Sleep and ADHD: The link you cannot ignore
14 April 2025 · 87 min · as at 2025-04-14
Gershom Aitchison (host) · Lauren Edmonds (intro voice or played clip) · Alison Bentley (guest) · Cynthia Pattia (intro voice or played clip) · Naledi Mugwena (intro voice or played clip) · Amy Dews-Gorborn (intro voice or played clip)
Listen to the episode on iono.fm · MP3
About the guest
Alison Bentley
sleep expert · Restonic Essential Sleep Clinic · Parktown
GP by training with a special interest in sleep. Did a PhD in restless leg syndrome, runs a private practice in sleep and set up the Restonic Essential Sleep Clinic with Restonic.
In Alison's own words:
“I'm a GP by training, but I've had a special interest in sleep ever since I began.”
“So I've kind of done a private practice in sleep. I've kind of gone back to do research and got my PhD in restless leg syndrome, and then, then went back into practice, and more recently set up, the Restonic Essential Sleep Clinic with Restonic.”
“So I see patients from six months old, to can't get them to sleep, two patients of eighty, and everything in between, and every single sleep disorder,”
Guest details come from the published episode notes or the guest's own words in the episode.
Episode analysis
Analysis by AI, drawn only from this episode; every point links to the moment it rests on.
In a fireside chat hosted by Gershom Aitchison, sleep physician Dr Alison Bentley examines how sleep problems overlap with, and worsen, ADHD in children and teenagers. Educational psychologists and school leaders put questions to her. She covers delayed sleep phase in teenagers, caffeine, light and melatonin, and sleeping tablets and their misuse. She also discusses restless legs and sleep apnea, supplements, and how to talk with teenagers about their sleep. Bentley brings a GP's broad view of patients, a PhD in restless leg syndrome and clinical work at the Restonic Essential Sleep Clinic.
Key ideas
- Bentley argues that a detailed sleep history should come before any ADHD medication. She does not claim that sleep problems cause all ADHD, but says they make it much worse. [20:18]▸ [20:20]▸ [20:29]▸
- Bentley notes that the medications used to keep narcolepsy patients awake are also used to focus children. She asks whether these children are actually sleeping. [03:27]▸ [04:21]▸ [05:04]▸
- Bentley describes teenagers with delayed sleep phase as effectively jet-lagged. They are non-functional in early lessons, and the condition can be diagnosed with a few questions. [11:44]▸ [11:59]▸ [12:50]▸ [12:55]▸ [14:01]▸
- Bentley says medication fails when a child is not sleepy. Sleeping tablets work best on the edge of sleep, and taking them too early does not work. [15:13]▸ [34:09]▸ [35:04]▸
- Bentley says every sleep disorder, including restless legs and apnea, is more common in children with ADHD, and that these disorders are often missed because nobody asks about them. [27:35]▸ [37:38]▸ [37:55]▸ [64:23]▸
- Bentley explains melatonin as a subtle rhythm hormone rather than a knockout pill. She calls it safe as a replacement in neurodivergent children, with unknown effects from long-term excess. [50:09]▸ [53:11]▸ [55:05]▸ [59:31]▸
- Bentley argues that 'normal' sleep is a social construct. Biphasic sleep lasted for millennia, and larks and owls function best on their own rhythms. [40:06]▸ [41:01]▸ [42:05]▸ [45:24]▸
- The host argues that schools teach nutrition and exercise but not sleep, and that honest conversations giving teenagers agency are central. [82:18]▸ [82:37]▸
Bentley's delayed sleep phase shift protocol
- Ask when the teenager naturally feels sleepy, for example one o'clock.
- Aim to move sleep only about an hour earlier, for example to twelve.
- Take melatonin about an hour and a half before the target time: two tablets, chewed.
- Wake seven hours later and get plenty of morning light, without sunglasses.
- Hold each new time for four days, sometimes adding a sleeping tablet, then move another hour.
- Keep melatonin going for three to six months, then withdraw it.
