child Adolesc Psychopharmacol. 2011 Feb;21(1):1-19. doi: 10.1089/cap.2010.0073. PMID: 21309695; PMCID: PMC3037197.

• 2 Demirci K, Yildirim Baş F, Arslan B, Salman Z, Akpinar A, Demirdaş A. The Investigation of Symptoms and Diagnoses of Adult-Attention Deficit/ Hyperactivity Disorder in Women with Iron Deficiency Anemia. Noro Psikiyatr Ars. 2017 Mar;54(1):72-77. doi: 10.5152/npa.2016.12464. Epub 2016 Mar 4. PMID: 28566963; PMCID: PMC5439476.

• 3 Sharif MR, Madani M, Tabatabaei F, Tabatabaee Z. The Relationship between Serum Vitamin D Level and Attention Deficit Hyperactivity Disorder. Iran J Child Neurol. 2015 Fall;9(4):48-53. PMID: 26664441; PMCID: PMC4670977.

• 4 Huss M, Völp A, Stauss-Grabo M. Supplementation of polyunsaturated fatty acids, magnesium and zinc in children seeking medical advice for attention-deficit/hyperactivity problems - an observational cohort study. Lipids Health Dis. 2010 Sep 24;9:105. doi: 10.1186/1476-511X-9-105. PMID: 20868469; PMCID: PMC2955638.

• 5 Lee MJ, Chou MC, Chou WJ, Huang CW, Kuo HC, Lee SY, Wang LJ. Heavy Metals' Effect on Susceptibility to Attention-Deficit/Hyperactivity Disorder: Implication of Lead, Cadmium, and Antimony. Int J Environ Res Public Health. 2018 Jun 10;15(6):1221. doi: 10.3390/ijerph15061221. PMID: 29890770; PMCID: PMC6025252.

• 6 https://www.tandfonline.com/doi/full/10.1586/14737175.8.4.519

Real Life ADHD Advice

I asked you guys with ADHD to give some input on what you’ve had success with. Here are the responses!

• VerVita supplement by Inspracell

• Alpha Brain supplement by ONNIT

• Lions Mane supplement 

• Eliminating food dyes, refined grains, and seed oils 

• Proper sleep

• Time blocking your day

• Taking outside breaks every few hours

• Chiropractic care - specialty in neuro / cranial sacral

Feminization of the Education System

Do you have a boy who seems to only struggle with focus at school? Dr. Leonard Sax has done amazing research on the feminization of the education system, and how this effects little boys. I wrote some about this HERE, and how I personally saw it come into play when I was an educator. But for a more in depth dive, I highly recommend his book Boys Adrift.

If your child has been diagnosed or their school is pushing for an eval, and you have any pause at all consider these questions:

The following questions/criteria for officially diagnosing ADHD are from the DSM-5 (American Psychiatric Diagnostics and Statistical Manual), and adapted by Dr. Leonard Sax in chapter 8 of his book, Boys Adrift. 

Are they hyperactive, impulsive, and/or inattentive?

This is a necessary symptom, HOWEVER not a sufficient enough criteria alone for the diagnosis of ADHD. Most children, especially boys, are hyperactive, impulsive, and/or inattentive. This, alone, does not justify an ADHD diagnosis. 

Is the “diagnosis” of ADHD before the age of 12?

“Problems severe enough to cause significant impairment must have present before the age of twelve.” (Dr. Leonard Sax, Boys Adrift, Ch. 8)

Is the impairment due to hyperactivity, impulsivity, or inattentiveness present in multiple settings, not just one or two?

Even adults are inattentive and impulsive from time to time, so of course children are going to be as well. This is completely normal human behavior.

Things to look out for: If one teacher is saying your child has problems sitting still and focusing in their class, but others say they’re doing great, I would question a diagnosis of ADHD - gym included! Dr. Sax even goes as far to say if most or all teachers report signs of ADHD, but their Scout troop leader or sports coach says there’s no problems to question a diagnosis. 

“Children who have problems only at school but not in other settings generally do not have ADHD. Moving that child to a different school (and if a boy, a boy-friendly or all-boy school) may fix the problem.” Dr. Leonard Sax, Boys Adrift

Have you ruled out your child’s “ADHD” symptoms are not attributable to another disorder?

• Sleep-Breathing Disorder: The majority of Americans suffer from a sleep-breathing disorder - many don’t even realize it. SBD cause sleep deprivation, which perfectly mimics the symptoms of ADHD. 

• Childhood Depression

• Pediatric Bipolar Disorder

• Family Issues / Issues in the Home

• Etc. Read Dr. Sax’s Boys Adrift for more info. His book Why Gender Matters is also great.