Medically reviewed by
Dacelin St Martin, MD
Triple board-certified in Sleep Medicine,
Internal Medicine, and Pediatrics.
Epidemiology | Cause | Symptoms | Comorbid Conditions | Diagnosis | Management
Overview
Restorative sleep is vital for a child’s body to function properly, making it indispensable for maintaining hormonal and metabolic processes. Nevertheless, sleep disorders are quite common in children.
Early detection and effective treatment of sleep disorders in children are critical to ensure that the mental and physical development of the child is not interrupted.
Epidemiology
Studies show that twenty-five percent, one out of four children, has at least one sleep problem.[1]
This rate can increase up to 75 percent in children with neurological diseases, such as autism spectrum disorder and attention deficit hyperactivity disorder (ADHD).[2][3]
More than 100 sleep disorders are defined in the International Classification of Sleep Disorders; however, three main categories dominate childhood sleep problems: insomnia, parasomnia, and hypersomnia, defined as insufficient sleep, disturbed sleep, and excessive sleep, respectively.[4]
Sleep patterns change as the child transitions from newborn to adolescence, causing sleep problems to vary with age.[5]
For example, 25 to 50 percent of children ages 6 to 12 months have night awakenings and have difficulty falling back asleep by soothing themselves.[5] This rate is reported in 30 percent of one-year-olds.
Causes
Some children need something specific for sleep, and this can be a particular object or environment. If the child wakes up at night, the absence of the object or the situation may interfere with the child resuming sleep.
Sleep problems in children can arise when parents don’t set clear rules about sleep or are inconsistent with reinforcing rules. These attitudes can lead to behavioral sleep disorders in children.[6]
Excessive anxiety about falling asleep and sleeping can lead to psychophysiological sleep problems in children.
These children may feel that they will not fall asleep at night, experiencing anxiety during the day about bedtime. The use of excessive amounts of caffeine or other stimulants can also disturb sleep.[7]
Stressful events, such as moving to a new home or staying away from home while traveling, can cause sleep problems in some children. These problems are mostly temporary, but they can become permanent if poor sleeping habits are not managed.
While most sleep disorders in children are sporadic, genes associated with a familial predisposition have been discovered in some conditions, such as narcolepsy.[8]
Symptoms
Although different sleep disorders manifest differently according to the child’s age, it is possible to mention some common symptoms.
If a child has one of the following symptoms, they may have insomnia:
- Difficulty initiating sleep
- Difficulty maintaining sleep
- Waking earlier than desired
- Bedtime resistance
- Difficulty sleeping without intervention from a parent [5]
Additionally, a child with insomnia may have a daytime consequence of these sleep difficulties, such as:
- Fatigue or sleepiness
- Academic problems
- Impaired cognitive capabilities
- Mood disturbances
- Behavioral problems, such as inattention and hyperactivity
The following symptoms may indicate hypersomnia in a child:
- Excessive sleepiness
- Cataplexy (sudden and transient episode of muscle weakness)
- Sleep paralysis
- Hypnagogic hallucinations (sleep hallucinations when falling asleep)
- Disrupted or fragmented sleep
- Metabolic, endocrinological, psychiatric, and psychosocial issues [8]
The following symptoms are associated with parasomnias:
- Disorientation, confusion, grogginess, and substantial agitation upon awakening
- Screaming or crying out during sleep
- Hyperventilation and tachycardia (fast heartbeat) during an episode
- Sleepwalking
- Unusual behaviors while sleeping, such as urination on the carpet
- Getting injured in sleep and not remembering the episode when waking[1]
Snoring is also may be a sign of sleep disorders in children, namely obstructive sleep apnea.[9]
A child who wakes spontaneously in the morning is probably getting a restorative night’s sleep; however, it’s essential to take note of a child’s behavior throughout the day. It’s crucial to observe behaviors after waking up, during the day, and before sleep.
Comorbid Conditions
Sleep disorders are common in children, and the prevalence of sleep disorders may be higher with some diagnoses.
Children with autism spectrum disorder, attention deficit hyperactivity disorder (ADHD), and sleep-disordered breathing are at higher risk of having sleep disorders.[10][11][12]
Diagnosis
Sleep disorders in children need to be diagnosed promptly. Parents are vital players in relaying symptoms and information regarding disturbed sleep to clinicians.
In most cases, a detailed clinical history from the patient and the parents will be sufficient for diagnosis. Physicians may also benefit from sleep questionnaires developed specifically for children, namely the Children’s Sleep Habits Questionnaire (CSHQ).
A video recording of episodes, especially in cases of parasomnia, can expedite a proper diagnosis.
In some cases where a diagnosis is difficult, the doctor may benefit from polysomnography (PSG), a diagnostic method where brain, heart, eye, and muscle activities are evaluated simultaneously during sleep.
Polysomnography is a tool for diagnosing sleep disorders by monitoring sleep phases and identifying when sleep is disturbed.
Finally, a simple but highly effective method for diagnosing sleep disorders in children is a sleep diary.
A sleep diary helps the child or parents document sleep patterns for two weeks before an appointment and includes sleep onset, night awakenings, and sleep duration, which assists the clinician in diagnosing a sleep disorder.
