Do asthma or ADHD medicines change how a young child sleeps?

About the scope of this page: Dr. Sam is a licensed pharmacist with a Doctor of Pharmacy degree, not a physician. What follows is a general explanation of how a medicine, supplement or remedy can relate to sleep, and it is no substitute for your child’s pediatrician. Talk to your child’s pediatrician before giving any medicine, supplement or remedy, and always follow the product label.

In brief

Both conditions, and the medicines that treat them, can affect sleep. The answer is almost never to stop a medicine at home. Instead, describe exactly what you are noticing to the prescriber so they can change the plan.

Even after the medical side is under control, plenty of families find sleep is still a struggle. That is the piece Actually Sleeping handles, with a plan from Dr. Sam, a pharmacist who treats medication questions with care and builds around your child’s treatment.

Asthma itself can disturb sleep

Nighttime flare-ups are one of the yardsticks the AAP uses to grade asthma. Infrequent night symptoms point to milder asthma, flare-ups more than once a week point to moderate asthma, and severe asthma can interrupt sleep frequently. Above all, the AAP emphasizes overall control. A child coughing or wheezing at night may need a stronger controller plan rather than a sleep fix.

How asthma medicines can affect sleep

• Montelukast. A boxed warning about serious neuropsychiatric events is required by the FDA. The effects it lists include bad or vivid dreams, sleepwalking, trouble sleeping, agitation and anxiety. It is approved for asthma starting at age 1. If mood or behavior changes, the FDA says to stop it and reach a health care professional immediately.
• Oral steroids given for flare-ups. Among short-term side effects, the AAP names behavior change and a bigger appetite, both of which fade once the course is finished.
• Inhaled steroids. According to the AAP, side effects are few, for example hoarseness or a yeast infection in the mouth. Using a spacer and rinsing the mouth reduce the risk.
• Albuterol. Nervousness and shaking appear among the common side effects listed by the National Library of Medicine. If your child seems keyed up after a bedtime treatment, bring it up, but never skip a rescue medicine your child needs in order to breathe.

ADHD medicines and young children

• Age. Children from 4 to 18 fall under the AAP’s ADHD guideline. Toddlers do not.
• First-line care for preschoolers, according to the AAP, is parent training in behavior management rather than medicine.
• Stimulants and sleep. Trouble falling asleep or staying asleep is among the common side effects of methylphenidate listed by the National Library of Medicine, which also advises asking your doctor or pharmacist how late in the day a missed dose can still be given.

If you are worried about a young child’s behavior, ask your pediatrician to include sleep in the assessment.

Questions worth bringing to the pediatrician

• “Since starting this medicine, my child sleeps differently. Is this a known effect, and what can we do?”
• “If my child wakes up coughing, is their asthma actually well controlled?”
• “Might snoring or pauses in breathing be contributing?”
• “Would a different time of day work better for this medicine?” Your pharmacist can also help with questions about timing.

A sleep problem is not solved with medicine

Stick to your child’s asthma action plan and what the prescriber tells you. Past that, a child with a medical condition sleeps according to the same factors as every other child: schedule, routine and the way they fall asleep. These children can still learn to fall asleep independently. What they need is a plan built around their treatment, which a generic list of tips seldom provides.

Actually Sleeping plans alongside the pediatrician’s treatment and never in place of it. You receive a plan written for your child, bootcamp-style coaching before the first night, daily 1:1 check-ins, and naps coached until they are solid. Families of toddlers talk about the difference in the over-12-months video reviews.

Book your free consultation, and have your child’s medication list with you.