Sleep disorders are a common problem in children. The most sensitive periods are up to four years and adolescence. Some sleep disorders can be intimidating to both the child and the parent, although they are not considered a medical problem. Others may indicate diseases that need to be treated. Finally, lack of sleep affects not only the well-being of all family members, but also the health of the child himself. MedaboutMe tells what the reasons are.

Causes of childhood insomnia

Insomnia or insomnia is not only a condition when a person does not sleep at all. Sleep deficiency disorder is also called insomnia: a child (or an adult) does not fall asleep well, often wakes up, gets up early. That is, everything where the amount of rest is less than the norm is considered insomnia.

• Babies can sleep up to 17 hours a day (and newborns up to 22 hours, although this sleep is intermittent).
• Students need 9-10 hours of sleep a day.
• Teenagers switch to the adult norm with a small plus: they need 8-9 hours.

Most often (85%) lack of sleep is a consequence of behavioral factors, the very violation of the regime. However, sleep is also influenced by somatic diseases and psychoemotional disorders, developmental disorders. It is clear that the lack of night rest aggravates the course of the disease, and a vicious circle arises.

Fact!

During sleep, the body produces somatotropin, a hormone necessary for growth, and a host of other bioactivator substances.

Insomnia in children is divided into types:

• Psychological – when it is difficult to fall asleep due to an excess of emotions, both negative and positive.
• Physiological: it is difficult to fall asleep, when lying is uncomfortable, it is stuffy and hot in the house, you want to eat or go to the toilet.
• Pathological – if you feel bad, something hurts, it is very difficult to fall asleep.
• Pharmacological – for example, while taking drugs that stimulate brain activity.
• Behavioral – violations of the regime, change of rituals. For example, when a baby is weaned from a pacifier or moved to his room.  

The most common sleep disorder is called restraining disorder. It is familiar to almost every parent – if a child is spinning in bed, asks for something to drink, then to the toilet, asks questions, comes up with excuses that prevent sleep, resists lying down. According to studies, this behavioral form of insomnia passes by the age of six, and, alas, it can only be combated by strict adherence to the regime, ignoring requests, and creating rituals before bedtime.

However, behavioral insomnia sometimes hides other disorders that prevent a child from getting enough sleep.

Diseases and sleep disorders in children

What diseases and disorders are manifested by sleep disorders?

Rickets

In the first year, rickets is the most common cause that interferes with a child’s sleep . In a serious stage, the disease is manifested by curvature of the bones, and at the initial deficiency of vitamin D increases the excitability of the nervous system. Moreover, this symptom can begin to manifest itself brightly at 3-4 months, and sometimes even earlier – from one and a half (especially in premature babies). 

The child shudders when falling asleep, is restless, fearful, irritable, his head sweats a lot, which is why he tries to scratch it on the mattress. Because of this, hair falls out on the back of the head, a receding hairline appears. Therapy is prescribed by a pediatrician, selecting the required dose of vitamin D based on tests.

Anemia

Iron deficiency anemia can also manifest as sleep disturbances (Pediatric Research). Although more often not immediately: studies indicate a connection between anemia at an early age and the development of insomnia in the preschool period.

Pain

Bone growth pain in children, heartburn and gastroesophageal reflux, bowel problems – anything that can cause pain will inevitably disrupt sleep. Therefore, sometimes, before looking for the cause in the regimen or other diseases, it is worth talking to the pediatrician about the available diagnoses or asking the child if something hurts him. Children may perceive long-term and habitual pain as part of their normal state of health.

Neurological disorders

Central nervous system dysfunctions inevitably lead to sleep disturbances. Moreover, they can manifest themselves as insomnia and hypersomnia (pathological drowsiness), nightmares, sleepwalking, etc.

In this case, it is important first of all to identify the etiology of sleep disorders, to check for the presence of epileptic activity. This is done by a neurologist.

What reasons should be the reason for a neurological examination?

• Persistent bedwetting over the age of four.
• Sleepwalking: talking, movement, sleepwalking.
• Frequent nightmares. 

Nightmares require increased attention, especially if the child does not wake up during them or does not respond to attempts at comfort, does not understand what is happening.

Important!

It is important to know that nightmares (“night terrors”) can indicate epilepsy. In this case, terrible dreams manifest themselves in almost the same way. The child seems to be waking up, but his eyes are frozen, the limbs are trembling, there is no reaction to adults.

In addition, although this is called a “nightmare”, it often happens that the baby does not feel fear, that is, the emotional coloring is absent or smoothed out. In the morning, the child is lethargic, depressed, complains of well-being.

Sleep disturbances in young children include problems with falling asleep and getting long periods of sleep. Behavioral insomnia is more common in children than in adults

Sleep apnea

Sleep apnea – breathing disorder during sleep – is a serious problem. In very young children, it can cause respiratory arrest or death (a rare but persistent sudden infant death syndrome, SIDS).

