A reader emailed me with this question about her son:


I am a mother of a 5 year old son. We are in the process of questioning whether he has ADHD or perhaps a sleep disorder. As a young baby/toddler he was an excellent sleeper (12+hrs/night). However over the last 1.5 years his sleeping has significantly changed. Very restless; difficulty falling asleep (sometimes up to 2hrs awake in bed); snoring; open mouth breather; tossing/turning. The nights when he does fall asleep & sleep 10+hrs he is still very tired/groggy in the mornings. He is in kindergarten & we are getting reports that he doesn't complete work properly because he is tired; difficulty focusing. At home by supper (5pm) he is extremely tired; head on the table; not wanting to play outside as he is too tired. We have a pediatrician & I have mentioned this to him however he is not really on board with a possible sleep disorder. Also my son's tonsils appear very large when you look in his mouth. Is this a possible sleep disorder versus early ADHD?

Please provide us with some guidance.....thank you

Dear Pamela,

I certainly think that you're right to be concerned. The snoring, mouth breathing, restless sleep, daytime sleepiness and difficulty focusing can all be signs of obstructive sleep apnea, a disorder in which a child's throat collapses while breathing in during sleep. When this happens, the child has very poor quality sleep, and often has frequent drops in his blood oxygen levels.

Obstructive sleep apnea can present with symptoms that overlap with ADHD, and which later go away after it (the apnea) has been treated. It is very common, present in 2-5% of children. The treatment of obstructive sleep apnea in children usually involves the removal of the tonsils and adenoids.

Obstructive sleep apnea is diagnosed with a sleep study. It sounds like your son might benefit from having one to see if he has it and needs treatment.

There may be other things going on as well. The difficulty falling asleep at night doesn't tie in to this; but it could be explained if his schedule is erratic or if he is napping. However, the symptoms you've described are very suggestive of obstructive sleep apnea, and so this diagnosis should be pursued.




Dennis Rosen, M.D.

Help your child get a great night's sleep with the new book:

Successful Sleep Strategies for Kids (a Harvard Medical School Guide)

About the Author

Dennis Rosen, M.D.

Dennis Rosen, M.D., is a pediatric pulmonologist and sleep specialist who practices at Boston Children's Hospital.

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