Medically reviewed by
Dacelin St Martin, MD
Triple board-certified in Sleep Medicine,
Internal Medicine, and Pediatrics.
What Is RSD In Children? | How Do I Know If My Child Has RSD? | How Can I Help My Child With Restless Sleep?
Overview
Many kids have sleep disturbances that negatively affect their mood, behavior, and ability to function. In 2014, a study estimated that up to 50% of children experience a sleep disorder.[1]
Previously, experts identified restless sleep as a consequence of another sleep condition, such as restless leg syndrome or sleep apnea, that causes sleep disruption.
Recently, researchers found that restless sleep in children can be a disorder on its own, known as “restless sleep disorder” or RSD, unrelated to another condition.
An international committee of sleep experts agreed on eight criteria for diagnosing RSD in children. Those include major body movements during sleep and restless sleep that persists over three months.
Moreover, the continuous sleep disruption results in the child having trouble focusing during the day, emotional and behavioral issues at home and school, and hyperactivity.
Continue reading to learn more about restless sleep disorder in children, how to identify it, how doctors diagnose and treat it, and tips to help your child sleep better at night.
What is RSD in Children?
A restless sleep disorder (RSD) is a newly defined pediatric sleep disorder that affects the child’s behavior.[2] RSD typically occurs in children 6-18 years old and can cause problems with attention, mood, performance, and attitude during the day.
Children with RSD move in bed all night, which prevents them from getting adequate restful sleep.
However, they do more than the typical tossing and turning in bed at night. Instead, a child with RSD has large body movements throughout the night, like repositioning or rearranging bed clothes in sleep on multiple occasions.[3]
As a result, the child wakes up tired, cranky, and irritable and may have issues at home and school due to poor sleep quality.
Moreover, the lack of adequate sleep in those children is not the result of other conditions that secondarily cause restless sleep, like restless leg syndrome (RLS) and parasomnia.[4]
Parents of children with RSD often use the following phrases to describe the child’s irregular sleep patterns:
● Wrestling in their sleep
● Thrashing in bed
● Sleeping like a helicopter
● Moving all night in bed
● End up at the bottom of the bed in the morning
This regular sleep disruption also affects children’s heart rates because it triggers their “fight or flight” response at night.
One clinic for sleep disorders estimates that around 7.7 percent of children who come through the sleep clinic might have RSD.[5]
How Do I Know if My Child has RSD?
It can be difficult for parents to know whether their child who’s struggling with sleep has a sleep disorder and whether it’s specifically a “restless sleep disorder.”
Parents worried about their kids’ sleeping patterns should look out for the following signs of restless sleep disorder in children:[6]
● Your child complains of restless sleep
● You notice that your child moves a lot (not just the legs) during sleep
● The irregular sleep pattern occurs at least three times a week for three months
● Your child has trouble focusing or functioning during the day
● Your child has emotional and behavioral problems at home and school, as well as irritability and hyperactivity
A referral to a sleep study is needed to diagnose RSD in children, where the child will have a consultation with a sleep specialist and nocturnal polysomnography (a sleep study).
A committee of 10 sleep clinicians came up with the following eight criteria for diagnosing RSD in children:[7]
● A complaint of “restless sleep” is reported by the child, the child’s parent, caregiver, or bed partner
● The child has restless sleep movements involving large muscle groups of the whole body, all four limbs, arms, legs, or head
● The movements occur during sleep or when the child appears asleep
● Video-polysomnography shows five or more large body movements per hour of sleep
● Restless sleep occurs at least three times per week
● Restless sleep has been present for at least three months
● Restless sleep causes significant impairment in behavioral, educational, social, or other areas of functioning (examples: daytime sleepiness, irritability, fatigue, mood changes, trouble concentrating, or impulsivity)
● The condition is not better explained by another sleep disorder, medical disorder, mental disorder, or environmental factor (examples: sleep-disordered breathing, restless legs syndrome, periodic limb movement disorder, sleep-related rhythmic movement disorder, insomnia disorder, atopic dermatitis, seizure disorder), or the effects of a substance (example: caffeine)
Moreover, children with RSD often have iron deficiencies.[6] Iron helps the brain transmit signals to stop excessive body movements (like restless legs) during sleep.
Checking your child’s ferritin levels (a protein needed for storing iron) can help further confirm a “restless sleep disorder” diagnosis.