Management
Most sleep disorders in children will resolve independently; however, the process can be prolonged and become chronic. In such cases, families should consult their primary health care provider for correct diagnosis and appropriate treatment options.
Cognitive-behavioral therapy is one of the first-line treatment options. Scheduled awakening is an example of the behavioral therapies used to manage sleepwalking or sleep terrors. In some cases, special medications, such as melatonin may also be used as a treatment option for insomnia.[13]
The most effective method that the family can benefit from regarding sleep disorders is providing and maintaining sleep hygiene. Sleep hygiene components include:
- Going to sleep and waking up at the same time every day, including weekends
- Setting appropriate and sustainable behavioral rules about sleep
- Creating and implementing sleep routines suitable for the child’s age
- Ensuring adequate physical activity during the day but avoiding excessive physical activity just before bedtime
- Providing ample early morning daylight while providing a dark and quiet environment before and during sleep
- Avoiding screen and bright light exposure at least 30 minutes before sleep
Conclusion
Sleep disorders in children are pretty common, and more than a hundred disorders have been identified.
Early detection and effective treatment of sleep problems in children will support the child’s neurological and physical development and reduce the emotional stress on the family.
For this, parents should observe their children’s behavior before and during sleep, at the time of waking, and during the day, and consult their physician when they see any abnormal behavior.
References:
- Maski, K., & Owens, J. A. (2016). Insomnia, parasomnias, and narcolepsy in children: clinical features, diagnosis, and management. The Lancet. Neurology, 15(11), 1170–1181. https://doi.org/10.1016/S1474-4422(16)30204-6
- Hvolby, A., Jørgensen, J., & Bilenberg, N. (2008). Actigraphic and parental reports of sleep difficulties in children with attention-deficit/hyperactivity disorder. Archives of pediatrics & adolescent medicine, 162(4), 323–329. https://doi.org/10.1001/archpedi.162.4.323
- Richdale, A. L., & Schreck, K. A. (2009). Sleep problems in autism spectrum disorders: prevalence, nature, & possible biopsychosocial aetiologies. Sleep medicine reviews, 13(6), 403–411. https://doi.org/10.1016/j.smrv.2009.02.003,
- American Academy of Sleep Medicine. International Classification of Sleep Disorders 2014 3rd ed Darien. IL American Academy of Sleep Medicine, 246-53.
- Ophoff, D., Slaats, M. A., Boudewyns, A., Glazemakers, I., Van Hoorenbeeck, K., & Verhulst, S. L. (2018). Sleep disorders during childhood: a practical review. European journal of pediatrics, 177(5), 641–648. https://doi.org/10.1007/s00431-018-3116-z
- Meltzer L. J. (2010). Clinical management of behavioral insomnia of childhood: treatment of bedtime problems and night wakings in young children. Behavioral sleep medicine, 8(3), 172–189. https://doi.org/10.1080/15402002.2010.487464
- Espie, C. A., Barrie, L. M., & Forgan, G. S. (2012). Comparative investigation of the psychophysiologic and idiopathic insomnia disorder phenotypes: psychologic characteristics, patients’ perspectives, and implications for clinical management. Sleep, 35(3), 385–393. https://doi.org/10.5665/sleep.1702
- Bassetti, C., Adamantidis, A., Burdakov, D., Han, F., Gay, S., Kallweit, U., Khatami, R., Koning, F., Kornum, B. R., Lammers, G. J., Liblau, R. S., Luppi, P. H., Mayer, G., Pollmächer, T., Sakurai, T., Sallusto, F., Scammell, T. E., Tafti, M., & Dauvilliers, Y. (2019). Narcolepsy – clinical spectrum, aetiopathophysiology, diagnosis and treatment. Nature reviews. Neurology, 15(9), 519–539. https://doi.org/10.1038/s41582-019-0226-9
- Chawla, J., & Waters, K. A. (2015). Snoring in children. Journal of paediatrics and child health, 51(9), 847–851. https://doi.org/10.1111/jpc.12976
- Richdale, A. L., & Schreck, K. A. (2009). Sleep problems in autism spectrum disorders: prevalence, nature, & possible biopsychosocial aetiologies. Sleep medicine reviews, 13(6), 403–411. https://doi.org/10.1016/j.smrv.2009.02.003
- Hvolby, A., Jørgensen, J., & Bilenberg, N. (2008). Actigraphic and parental reports of sleep difficulties in children with attention-deficit/hyperactivity disorder. Archives of pediatrics & adolescent medicine, 162(4), 323–329. https://doi.org/10.1001/archpedi.162.4.323
- Howell M. J. (2012). Parasomnias: an updated review. Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics, 9(4), 753–775. https://doi.org/10.1007/s13311-012-0143-8
- Bruni, O., Angriman, M., Melegari, M. G., & Ferri, R. (2019). Pharmacotherapeutic management of sleep disorders in children with neurodevelopmental disorders. Expert opinion on pharmacotherapy, 20(18), 2257–2271. https://doi.org/10.1080/14656566.2019.1674283