As described in the episode: [55:05]▸ [56:01]▸ [56:48]▸
Lessons
- Bentley advises parents and professionals to ask children directly whether they are sleepy at bedtime and when they do feel sleepy, before assuming ADHD or depression. [14:01]▸ [33:06]▸ [33:19]▸
- Bentley says caffeine can affect sleep for about six hours and feeds a cycle of poor sleep and more caffeine. Removing it makes more sense than medicating around it. [21:40]▸ [26:09]▸ [36:12]▸
- Bentley recommends dim light and real downtime before bed, because melatonin needs dim light and working right up to lights-out prevents sleepiness. [22:14]▸ [24:15]▸
- Bentley says snoring in children is not normal and suggests possible apnea. Removing tonsils and adenoids has a high cure rate. [63:26]▸ [64:23]▸
- Bentley tells parents to enforce bedtime as a parent rather than a friend, arguing that the bedtime fight reduces fights the next day. [28:20]▸ [39:10]▸ [39:10]▸
Who it's for
Parents of children or teenagers with ADHD, autism or sleep difficulties, as well as teachers, school leaders, educational psychologists and clinicians. It suits anyone deciding whether daytime inattention, anxiety or low mood might be driven by poor sleep.
Facts stated in the episode
- Bentley says the literature puts the effects of caffeine at about six hours. [21:40]▸
- Bentley cites data that twenty-three percent of South African adults have moderate to severe sleep apnea. [62:30]▸
- Bentley says removing tonsils and adenoids has a ninety percent cure rate for apnea in children. [63:26]▸
- Bentley says forty percent of women with sleep apnea have no traditional symptom. [69:10]▸
- On the STOP-BANG screen, Bentley says five out of eight criteria indicates an 80% chance of apnea. [69:24]▸
- Bentley says melatonin was available over the counter until about eight years ago, when it was taken off the shelves. [58:01]▸
- Bentley says people coming off cannabis have forty-five days of insomnia. [73:51]▸
Questions this episode answers
- Can poor sleep look like ADHD in children?Bentley says a bad night's sleep causes an attention deficit the next day. She argues ADHD is made much worse by sleep problems, though not all ADHD is caused by them. The panellist S5 adds that caffeine, devices and late nights can produce ADHD-like symptoms in teenagers. [05:33]▸ [19:36]▸ [20:29]▸
- Why can't my teenager fall asleep before 1 or 2am?Bentley describes delayed sleep phase: teenagers' sleepiness drifts later, and holidays can push it several hours out. Waking at half past six then feels like waking at four in the morning, which amounts to jet lag. [11:44]▸ [11:59]▸
- Why doesn't my child's sleeping tablet or melatonin work?Bentley says no medication works if you are not sleepy. Taking tablets at seven when natural sleepiness comes much later fails, and melatonin only has a subtle effect close to your natural rhythm. [15:13]▸ [34:09]▸ [55:05]▸
- Is melatonin safe for children?Bentley calls melatonin one of the safest drugs and says neurodivergent children often lack it, so replacing it makes sense. She cautions that there are no studies on taking too much for years. [50:09]▸ [53:11]▸ [59:31]▸
- Are sleeping tablets addictive?Bentley says sleeping tablets on their own are not addictive in the clinical sense. Most users take low doses and function well, but using them to come down from caffeine is not appropriate. [35:04]▸ [35:35]▸ [35:48]▸ [36:12]▸
- Should kids snore?Bentley says no child should snore. Snoring children likely have some apnea, which fragments their sleep and leaves them tired, and removing tonsils and adenoids has about a ninety percent cure rate. [63:26]▸ [64:23]▸
- Do supplements like GABA, magnesium or CBD help sleep?Bentley says the evidence supports only magnesium. CBD does not work for insomnia itself but can help anxiety or pain. [72:47]▸ [74:18]▸
- How can a teenager's sleep be shifted earlier?Bentley moves sleep about an hour earlier using chewed melatonin before the target time and bright morning light. She repeats this every four days, then keeps melatonin for some months before stopping it. [56:01]▸ [56:48]▸
- Is waking in the middle of the night abnormal?Bentley explains that biphasic sleep, with a waking period in the night, was normal for millennia. She says solid eight-hour sleep is a recent social norm. [41:01]▸ [42:05]▸
In their own words
Longer stretches of the conversation, word for word from the transcript, turn by turn.
Why a sleep doctor questions ADHD medication
Note (AI): Bentley sets out her practice and the observation behind the episode: stimulants used for narcolepsy are also used to focus children, which raises the question of whether these children are sleeping.
