Pediatric sleep disorders are conditions that cause poor sleep quality and quantity in children. Children’s health and development are largely determined by how much sleep they get. Young children and teenagers may suffer from several sleep problems that parents and caregivers may not know about. Common sleep problems in children include restless leg syndrome, sleep apnea, insomnia, cataplexy, and parasomnias, which interfere with sleep-related behaviors like sleepwalking and night terrors.
Good quality sleep is vital for the development of young minds and for restoring mental and physical health. Children’s bodies must recharge and retain the information they have learned throughout the day. During deep non-REM sleep, the body’s energy and immunity are restored, growth occurs, biological functions are repaired, and important brain development hormones (human growth hormones) are released.
Children’s sleep problems, particularly parasomnias, are unlikely to last until puberty. However, they may negatively impact a child’s general quality of life and behavior during the day. Even though adults could experience similar issues related to sleep, children’s etiology or set of causes, presentation, and related results might differ greatly from those of adults. Furthermore, childhood development factors also significantly impact children’s sleep, as seen in the cases of early childhood insomnia and teenage delayed sleep phase syndrome.
This article reviews the reasons for children’s sleep disorders, typical symptoms, strategies for assisting kids with sleep issues, and when to consult a physician.
Identifying Signs of Sleep Disorders in Children
A huge difference exists between normal sleep behavior and behaviors recognized as red flags. Normal sleep behaviors include having a regular sleep schedule, sleeping 7-9 hours every night for optimal functioning, sleeping and waking up at roughly the same time every day, going to bed and waking up at roughly the same time each day, having dreams during the REM stage of sleep, and waking up every morning fully refreshed and alert.
Behavior and characteristics that are not typical and can be recognized as red flags may indicate sleep disorders and could serve as critical factors in identifying potential health issues. Sleep disorders in children can manifest in a variety of ways. Potential red flags include:
- Trouble controlling emotion
- Snoring followed by gasping and breathing pauses during sleep
- Weak immune system
- Difficulty falling asleep at night and waking up in the morning
- Labored breathing while sleeping
- Sleep terrors or nightmares
- Daytime sleepiness/trouble staying awake during the day
- Irritability and hyperactivity
- Unexplained decrease in daytime performance
- Poor memory, focus, and problem-solving skills
- Unusual events during sleep, such as sleepwalking or nightmares
- Not gaining weight appropriately
- Teeth grinding
- Involuntary urination in bed during sleep/bedwetting
- Restless sleep and sleeping in unusual positions
Common Pediatric Sleep Disorders and Their Symptoms
Insomnia
Insomnia (persistent problems falling and staying asleep) is one of the most common sleep disorders in children and affects 20 percent to 30 percent of children. Insomnia in children is divided into three categories by medical experts which include:
- Behavioral insomnia is common in children as young as 6 months and up to 5 years old. It is associated with bedtime refusal, prolonged night awakenings requiring parental intervention, and resistance to falling asleep.
- Conditioned insomnia is common in children who have reached adolescence. It occurs when older children experience feelings of anxiety associated with bedtime. The children feel alert, irritated, and worried rather than relaxed and sleepy.
- Transient sleep disturbances: This insomnia is usually short-course and disappears without medical intervention. It is caused by the stress of joining a new school, sickness, travel, or other stressful life events.
Symptoms of insomnia include difficulty falling and staying asleep, irritability, mood swings, aggression, memory issues, hyperactivity, and decreased attention span.
Obstructive sleep apnea
This involves repeated breathing interruptions in children during sleeping and usually causes reduced oxygen levels and increased carbon dioxide levels, disturbing sleep. Symptoms include poor school performance, waking up choking or gasping, snoring, dizziness and sleepiness during the day, and Attention-deficit/hyperactivity disorder (ADHD).
Central sleep apnea
Central sleep apnea (CSA) occurs when the area of the brain responsible for breathing regulation malfunctions. It does not involve snoring or gasping. Due to the immaturity of the brain’s respiratory center, CSA is very prevalent among extremely preterm newborns. Symptoms of CSA include daytime sleepiness, headaches in the morning, and difficulty focusing.