In older children, apnea leads to temporary hypoxia, a restriction of oxygen supply to the brain tissue. This also affects the well-being of adults, and for a child it can become a serious limitation of development.

If the baby snores (and this is not uncommon, for example, with adenoids in a child), you need to examine him as soon as possible and start solving the problem. You also need to know that snoring can be quiet, intermittent, you can’t hear it from the next room. But in the morning, the child, despite the full duration of sleep, will seem tired, sleepy or irritable, moody. 

Fact!

The researchers found that baby snoring is often associated with hyperactivity, increased anxiety, and nervous irritability. All this can be a consequence of brain hypoxia during sleep.

Migraine

Childhood migraines are uncommon. As a rule, the number of complaints related to them increases at school age, with a peak in adolescence. Research shows a link between sleep disturbances and migraine headaches. A lack of rest at night can trigger seizures, and vice versa: an early aura before a migraine can disrupt sleep.

Anxiety disorder and depression

If depression is more common in older students, then anxiety disorder can also be in the preschool period.

Sleep disorders are one of the diagnostic criteria for depression in both adults and children. The child may practically stop sleeping, or vice versa, be pathologically drowsy.

With anxiety disorder, 9 out of 10 children have sleep disturbances. Most often – nightmares, constant awakening, unwillingness or inability to fall asleep normally, sleep alone. Recent studies have found a bi-directional relationship between anxiety and sleep disturbance (which is fairly obvious): the more anxiety, the worse the sleep. The worse the sleep, the stronger the anxiety.

Fact!

Interestingly, when interviewing a doctor, children and adults are more likely to point to sleep disturbances in depressive conditions, and in anxious ones, they tend to hide night problems.

Autism spectrum

Sleep disorder in children with autism (ASD) occurs in 50-80% of cases. Perhaps some of the situations are simply not diagnosed. One of the features of the effect of ASD is a decrease in the production of the sleep hormone melatonin and an abnormal release of the neurotransmitter GABA. That is, the basic reason is the imbalance in the body’s work.

This problem is difficult to address with behavioral interventions. Although bedtime rituals, routine, and darkness in the room all contribute to increased melatonin production, it may still be lacking. In this case, the question of prescribing drugs to combat insomnia is being decided. Experts (a study in Sleep) point to an improvement in the sleep of children with ASD when taking minimal doses of melatonin.

Fact!

Prescribing melatonin for children is a controversial issue. Experts argue that it should be decided on an individual basis. It is a hormonal agent with side effects, especially in childhood. 

Attention Deficit Hyperactivity Disorder

A fairly natural factor in sleep disturbance is ADHD syndrome. And it is also clear that the worse the sleep, the less resources for concentration and normalization of the child’s activity.

However, few people know that sleep disorders can mimic the symptoms of ADHD, leading to misdiagnosis and treatment.

In both cases, it is necessary to establish sleep: this will weaken the signs of inattention, excessive activity and impulsivity.  

Various questionnaires are used to assess sleep disorders in children: the Sleep Disturbances Scale for Children, the Child Sleep Questionnaire, the Children’s Sleep habits Questionnaire, and the BEARS Bedtime problems scheme.

Together, they assess the behavior when going to sleep, daytime sleepiness, the number of nighttime awakenings, and the presence of snoring.

When to see a doctor and what is done for diagnosis?

Children’s sleep disorders are a task with a touch of parental subjectivity. Someone makes an appointment with a doctor after a couple of nights with insomnia, someone does not go to a specialist for months. When to go?

Experts advise seeking help if a child has three problem nights in a week that are not related to an infectious disease (SARS, flu, etc.) or a change in bedding rituals, moving, and so on. That is, without obvious and self-correcting reasons.

At the consultation, the doctor will ask the parents and, if possible, the child, examine, get acquainted with the medical histories. To exclude somatic pathologies as the causes of insomnia, blood, urine, feces (for worm eggs) are analyzed, if necessary, an ECG, EEG (including during sleep), and other examinations.  

Medicines for insomnia in children

In childhood, it is always recommended to carry out behavioral correction first before starting pharmacotherapy. The use of sleep drugs in children requires further research due to the increased risk of side effects and complications.

This is a rather weak consolation in the case of severe insomnia and the inaccessibility of behavior therapy for the child. In pharmacotherapy, rather serious drugs are used – benzodiazepines, antidepressants, antiepileptic drugs, antihistamines.

Of the conventionally “mild” drugs, placebo-controlled studies confirm the effectiveness of melatonin in the rate of falling asleep and the duration of sleep. Although a number of scientific works prove that even in children with ADHD and ASD without behavioral correction, this drug helped to reduce the time to fall asleep by only 5-7 minutes, which once again proves that the mode and conditions of falling asleep are important for any causes of sleep disorders in children.

In any case, before you start giving your child something – from “soothing herbal preparations” to medications, you must first make an appointment with a doctor and find out if there are any underlying causes of the disorder, other methods of correction, and how suitable these funds are for your child. …