Alison Bentley, guest · [03:27]So I see patients from six months old, to can't get them to sleep, two patients of eighty, and everything in between, and every single sleep disorder, I learned very quickly that I couldn't just do sleep apnea, because that's the big business in, in sleep medicine, because doctors sat there and went, is the sleep apnea, will Alison see them? So I went, I'll see anything. So that pretty …
Read the full passage (316 words, 03:27-05:12)
Alison Bentley, guest · [03:27]So I see patients from six months old, to can't get them to sleep, two patients of eighty, and everything in between, and every single sleep disorder, I learned very quickly that I couldn't just do sleep apnea, because that's the big business in, in sleep medicine, because doctors sat there and went, is the sleep apnea, will Alison see them? So I went, I'll see anything. So that pretty much, so I do see patients with insomnia, sleep apnea, narcolepsy, the whole bang shoot. So it's, it's always interesting because I never know who's going to walk through the door. and, and I have a special interest in children's sleep because I think it's, it's just assumed that children sleep well. Like, that's just assumed. Like, they sleep well, right? And I kind of go, no, they don't, actually. If you look at the data, the prevalence of sleep disorders is pretty much the same no matter what age you are, and what, particularly when it comes to ADHD, Really many years ago, kind of went, hang on a second, like we use the same medications to treat narcolepsy to keep people awake as we do to keep children focused. Like, that's odd, isn't it? Like, are we having a conversation about this? Is there any sense that we're kind of going, are these children actually sleeping? And that's why the medication works, because it's waking them up. So that's where my interest comes in, and I've done a couple of talks to neurologists and pediatricians, et cetera, on ADHD and sleep and how, how it links together, but it's just not kind of seen, the, the, the sleep problems that Kids with ADHD have, partly because I think doctors only see people when they're awake. They don't think about what's happening at night and how that contributes to what they're seeing during the day.
Teen jet lag and the three-question diagnosis
Note (AI): Explains how holiday habits push teenagers into a delayed sleep phase and why early school starts leave them non-functional. It also gives the simple questions that identify the problem.
Alison Bentley, guest · [11:44]And then holidays, I mean, we know teenage boys are staying up gaming till two in the morning. Parents are going, shame, it's the holiday, let them sleep till ten eleven in the morning. And then school starts again, and they're stuck on another time zone. I mean, like really out. I mean, there's the one hour out, that's manageable. But when you're four hours out of the normal time …
Read the full passage (541 words, 11:44-14:16)
Alison Bentley, guest · [11:44]And then holidays, I mean, we know teenage boys are staying up gaming till two in the morning. Parents are going, shame, it's the holiday, let them sleep till ten eleven in the morning. And then school starts again, and they're stuck on another time zone. I mean, like really out. I mean, there's the one hour out, that's manageable. But when you're four hours out of the normal time zone, and you only feel sleepy at two o'clock in the morning, and you can only fall asleep at two, and then waking up at half past six is equivalent to being woken up at four o'clock in the morning, and you feel awful. So parents are battling to get their kids out of bed in the morning, massive fights in the family to get this child out of bed. They're tired, but more than being tired, they are feel physically ill. So their blood, I mean, at four o'clock in the morning, your blood pressure's low, your pulse rate is low, your gut is inactive, you are, should be asleep, like your whole body. So you essentially have jet lag. So they're waking up with jet lag, they're not hungry, they don't eat breakfast, and they're coming to school, and for the next three hours or until their natural wake-up time, which could be ten, eleven o'clock in the morning, that whole period, they are asleep. Functionally, they are asleep. They are, they are awake, but they are non-functional. And so, you know, and that's often when, when schools go, no, math's first period, because that's when you're awake. Oh, no, they're not. Like, routinely, they're not awake at eight o'clock in the morning. So the sleepy kid is, is often, and in teenagers, that's the major problem that we have, is delayed sleep phase. So they are running three or four hours of, of sleep a night, and, and when you talk to them, and, and what annoys me a little bit is I feel like I've spoken about this problem so many times to doctors. That I can't go, this is a big problem, right? You need to see it. And so many times I'm seeing patients and young patients who are really, really battling. And I'm asking them questions about, so are you sleepy when you go to bed at ten o'clock? And they go, not at all. And I go, well, when are you sleepy? And they go, one, two o'clock in the morning. So I go, okay, so if you do fall asleep at one, two o'clock in the morning, how long can you sleep for? They go, oh, I can sleep to eleven in the morning, no problem. And I go, so if I told you that school was going to start at midday, kra, midday, would you have a sleep problem? And they go, no, I'd be fine. Okay. It is such an easy di- it's just such an easy thing to diagnose because it's three questions, right? It's not, it's not high fun. You don't need sleep studies. You don't need blood tests. You don't need anything. It's about just talking to the kid and saying, what is happening with your sleepiness?