Hypoventilation
Also known as respiratory depression, it happens when insufficient ventilation/breathing prevents proper gas exchange in the lungs. Causes include
Respiratory Infections like pneumonia, bronchiolitis, Neuromuscular Disorders, Central Respiratory Drive Disorders, Congenital Abnormalities, Obstructive Sleep Apnea (OSA), and trauma and injuries. Symptoms include lethargy, fatigue, shortness of breath, difficulty in eating, skin and lips turning blue, confusion, and a decline in mental status.
Circadian rhythm sleep disorders (CRSDs)
These are also known as sleep-wake cycle disorders that share a common character of disruption in sleep timing. These disorders happen when the child’s sleeping and waking time go out of sync with standard time. Various symptoms of these disorders include extreme daytime sleepiness, reduced alertness, and issues with decision-making and memory.
Narcolepsy
Narcolepsy is a sleep disorder that causes excessive daytime sleepiness and an unavoidable temptation to sleep. Narcolepsy in children usually consists of excessive sleepiness and cataplexy, as well as rapid-eye movement-related symptoms such as sleep paralysis, sleep terror, and hypnagogic or hypnopompic hallucinations.
Parasomnias
In children, parasomnia occurs when episodic behavioral events like confusional arousals, sleepwalking, and sleep terrors interrupt sleep, so parents/caregivers often worry about their children. These events are most common in preschoolers, and the frequency gradually decreases.
Restless legs syndrome
This is a sleep disorder in which there is an uncontrollable urge to move legs during sleep. Symptoms include tossing and turning in bed, throbbing pain in the legs, and frequent leg kicking.
Intervention Strategies for Pediatric Sleep Issues
Pediatric sleep issues need a serious and comprehensive approach that includes various factors influencing sleep in children. Below are listed some intervention strategies for pediatric sleep issues:
Consistent Bedtime Routine
A consistent bedtime routine is important for children. Activities like warm baths before bed, storytelling, or calming music help signal children that it is time to wind down and sleep. Ensure children sleep and wake up simultaneously each day, including weekends. Consistency helps regulate the body’s circadian rhythms (cycles of alertness and sleepiness).
Create a Comfortable Sleep Environment
Ensure the bedding and mattress are comfortable. Remove TVs, phones, and other electronic devices from the bedroom to minimize distractions. The bedroom should also be cool, quiet, and dark.
Limit Stimulants Before Bedtime
Children should not consume sugary snacks or caffeine before bed at night. The sugar increases blood sugar levels, which leaves the body overstimulated and restless.
Encourage Physical Activity
Encourage frequent movement/exercise/walking during the day, but avoid strenuous exercise right before bed.
Address Anxiety and Stress
Ensure you monitor any worries or fears your child is facing. To reduce worry, create relaxing bedtime routines.
Dietary Considerations
Children should eat healthy and a balanced diet for overall well-being. They should be encouraged to eat complex carbohydrates that trigger the release of the sleep hormone called serotonin, which helps increase the production of calming brain waves. Heavy meals before bedtime should be discouraged as they may result in heartburn and acid reflux, interrupting sleep.
Treatment options
Suppose the above strategies are not helping address sleep issues. In that case, it is important to consult a pediatrician because sleep issues might be associated with underlying medical conditions.
Some treatment options, according to Medscape, that a pediatrician might recommend include:
Cognitive-Behavioral Therapy for Insomnia (CBT-I)
Children can benefit from Cognitive-Behavioral Therapy for Insomnia (CBT-I), which can be modified to include methods like cognitive restructuring, teaching children how to manage their anxiety, relaxation training, and mindfulness, and teaching sleep hygiene.
Adenotonsillectomy and Ventilatory Support
Adenotonsillectomy, or tonsillectomy, is a surgery to remove tonsils or adenoids in children who experience snoring or obstructed breathing during sleep.
