Sleep disorders in Children

Dr Ravinder K Gupta, Dr Princy Choudhary
Is your child having trouble sleeping? We all know that restful sleep is necessary to heal and repair the body.
Children and adolescents need at least nine hours of sleep per night. Sleep problems and a lack of sleep can have negative effects on the child’s performance in school, during extracurricular activities, and in social relationships. Childhood sleep problems are common, and frequently reduce the wellbeing and functioning of both child and family.
During the period of growth children have an increased sleep requirement. However, most of them do not get enough sleep due to various factors like increasing academic activities, watching television late into night, using mobile phones etc. Poor sleep habits are likely to cause day time drowsiness, aggressive behavior, conduct disorder, anxiety, depression and reflect in their school performance. Sleep deprived teens often have periods of subconscious bouts of sleep during day time making them prone to injuries and accidents.
The majority of childhood sleep disorders are behavioral in origin. Childhood behavioral sleep problems manifest across age groups as various forms of difficulty initiating and/or maintaining sleep. These difficulties are often amenable to home-based behavioral interventions, which can be taught to parents. Sustaining the intervention for sufficient sleep duration can be challenging for families.
What are common sleep disorders?
Somnambulism (Night Walking) is a disorder in which childwalks while asleep. Sleepwalking is more common in boys than in girls. Sleepwalking may result from an immature central nervous system or from being overly tired. It usually happens about an hour or two after the child falls asleep. Sometimes sleepwalking can persist into adulthood. Because sleepwalkers can be harmed, parents need to protect the child from injury.
Nightmares also known as dream anxiety disorder. It is characterized by fearful dreams in the last one-third of sleep. The child wakes up frightened and remembers the dream vividly. They are a common part of childhood. At the toddler stage, kids begin active dreaming where it is often hard to distinguish reality from imagination. Preschoolers and elementary school-age kids may experience nightmares that are a result of everyday emotional episodes. Arguments’ with classmates or siblings, academic stress, or fear of separation can cause nightmares.
Sleep Terror or Night Terror (Pavor Nocturnus): the child has a sudden arousal from sleep with extreme agitation, screaming, crying, increased heart rate, and dilated pupils. Like sleep walking, night terrors seem to be linked to an immature central nervous system and are often outgrown. These sleep terrors usually begin after eighteen months and disappear by age of six. Night terrors are rarely remembered in the morning in contrast to night mares. Make sure the child’s room is safe to protect against an injury during a night terror. It also helps to stay on a regular sleep regimen and to manage stress so the child is not anxious at bedtime.
Nocturnal Enuresis (Bed Wetting) is a condition associated with repetitive voiding of urine while asleep. Bedwetting may continue well into the elementary years for both girls and boys. While bedwetting is sometimes due to anxiety or other emotional issues, nothing is wrong in most kids. They will eventually outgrow bedwetting. Girls usually stop before boys. On the other hand, although it’s uncommon, bedwetting can be the result of an infection or an allergy.
Bruxism is a condition in which the child grinds, gnash or clench teeth while asleep. Bruxism primarily causes headaches, earaches, facial pain and jaw problems. Sometimes there is chipping of teeth or wearing down of their tooth enamel.
Somniloquy is the act of speaking while asleep. It can be quite loud, ranging from simple mumbling sounds to loud shouts and long, frequently inarticulate speeches, and can occur many times during a sleep cycle.
What is Narcolepsy?
Narcolepsy is characterized by excessive day time sleep, often associated with disturbed night time sleep. There is irresistible desire to sleep and sudden bouts of sleep each lasting for 10-30 minutes occurring during day time. Age of onset is 10-20 years. It may be associated with following symptoms: Cataplexy (Sudden decrease in muscle tone)Hypnogogic Hallucination (Hallucinations occurring just before falling asleep) and Sleep Paralysis (It is when, during waking up or falling asleep, a person is aware but unable to move or speak.)
What is Insomnia?
Insomnia is a disruption of the sleep cycle that includes difficulties with getting to sleep, difficulty staying asleep, and possibly early morning awakenings. In children, insomnia can last a few nights or can be long term, lasting weeks. Children with sleep anxiety may have insomnia. Other insomnia triggers include daily or chronic stress, pain, or mental health issues.
Management of Sleep disorders
Behavioral Therapy is the most important tool used to control sleep disorders in children. Although behavioral therapy may vary from disorder to disorder, a common thread is that behavioral therapists encourage children to try new behaviors, reward positive behaviors and to ignore unwanted behaviors. Parents, teachers and peers, either collectively or individually, may use this approach to help the children. Thus, in behavioral therapy, parents and children learn to promote desirable behaviors and reduce unwanted behaviors.
If behavioral therapy fails, pharmacological therapy to control sleep disorders is required.
Tips to Improve Child’s Sleep
Establish a regular time for bed each night and do not vary from it. Similarly, the waking time should not differ from weekday to weekend by more than one to one and a half hours.
Create a relaxing bedtime routine, such as giving your child a warm bath or reading a story.
Do not give children any food or drinks with caffeine less than six hours before bedtime.
Make sure the temperature in the bedroom is comfortable and that the bedroom is dark.
Make sure the noise level in the house is low.
Avoid giving children large meals close to bedtime
Make after-dinner playtime a relaxing time as too much activity close to bedtime can keep children awake.
Infants and children should be put to bed when they appear tired but still awake (rather than falling asleep in their parent’s arms, or in another room).
Limiting screen time is also important as light, especially blue light emitted from LED-lit devices (eg smartphones, electronic tablets, computer and television screens), can suppress endogenous melatonin and hinder sleep onset and quality. In the setting of a typical sleep-wake schedule, endogenous melatonin levels tend to rise two hours prior to sleep onset. As such, guidelines often recommend limiting exposure to screens for at least one hour before bedtime.
Talk to child’s health care provider if these tips don’t help.
(The authors are Professor and Head, Department of Pediatrics ASCOMS Intern, Department of Pediatrics ASCOMS)


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