Three types of people who take sleeping tablets
Note (AI): A clear framing of sleeping-tablet use and addiction that separates appropriate use from misuse. It is useful for parents worried about medication.
Alison Bentley, guest · [35:04]Well, the deal is that there are three types of people who take sleeping tablets. They're the addicts, and they're addicts. And the sleeping tablets are the least of their problems, okay? They'll take fifteen sleeping tablets a day, but that's because they can't come down from their tick and their cat and their whatever else they're taking, but the sleeping tablets are not the problem. So there are the …
Read the full passage (277 words, 35:04-36:29)
Alison Bentley, guest · [35:04]Well, the deal is that there are three types of people who take sleeping tablets. They're the addicts, and they're addicts. And the sleeping tablets are the least of their problems, okay? They'll take fifteen sleeping tablets a day, but that's because they can't come down from their tick and their cat and their whatever else they're taking, but the sleeping tablets are not the problem. So there are the addicts. Then there are the problem children, like these ones, where it don't, they don't work. The sleeping tablets are not working, no matter what they try, no matter what combinations, how high they go, they just don't work. The majority of people who take sleeping tablets are taking low doses, sleeping very well, functioning very well during the day, and they are fine, and we should leave them alone, okay? Because they're fine. But these other two groups we need to worry about, okay? Sleeping tablets on their own are not Addictive. They're not heroin, for goodness sake. They're like, and people generally are not addicted. Like, addiction has a very specific definition. You know, there's a compulsive drug seeking. There is a preference of the drug over job, school, life. You'll let your life fall apart for that drug. That's not your average person who takes a sleeping tablet, for heaven's sake. So we need to calm down about sleeping tablets. They may be the correct thing to use in the correct circumstances, but your teenager that is using them because they're coming down, trying to come off a caffeine high, not appropriate. Like, could we take away the caffeine? Because that makes more sense.
Biphasic sleep and what counts as normal
Note (AI): The historical argument that solid eight-hour sleep is a recent social construct, and that waking in the middle of the night can be normal.
Alison Bentley, guest · [41:01]So I'm going to take you back to the 1500s in England, okay? The literature we have about the 1500s is that you went to work, which was always in the fields, cause that's what everybody did, right? Then you would come home, you would wash, you would have like English tea, tea and a sandwich, and you'd go to sleep because it's, you're tired. So you'd sleep, go to …
Read the full passage (435 words, 41:01-43:01)
Alison Bentley, guest · [41:01]So I'm going to take you back to the 1500s in England, okay? The literature we have about the 1500s is that you went to work, which was always in the fields, cause that's what everybody did, right? Then you would come home, you would wash, you would have like English tea, tea and a sandwich, and you'd go to sleep because it's, you're tired. So you'd sleep, go to sleep at seven and you would, and it's dark, okay? So you'd go to sleep at seven and you'd wake up at eleven. Everyone would wake up at eleven. The whole community was awake between eleven and two. Put the fires on, have dinner, have a habitual time, and then go back to sleep at about two o'clock in the morning. So sleep was biphasic to these two pieces. Because there's a lot of literature about it's easier to conceive children at midnight, God hears prayers at midnight, and we're going, who the hell's awake at midnight, you know, for all of this stuff to happen. Well, the answer was everybody was awake. And it's an interesting concept, as in the conversations that people would have after you've had four hours of sleep, after your busy day, would be very different to the way we do it, where we're having conversations at the end of our busy day, right, when we're tired, okay? So biphasic sleep was a thing for millennia, honestly millennia, right? As long as humans have been humans, we've had this biphasic sleep because it just made sense. When we got control of light, we shifted that first phase to touch the second phase, and so we have these two phases now sitting over here. If you extend the time that you spend in bed, it splits at exactly that point. So three hours into your sleep, that's where it splits. So people have insomnia who are going to bed too early, will say they sleep for three hours and they wake up and they've got two hours awake in the middle of the night. And then they sleep for another couple of hours. And I go, well, you know, in fifteen hundreds, that would be normal. Okay, that wouldn't, but what we do is, because we think that normal is the solid eight hours of sleep, it's not solid to begin with, but that solid eight hours of sleep is normal. Okay, well, it's only been normal for about five hundred years. Okay, the other three thousand years or seven thousand years that we've been around, it wasn't normal at all.
