Children and Sleep

Approximately 25% of all children experience a sleep problem at some point during their childhood ranging from difficulty in falling asleep to sleep apnea. Sleep is crucial to development. Lack of qualitative, restorative sleep can lead to many daytime problems such as sleepiness, irritability, hyperactivity, impaired learning, and lack of attention. For more information about how much sleep children need, please refer to understanding your sleep need.

These common pediatric problems are generally symptoms of an underlying sleep disorder. They include the following:

• Snoring can be seen in all age groups of children from toddlers to teenagers. It can be associated with behavioral control problems and academic failure.
• Excessive daytime sleepiness, or hypersomnia, is often manifested in children differently than in adults, in that sleepy children often display symptoms of hyperactivity, irritability and inattention, and can be confused with symptoms of attention deficit hyperactivity disorder (ADHD).
• Insomnia, a condition characterized by a difficulty initiating or maintaining sleep, is most commonly manifested in children as a difficulty getting to sleep at night and an inability to get up for school in the morning.
• Abnormal behaviors during sleep, including sleep walking or acting out during sleep.

Common sleep disorders in children and adolescents include:

• Obstructive Sleep Apnea is characterized by repetitive breathing stoppages during sleep, causing the child to either wake up or go a lighter stage of sleep. Snoring may or may not be present even though the breathing stoppages occur. The repetitive arousals needed to open the airway fragment sleep, leading to frequent brief awakenings and daytime sleepiness.
• Inadequate sleep hygiene is a common problem in adolescence. In the age of iPhones, text messaging, video games, social networking, and other electronic media, many kids have a long list of excuses to delay bedtimes.
By going to bed late and getting up early for school, they tend to accumulate a profound sleep debt by Friday night and then pay back that debt on the weekends, often sleeping in until late morning or noon. Sleeping in for an extra 3-5 hours on days off resets the biological clock to a later or delayed “time zone”. For a teenager in Ohio living in Eastern Standard Time, it is common for them to live their weekend as if they were living in the Pacific or California time zone. After two nights of going to bed at midnight or later on the weekend, they need to come back to the Ohio time zone and go to bed before 9-10:00 PM for school the next morning. Unfortunately, their brain is not ready to go to sleep that early and they may be unable to fall asleep even if they make the effort to go to bed at a reasonable time. As a result, they wake up sleep deprived the next morning, and the vicious cycle repeats with the accumulation of another sleep debt during the week waiting to be paid back the following weekend, all the while leading to decreased school performance.
• Narcolepsy is a disorder of excessive sleepiness that often begins during adolescence, but is often not diagnosed until many years later in adulthood (see Narcolepsy for details). Although chronic sleep deprivation from late bedtimes and early rise times is a more common cause of excessive daytime sleepiness in children, narcolepsy should be suspected in adolescents and young adults who complain of daytime sleepiness in spite of allowing themselves adequate sleep at night
• Circadian rhythm disorders occur when the brain’s biological 24-hour or “circadian” clock is not syncronized with the desired sleep-wake schedule. For example, the brain’s circadian clock tends to slow down during puberty, leading to a natural tendency for adolescents to want to go to bed late and sleep in the next morning. When this "phase delay" or slowing of the circadian clock leads to missed school days or distress, the child may have a “delayed sleep phase syndrome”. A delayed sleep phase syndrome is very common in adolescence, but is generally easily treated with appropriate intervention.
• Parasomnias are unwanted behaviors that manifest during sleep such as sleepwalking, sleep terrors, nightmares and sleep-related enuresis. Parasomnias in children tend to improve or resolve over time, but medical intervention may be required, particularly when safety issues for sleep walkers or social distress is involved.
• >Restless Legs Syndrome (RLS) and Periodic Limb Movement Disorder (PLMD) can also be seen in children. The inability to sit still in children with RLS can sometimes lead to a misdiagnosis of attention deficit-hyperactivity disorder (ADHD). RLS and periodic limb movement disorder can disrupt sleep, leading to daytime academic and behavioral consequences.

Symptoms

If your child is complaining of feeling sleepy during the day, exhibits irritability, hyperactivity or has difficulty learning or concentrating in school, you may want to consider a sleep medicine evaluation to determine the underlying cause of the problem.

It is very important to remember that children exhibit sleepiness very differently than adults. Children rarely raise their hand and say "I want to take a nap" or "I feel sleepy." On the contrary, they tend to deny such symptoms even in the face obvious exhaustion. Instead, children tend to become over-active "race cars" to the point of hyperactivity, a behavior that some researchers feel may represent a means of sustaining wakefulness in the setting of excessive sleepiness. Indeed, recent research has found that many such children may be misdiagnosed as having attention deficit-hyperactivity disorder (ADHD) and be prescribed Ritalin or a similar stimulant which is also effective in improving alertness and their ability to sit still and concentrate. Any child who snores and has symptoms resembling ADHD should be suspected as having a possible sleep disorder such as obstructive sleep apnea as the underlying cause of their symptoms.

Consequences

Children with sleep complaints are more likely to suffer from daytime sleepiness, be moody, feel anxious or depressed, and experience behavioral or learning problems. If you suspect a sleep problem, document the symptoms in a sleep diary and consult your pediatrician or a qualified sleep medicine specialist to address the sleep issues at hand. Do not delay seeking help since the longer the wait, the more serious the potential consequences. Treating a sleep disorder can improve academic performance and overall health.

Diagnosis

The clinician should determine the nature and extent of the sleep problem, as well as ascertain the possible underlying causes through an in-depth interview with the patient and caretakers and a physical examination. If needed, the child may undergo an overnight sleep study (polysomnogram) to monitor brain wave activity, breathing, heart rate, oxygen levels and body movements or behaviors during sleep. In some cases, a Multiple Sleep Latency Test may be performed to evaluate daytime sleepiness.

Treatment

Good sleep hygiene is essential in helping children navigate through the night and establish healthier sleep patterns. Treatments for pediatric sleep disorders vary according to the symptoms experienced and the diagnosis established. Options may range from behavioral measures to establish a healthy sleep-wake schedule, to surgical procedures or pharmacological interventions depending on the underlying diagnosis.

For More Information

For more information about children and sleep, visit the American Academy of Sleep Medicine at http://www.sleepeducation.com and the National Sleep Foundation at http://www.sleepfoundation.org.