Could It Be the Airway?

The Overlooked Connection Between Sleep-Disordered Breathing and ADHD in Kids

When a child is struggling with attention, hyperactivity, or impulsive behavior, many parents and educators consider ADHD. But what if those symptoms aren’t rooted in a brain-based disorder, but rather in how well a child is sleeping—or breathing?

More and more research is pointing to an often-overlooked contributor to ADHD-like symptoms in children: Sleep-Disordered Breathing (SDB). This umbrella term includes conditions like obstructive sleep apnea, snoring, and upper airway resistance syndrome—all of which can interfere with deep, restorative sleep.

What Is Sleep-Disordered Breathing?

Sleep-disordered breathing occurs when a child’s airway becomes partially blocked during sleep. This can be due to:

• Enlarged tonsils or adenoids

• A high, narrow palate

• A tongue that rests low in the mouth or falls back during sleep

• Allergies, chronic congestion, or a deviated septum

• Mouth breathing habits

• Structural or functional concerns, such as tongue-ties or poor orofacial development

When airflow is restricted—even slightly—the brain has to remain alert to keep the body breathing. As a result, the child may never reach the deeper stages of sleep necessary for proper brain function, hormone regulation, and emotional stability.

Sleep and the Developing Brain

We know sleep is crucial for children’s growth and development. But during deep sleep, the brain performs vital tasks:

• Clearing waste through the glymphatic system

• Consolidating learning and memory

• Regulating mood and emotional responses

• Releasing growth hormone

If a child is waking frequently—consciously or unconsciously—their body and brain are under chronic stress. And what does that look like during the day? Often:

• Inattention

• Hyperactivity

• Impulsivity

• Tantrums or emotional dysregulation

• Difficulty waking up in the morning

• Bedwetting

• Poor academic performance

• Behavioral challenges

These symptoms can mirror—or be misdiagnosed as—ADHD.

ADHD or Sleep Deprivation?

One study found that children with sleep-disordered breathing were 40–100% more likely to be diagnosed with behavioral or learning problems, including ADHD. In fact, some studies suggest that up to 25% of children diagnosed with ADHD may actually have an underlying sleep or airway issue.

It’s important to note: not all children with ADHD have sleep-disordered breathing. But when these behaviors are present, it’s worth looking beyond the surface. Treating the root cause—if it lies in the airway—can lead to dramatic improvements in behavior, focus, and emotional regulation.

Signs Your Child May Have Sleep-Disordered Breathing

Pay attention to these red flags:

• Snoring, even lightly

• Mouth breathing (day or night)

• Restless sleep, tossing and turning

• Nightmares or night terrors

• Frequent bedwetting past age 5

• Chronic nasal congestion

• Dark circles under the eyes (“allergic shiners”)

• Waking unrefreshed despite a full night’s sleep

• Falling asleep during the day or needing naps beyond toddlerhood

What Can You Do?

If you suspect your child may be experiencing SDB, start by consulting with professionals who understand airway and sleep health. This might include:

• A craniosacral therapist or occupational therapist specializing in oral and facial function

• A pediatrician open to airway-focused concerns

• A sleep specialist (for a sleep study, if needed)

• An orofacial myofunctional therapist

• An ENT (ear, nose, and throat doctor)

• A pediatric dentist with training in airway development

Early intervention can make a life-changing difference. Addressing structural and functional contributors to poor sleep may improve not just your child’s focus and behavior, but also their overall health, learning, and emotional well-being.

Final Thoughts

If your child has been struggling with attention, behavior, or sleep issues, know that you’re not alone—and that there may be more to the story. Exploring the role of sleep-disordered breathing is a powerful step toward supporting your child’s development in the most foundational way: helping them breathe better to thrive better.