Treating delayed sleep phase with melatonin and light
Note (AI): Bentley describes her step-by-step protocol for shifting a teenager's sleep earlier with timed melatonin and morning light, including the timing, the duration and the tapering off.
Alison Bentley, guest · [56:01]So the delayed sleep phase syndromes, that's what we do with those kids. We go, when's your natural sleepy time? One o'clock. So let's move you to twelve. We can't move you much more than an hour. We move you to twelve. So you're going to take your melatonin at half past ten, and you're going to take two tablets, and you're going to chew them. Why? Because I want …
Read the full passage (466 words, 56:01-58:01)
Alison Bentley, guest · [56:01]So the delayed sleep phase syndromes, that's what we do with those kids. We go, when's your natural sleepy time? One o'clock. So let's move you to twelve. We can't move you much more than an hour. We move you to twelve. So you're going to take your melatonin at half past ten, and you're going to take two tablets, and you're going to chew them. Why? Because I want to squash your natural melatonin, which is over here. I want that to stop. Move it to here. Let's get you to sleep at twelve. You're going to wake up seven hours later. You're going to have lots of light. And you're going to hate me, and I don't care, because I'm not in your bedroom, and your parent is, okay? But you're going to get up, and you're going to go have breakfast outside, or you're going to go for a walk, or you're going to just open the curtains, or on the drive to school, you're not going to wear sunglasses. That's going to happen, because light is the break for sleep. So pull the sleep with the melatonin in front, and we break it with light. If you're in Scandinavia, you have to go and buy a light box, okay? In South Africa, we have light every morning. We're lucky. And so we do that at twelve o'clock. We do that for four days. Sometimes we add a sleeping tablet to force the sleep there, and then we go, right, another hour, four days, another hour, four days, and then we get them back to where they need to be. So the point of our delayed sleep phase syndrome, it can be treated. Really well. Do teenage boys love routine? No. Do I care? No. Cause that's how what they need to do. And I'd say to the parents, you've got to do this. And often the parents go, and I say to the kids, here's the good news. You can stay up till one o'clock right now. Like, don't even bother trying to fall asleep at ten. And they go, yes. And I go, here's the bad news. It's not going to last. Okay. It's not going to last. You've got to get up in the morning. So enjoy it for now. And we pull you back there and get you back into the right time zone. And then we keep them on melatonin for a while. What's a while? I don't know. Three months, six months. Do I care? No. Kids are sleeping. And then we take away the melatonin. We go, hopefully your own melatonin comes back in the right place now. And then we get them off the melatonin. It's a short term treatment, but it is a treatment.
How sleep apnea shows up at night
Note (AI): Explains the mechanism of apnea and the adrenaline surges it causes, and why night-time anxiety or panic may be a sleep disorder rather than a mood problem.
Alison Bentley, guest · [67:01]Sleep apnea happens. That, that's what happens in the middle of the night. So often you get a presentation. So I mean, sleep apnea, get it on the same page. So it's a collapse that happens at the back of the throat. So the throat just collapses in on itself. Can't move air. And so your oxygen starts to drift down. At some point, ten seconds later or so, your …
Read the full passage (466 words, 67:01-69:14)
Alison Bentley, guest · [67:01]Sleep apnea happens. That, that's what happens in the middle of the night. So often you get a presentation. So I mean, sleep apnea, get it on the same page. So it's a collapse that happens at the back of the throat. So the throat just collapses in on itself. Can't move air. And so your oxygen starts to drift down. At some point, ten seconds later or so, your brain goes, you'd better wake up, otherwise we're gonna die. So you wake up, whole thing opens up, lots of snorting and moving in bed and stuff. And then if everything's exactly the same, you have the same thing again. So, and that can go, I write reports on a weekly basis for people who are doing that seventy times an hour. Okay. So massive numbers. So you, you just multiply that up per hour of sleep. So eight hours of sleep, even at fifty times per hour, that's four hundred times that you get woken up during the night. Now, they will never be aware of all of those wake-ups. They might be aware of one or two of them. They very rarely wake up gasping, like that kind of sense, they very rarely wake up like that, but what they often wake up with is the consequence of that. So that happens, there's this adrenaline surge, and then they wake up with that adrenaline surge. So they often wake up saying, I wake up and my heart is beating, and I feel anxious, and I'm like, hey, what just happened? Like, I feel like I had a panic attack while I was asleep, okay? And I say, yeah, it's the adrenaline surge that happens at the end of the apnea, which, which causes all of the long-term consequences, cardiovascular, metabolic, et cetera, et cetera. So all of those consequences down the road is because of that adrenaline surge, which should not be happening at night while you're asleep. And so you can get those kind of things. You wake up and you go, Mark, I feel awful. Like, why do I feel so just awful? it can be from that. So, I mean, if he has, and again, any, the neurodivergent adults and kids, much more likely to have sleep apnea, restless legs, the whole thing shoot as well. So he's like, if he does have apnea, then, then we've got to look at that as being, that's his symptom, that he wakes up with that. And I don't think you we have any been talking originally like how the different, how sleep apnea can present so differently in, in different people, that in women it doesn't present traditionally at all. Forty percent of women have not a single traditional symptom of sleep apnea.