Medication and surgery (if prescribed by a healthcare professional)
After consulting with a patient, a healthcare provider may recommend medication for specific sleep disorders.
Pediatric sleep issues must be approached with patience and consistency. A child’s individual needs may need to be addressed by interventions tailored specifically to those needs. Regular communication with healthcare professionals, such as pediatricians, physicians, and sleep specialists, can provide additional support and guidance.
Below is a list of a few medications that are used to treat sleep disorders.
Please note that none of these medications are approved by the US Food and Drug Administration (FDA) for adolescents and children. Medical doctors should prescribe these only in case of serious sleep disorders.
Desmopressin
Desmopressin is used to treat primary nocturnal enuresis (involuntary discharge of pee at night by children who are old enough to have bladder control) in children older than six years. Desmopression increases the cellular permeability (the comfort with which a molecule can pass through the cell membrane) of the collecting ducts, resulting in the process of absorbing water again by the kidneys.
Antidepressants
Tricyclic antidepressants are prescribed to children for treating narcolepsy (excessive, uncontrollable daytime sleepiness) and enuresis (bedwetting).
Imipramine (Tofranil, Tofranil PM)
Imipramine could be used to treat pediatric ADHD – attention deficit hyperactivity disorder, as well as enuresis and narcolepsy.
Melatonin
Melatonin can be used to treat circadian rhythm disturbances without light perception. Over-the-counter forms of melatonin vary in quality and reliability. Children should take only small doses, not exceeding 10 mg daily.
The Role of Parents in Managing Childhood Sleep Disorders
Parents, who are children’s primary carers, greatly influence their children’s daily schedules and sleeping patterns. Treating sleep disturbances early can benefit a child’s long-term well-being, as sleep is essential to children’s physical and mental development. There are several critical aspects to parental involvement in treating sleep disturbances in children:
Establishing a Consistent Sleep Routine
Parents and caregivers should establish a consistent bedtime routine encouraging reading books and calming activities like a warm bath to help regulate the body’s internal clock and promote better sleep.
Creating a Sleep-Friendly Environment
Parents must ensure children have a sleep-friendly, quiet, and comfortable environment to facilitate quality sleep. Minimizing noise and distractions in the bedroom can contribute to a more peaceful sleep environment.
Promoting Healthy Sleep Hygiene
It is important to teach children healthy sleep habits, including limiting screen time before bed and preventing stimulating activities during the last hour before bedtime, to promote good sleep hygiene.
Sleep education can also benefit children by educating them on the benefits that sleep has on their overall health.
Identifying and Addressing Sleep Disorders
Caregivers and parents should check on unusual patterns in the children’s sleep, such as night terrors, snoring, frequent nightmares, and difficulty falling and staying asleep.
If a sleep disorder is identified, it is important to immediately seek help from a pediatrician or sleep specialist for a proper diagnosis and treatment plan.
Modeling Healthy Sleep Habits
Parents must commit to a healthy sleep routine as an example for their children. Emphasizing this commitment will set a positive example for the whole family.
Collaborating with Schools and Caregivers
Regarding a child’s sleep routine and any specific needs or difficulties related to sleep, parents should speak with their child’s teachers or caregivers. To manage sleep-related issues consistently, parents and other caregivers should work together.
Seeking Professional Help
Medical professionals, such as sleep specialists or pediatricians, must be consulted for appropriate medical intervention when sleep disorders are complicated and serious.
Parents and caregivers can boost children’s well-being and development by engaging in the above factors, thereby helping to manage childhood sleep disorders and prevent children from following unhealthy sleep patterns.
References:
- https://mayoclinic.org/diseases-conditions/sleep-apnea/symptoms-causes/syc-20377631
- https://my.clevelandclinic.org/health/diseases/8718-sleep-apnea
- https://www.sleepfoundation.org/sleep-apnea/central-sleep-apnea
- https://www.webmd.com/sleep-disorders/sleep-apnea/sleep-apnea
- https://www.snorecentre.com/treatments/lifestyle-changes-for-sleep-apnoea/
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