How Can I Help My Child With Restless Sleep?
Having a child who struggles with a sleep disorder can be mentally and physically draining.
The good news is doctors can address “restless sleep disorder” with iron supplementation. An increase in iron intake (oral or IV) helps children with RDS with their sleep.[8]
After receiving iron supplementation for RSD, many children sleep better, and their mood and behavior drastically improve.
If your child has been diagnosed with RSD, check their ferritin levels. If they’re low, speak to their healthcare provider about supplementing with iron.
Over time, get your child’s iron and ferritin levels re-tested. If they dip too low, discuss additional iron supplementation with their doctor.
However, getting your kid into a sleep study to confirm an RSD diagnosis may take a few months. Meanwhile, add iron-rich foods (spinach, lentils, beans, fish) to your child’s diet. You can also ask their pediatrician to check ferritin and iron levels and whether you can start with iron supplementation before the sleep study.
Children should get good quality sleep, not only sufficient hours of sleep. Below are extra tips for improving your child’s sleep:
● Create a quiet, peaceful, and comfortable bedroom environment. Adjust the room’s temperature (not too hot or cold), access to natural light, and noise isolation
● Find the best mattress for your child’s needs and comfort
● Minimize exposure to blue light (from TV, tablets, iPads, phones, and other electronic devices) before bedtime to make it easier for your kids to fall asleep
● Make sure your child gets 9-12 hours of sleep each night. Create a healthy bedtime routine (a stable sleep schedule, going to bed and waking up at the same time every day, no night-to-night changes in bedtime, even on weekends)
● Involve your children in daytime activities that help them use up their energy during the day, but give them enough time to settle down and unwind before their bedtime. That will make it easier for them to fall asleep and stay asleep through the night
● Don’t let your kid go to bed too hungry or full (both can keep them up at night)
If your child has persistent sleep problems, including restless sleep or insomnia, or you suspect RSD, raise the issue with their pediatrician. They can assess the matter, rule out other causes of poor sleep, and refer them to a sleep study if needed.
Resources:
- Carter, K. A., Hathaway, N. E., & Lettieri, C. F. (2014). Common sleep disorders in children. American family physician, 89(5), 368–377.
- RSD |. Published August 20, 2020. Accessed March 30, 2023. https://worldsleepsociety.org/rsd/
- Ferri, R., DelRosso, L. M., Provini, F., Stefani, A., Walters, A. S., & Picchietti, D. L. (2021). Scoring of large muscle group movements during sleep: an International Restless Legs Syndrome Study Group position statement. Sleep, 44(9), zsab092. https://doi.org/10.1093/sleep/zsab092
- Kapoor, V., Ferri, R., Stein, M. A., Ruth, C., Reed, J., & DelRosso, L. M. (2021). Restless sleep disorder in children with attention-deficit/hyperactivity disorder. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 17(4), 639–643. https://doi.org/10.5664/jcsm.8984
- DelRosso, L. M., & Ferri, R. (2019). The prevalence of restless sleep disorder among a clinical sample of children and adolescents referred to a sleep centre. Journal of sleep research, 28(6), e12870. https://doi.org/10.1111/jsr.12870
- DelRosso, L. M., Mogavero, M. P., Ferri, R., & Bruni, O. (2022). Restless Sleep Disorder (RSD): a New Sleep Disorder in Children. A Rapid Review. Current neurology and neuroscience reports, 22(7), 395–404. https://doi.org/10.1007/s11910-022-01200-y
- DelRosso, L. M., Ferri, R., Allen, R. P., Bruni, O., Garcia-Borreguero, D., Kotagal, S., Owens, J. A., Peirano, P., Simakajornboon, N., Picchietti, D. L., & International Restless Legs Syndrome Study Group (IRLSSG) (2020). Consensus diagnostic criteria for a newly defined pediatric sleep disorder: restless sleep disorder (RSD). Sleep medicine, 75, 335–340. https://doi.org/10.1016/j.sleep.2020.08.011
- DelRosso, L. M., Picchietti, D. L., & Ferri, R. (2021). Comparison between oral ferrous sulfate and intravenous ferric carboxymaltose in children with restless sleep disorder. Sleep, 44(2), zsaa155. https://doi.org/10.1093/sleep/zsaa155