Quotes
“It takes a community to grow children.”
“if you have a bad night's sleep, you have an attention deficit the next day. Not the disorder, but an attention deficit.”
“Functionally, they are asleep. They are, they are awake, but they are non-functional.”
“no kid should be put on medication unless you've taken a really good history about their sleep.”
“Could you please ask the questions about their sleep and see sleep as possibly the thing?”
“Sleeping tablets on their own are not Addictive. They're not heroin, for goodness sake.”
“Mom sitting there, no one's asked. No one's spent the time with this kid and asked them about this kind of stuff.”
“It is about being a parent, not being your kid's best friend.”
“because light is the break for sleep. So pull the sleep with the melatonin in front, and we break it with light.”
“the other two thirds of your, of your life depend entirely on what you do in that one third.”
“the cure to anxiety is control.”
“You have to abandon yourself to the forces of sleep, okay? That's the tagline.”
What was said, by topic
Sleep and ADHD
“You can't medicate in resilience, and you can't medicate in good sleep hygiene and good tech habits and things like that.”
“Really many years ago, kind of went, hang on a second, like we use the same medications to treat narcolepsy to keep people awake as we do to keep children focused. Like, that's odd, isn't it?”
“partly because I think doctors only see people when they're awake. They don't think about what's happening at night and how that contributes to what they're seeing during the day.”
“I mean, all of us know, if you have a bad night's sleep, you have an attention deficit the next day. Not the disorder, but an attention deficit.”
“I'm finding more and more in my concessions department that ADHD is very, very under-known by the parents or ill-informed.”
“So I think my, my kind of motto is that no kid should be put on medication unless you've taken a really good history about their sleep.”
“And I'm not saying that all ADHD is caused by sleep problems, not at all, but I'm saying that ADHD is made a lot worse if you have a sleep problem.”
“So the sleep apnea, the restless legs, the delayed sleep phase, the, you know, the, the lights, the caffeine, the homework, the routines, the all of that, all of that has to be taken into account.”
“I have a one particular client, grade nine, fifteen year old. Female, who's in a high achieving school and was diagnosed ADHD, autism last year, and the ADHD was before as well as dyslexia.”
“It would be fascinating for us to, as, as professionals working with children, to say, if they slept well and were ready for the day, How much stuff disappears, how much anxiety, how much mood swings, how much depression,”
“So that's why I have a talk for the psychiatrist. It's called, what if it's not depression? Like, could you think outside of your silo?”
Guest background
“I'm a GP by training, but I've had a special interest in sleep ever since I began.”
“So I've kind of done a private practice in sleep. I've kind of gone back to do research and got my PhD in restless leg syndrome, and then, then went back into practice, and more recently set up, the Restonic Essential Sleep Clinic with Restonic.”
“So I see patients from six months old, to can't get them to sleep, two patients of eighty, and everything in between, and every single sleep disorder,”
Sleep research in South Africa
“pretty much all the data we use when we speak to patients is derived from Harvard or Europe or Australia, with very few numbers of black patients or African patients in them.”
Teenage sleep and school
“a lot of the teens that I speak to at the high school, sometimes I don't know how they survive the day, because they're only getting two to three hours of sleep, and this is on a, on a daily basis,”
“And so, you know, and that's often when, when schools go, no, math's first period, because that's when you're awake. Oh, no, they're not. Like, routinely, they're not awake at eight o'clock in the morning.”
“And I teach, I start teaching the metrics at twelve past nine. And from that point onwards, I've said to them they can eat while I'm busy teaching.”
“They, they are difficult to do research on because there's so much going on. And because there is no average sixteen-year-old, for example.”
“So, I mean, they've, they've done studies where they've taken, in the U.S., where they've taken Schools and move them later and shown that everything works better except the parents bitch, because the parents can't get to work on time.”
“Schools teach nutrition. We don't teach sleep. Schools teach exercise. We don't teach sleep.”
Melatonin and sleep medication
“There's a saying that is going around saying parents medicate their children when the parent isn't coping, and I think that happens with sleep predominantly.”
“Okay, no, no sleeping tablet's gonna work if you take it at seven o'clock at night and your bedtimes are actually at eleven.”
“the first night we're on camp, it's I need my pill to go to sleep at night. But by the second and third night, they're sleeping before the pill happens and they're waking up and things are happening normally.”
“No medications work if you're not sleepy. Sleeping tablets work the best if you are sleepy, and you just can't get over that edge.”
“The majority of people who take sleeping tablets are taking low doses, sleeping very well, functioning very well during the day, and they are fine, and we should leave them alone, okay?”
“So we need to calm down about sleeping tablets. They may be the correct thing to use in the correct circumstances, but your teenager that is using them because they're coming down, trying to come off a caffeine high, not appropriate.”
“But in your neurodivergent kids, we know, we have good data to say that they do not produce good melatonin. They don't. And so the main reason why your autism spectrum disorder kids don't sleep well is because they have low melatonins.”
“Normal kids, you're now gonna sleep in an ICU environment within, within a week, you couldn't measure their melatonin, it was gone,”
“So melatonin, melatonin is one of the safest drugs it, it really is that you can possibly take.”
“What it does is, is replace this biological rhythm that you don't have. It's a subtle effect, okay? You take it here, an hour and a half later, you're going to feel sleepy.”
“I think Previously, up until about eight years ago, melatonin was over the counter. You could just get it everywhere. And then it was taken off the shelves.”
“So the same thing, we have no studies that say what happens if you take too much melatonin for ten years. No studies at all to say what happens.”
Sleep basics
“The whole point of sleep is that you regenerate, restore, kind of whatever's been burnt out during the day, you kind of fix it so that you wake up in the morning with no sleep debt and you can function properly during the day.”
“I think critical to the sleep issue is that there are basic tenets of sleep, and that is that you gotta be sleepy to be able to fall asleep.”
“Long before you feel sleepy during the day, you have this massive loss of executive functions. So thinking innovatively, thinking laterally, knowing where you are in a sequence,”
“So estrogen, progesterone are all good for sleep. So they're, that's why you get problems in menopause, because you lose, you lose those protective hormones about sleep.”
“You're more likely to be absent if you have a sleep disorder. You're more likely to have what's called presentism, okay?”
Delayed sleep phase syndrome
“But when you're four hours out of the normal time zone, and you only feel sleepy at two o'clock in the morning, and you can only fall asleep at two, and then waking up at half past six is equivalent to being woken up at four o'clock in the morning, and you feel awful.”
“It is such an easy di- it's just such an easy thing to diagnose because it's three questions, right? It's not, it's not high fun. You don't need sleep studies. You don't need blood tests.”
“So pull the sleep with the melatonin in front, and we break it with light. If you're in Scandinavia, you have to go and buy a light box, okay? In South Africa, we have light every morning.”
Caffeine, screens and routines
“All of that in an average, if we can say, normal child can also present as ADHD symptoms because of the usage of that in the late bedtimes.”
“But generally the literature would say that the effects of caffeine last six hours. Okay? That's a long time and much longer than you'd think.”
“But then melatonin, and melatonin only gets produced in dim light. So you need to have this dim light in the evening, and you produce melatonin, and what melatonin does is drop your body temperature,”
“So you need to have a downtime. I think as a society, we've lost the concept of a rest, okay, not, so we go work, work, work, come home, have dinner, get children to bed, go to bed ourselves, and there's no rest.”
“And the particular problem with caffeine is if they are not sleeping well, they use more caffeine, and then they don't sleep well, and then they use more caffeine.”
Sleep apnea and restless legs
“I mean, what Ritalin does, or methylphenidate, what it does, is it increases dopamine levels in the brain. That's what it does. Well, guess what is caused by a drop in dopamine? Restless leg syndrome, which is much higher in kids with ADHD.”
“The other question you have to ask them is, do you ever have a funny feeling in your legs? Like you got to move them at night, you can't lie still.”
“I diagnose restless legs all the time in patients who have seen umpteen psychiatrists, umpteen doctors about their insomnia, and I say, has anyone asked you about your legs before?”
“The data on sleep apnea in adults in South Africa, we don't have data in children, data in sleep, sleep apnea in adults, twenty-three percent of the population, the adult population have moderate to severe apnea.”
“So it's, it's, it's switched around, and so we're not noticing the apnea in kids because the tonsils and adenoids are still there. Ninety percent cure rate if you take out tonsils and adenoids.”
“And so if kids are snoring, they've likely got some apnea. And if they have apnea, their sleep is being fragmented, they're waking up tired in the morning,”
“So they often wake up saying, I wake up and my heart is beating, and I feel anxious, and I'm like, hey, what just happened? Like, I feel like I had a panic attack while I was asleep, okay?”
“Forty percent of women have not a single traditional symptom of sleep apnea. But they still have sleep apnea.”
“So we kind of snoring, tiredness, observed apneas, high blood pressure, BMI over 30, age over 50, neck circumference, and gender being male. Five out of eight, 80% chance you have apnea.”
Parenting and teen agency
“but the important thing about that is that if you have the fight about bedtime, you theoretically get less fight, less fights the next day on everything else.”
“It is about being a parent, not being your kid's best friend. It is about saying to your kid, you're going to bed now.”
“if there's anything for parents to take out of this for professionals is have a conversation, ask the right questions, and teenagers respond very well to honesty.”
What normal sleep is
“And I think we kind of normalize upper class, middle class sleep, okay? Whereas normal is actually not that at all.”
“So biphasic sleep was a thing for millennia, honestly millennia, right? As long as humans have been humans, we've had this biphasic sleep because it just made sense.”
Larks and owls
“So he said, right, from now on, your working hours are eleven until eight. He said, the amount of work that got done was astronomically higher than expecting them to work at eight when they were non-functional,”
“But I'm an owl, I can't fall asleep before half past eleven. My sweet time, time to wake up in the morning is quarter to seven. I don't see patients before nine,”
“In fact, I believe that people who have delayed sleep phase syndrome choose to do those occupations because they can stay up.”
“I was in the hotel industry, I left it because I'm an early bird.”
Supplements and substances
“So it's the data, and, and as a doctor, I'm obliged to practice evidence-based medicine and to use only evidence. So the evidence does not support the use of anything except magnesium.”
“one of the big reasons why people keep going back onto cannabis is because when they come off, they have forty-five days of insomnia before it resolves.”
“CBD doesn't work. I mean, so it doesn't work for insomnia itself. Works for anxiety, works for pain.”
Sleep and anxiety
“The worst thing you can do if you can't sleep is lie in bed and, and try to sleep.”
“So I said, so what you're telling me is that the anxiety comes because you can't sleep. And they go, Yeah, actually.”
“with the level of anxiety that we're seeing in our society, it's, you know, for me, I say to the kids, the cure to anxiety is control.”
“And the really tricky thing about sleep is you can't control it at all. It's an incredibly passive activity.”
Episode notes (as published)
From the episode notes published with the podcast.
Dive into this riveting episode where Dr. Alison Bentley, a sleep expert, unravels the connection between sleep and ADHD in kids and teens. You may be surprised to learn how sleep problems can mirror ADHD symptoms, leading to misdiagnoses and missed opportunities for real solutions. From the science of delayed sleep phase syndrome to the impact of caffeine, screens, and school schedules, this episode will change how you view your child’s focus, mood, and energy. It’s a wake-up call for parents, teachers, and anyone who cares about childrens' well-being. But it’s not all challenges, this episode is packed with actionable advice to transform sleep and unlock potential. Dr. Bentley shares expert strategies for building effective bedtime routines, using melatonin correctly, and catching sleep disorders early. With insights from educational psychologists and school leaders, you’ll get a front-row seat to real-world tips that work. Tune in to discover how prioritizing sleep can boost resilience, sharpen focus, and set kids up for success, don’t miss this game-changer! Edu Inc website · Facebook (Public) · Facebook (closed group) · Twitter (closed group) · YouTube · Review us on Google
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