Sleep Disorders in Children

Although adults often think that children “sleep like a baby,” studies suggest that many youngsters do suffer from insomnia. In one survey of children in pediatricians’ waiting rooms, more than 40% were reported by their parents to experience some form of insomnia: unrefreshing sleep, difficulty falling asleep, trouble staying asleep, or early morning awakenings.

Sometimes even sooner than a child can talk and walk independently, poor sleep habits and certain interactions with parents can get in the way of falling asleep.

Changing bedtime behaviors by creating a bedtime routine and setting limits sometimes helps children with insomnia. Most sleep experts agree it is important to allow children to fall asleep on their own. Children can become used to your presence in the room at bedtime and expect it even if they wake during the night. This can lead to Sleep Onset Association Disorder where they must have a certain person, object or activity or they cannot fall asleep. This is seen in toddlers and preschoolers where insomnia is seen in school-age children and teenagers.

“Growing pains”, “tingling”, “creepy crawlies”: no matter how it is described, the strange feelings in a child’s legs can keep him/her up at night. Uncomfortable feelings in the legs may be a symptom of Restless Legs Syndrome (RLS). This disorder creates discomfort and can compel the sufferer to move her legs, even while trying to fall asleep.

Children with symptoms of RLS at least a few times a week sleep an hour less (8.9 hours vs. 9.9 hours) and are twice as likely to wake up during the night (40% versus 21%) as children with no RLS symptoms, according to NSF’s 2004 Sleep in America poll.

Though the cause of restless legs syndrome is unknown, it may run in the family or be due to iron deficiency. Treatment in children is not well established, but deserves discussion with a pediatrician and sleep specialist.

Nightmares are vivid nocturnal events that can cause feelings of fear, terror, and/or anxiety. Usually, the person having a nightmare is abruptly awakened from REM sleep and is able to describe detailed dream content. Usually, the person having a nightmare has difficulty returning to sleep. Nightmares can be caused by many factors including illness, anxiety, the loss of a loved one, or negative reactions to a medication. Call your doctor if your child has nightmares more often than once a week or if nightmares prevent him/her from getting a good night’s sleep for a prolonged period of time.

Children who are experiencing a night terror or sleep terror seem to awaken abruptly in a terrified state. They appear to be awake, but are confused and unable to communicate. They do not respond to voices and are difficult to fully awaken. Night terrors last about 15 minutes, after which time children usually lie down and appear to fall back asleep. Children who have sleep terrors usually don’t remember the events the next morning. Night terrors are similar to nightmares, but differ in that night terrors usually occur during deep sleep, in the first half of the night rather than during REM. Also, the patients are not easily awakened and they don’t remember the incident.

Children experiencing sleep terrors may pose dangers to themselves or others because of limb movements. Night terrors are fairly common in children and occur in approximately 5% of them, mostly between the ages of three to five. Children with sleep terrors will often also talk in their sleep or sleepwalk. This sleep disorder, which may run in families, also can occur in adults. Strong emotional tension and/or the use of alcohol can increase the incidence of night terrors among adults. Stress can also trigger night terrors in children, as can illness, but one of the most common causes is inadequate sleep.

Sleepwalking occurs when a person appears to be awake and moving around but is actually asleep. They have no memory of their actions. Sleepwalking most often occurs during deep non-REM sleep (stage 3) early in the night. This disorder is most commonly seen in children aged eight to twelve; however, sleepwalking can occur among younger children and adults.

Sleepwalking appears to run in families. Contrary to what many people believe, it is not dangerous to wake a person who is sleepwalking. The sleepwalker simply may be confused or disoriented for a short time upon awakening. Although waking a sleepwalker is not dangerous, sleepwalking itself can be dangerous because the person is unaware of his or her surroundings and can bump into objects or fall down. They can fall out of windows or leave the house. There are many “accidents” and “suicides” that may have been instances of sleepwalking. In most children, it tends to stop as they enter the teen years.

Confusional arousals usually occur when a person is awakened from a deep sleep during the first part of the night. This disorder, which also is known as excessive sleep inertia or sleep drunkenness, involves an exaggerated slowness upon awakening. Children experiencing confusional arousals react slowly to commands and may have trouble understanding questions that they are asked. In addition, people with confusional arousal often have problems with short-term memory and have no memory of doing these things the following day.

Sleep talking is a sleep-wake transition disorder. Although it usually is harmless, sleep talking can be disturbing to sleep partners or family members who witness it. Talk that occurs during sleep can be brief and involve simple sounds, or it can involve long speeches by the sleeper. A person who talks during sleep typically has no recollection of the actions. Sleep talking can be caused by external factors including fever, emotional stress or other sleep disorders.

In this condition, the affected child is unable to maintain urinary control when asleep. There are two kinds of enuresis: primary and secondary. In primary enuresis, a child has been unable to have urinary control from infancy onward. Primary bedwetting appears to run in families. Children are more likely to have it if their parents or siblings had it as children. In secondary enuresis, children have a relapse after previously having been able to have urinary control. Enuresis can be caused by medical conditions (including diabetes, urinary tract infection, or sleep apnea). Some treatments for bedwetting include behavior modification, alarm devices, and medications. Of course, if there is another underlying sleep disorder, such as sleep apnea, that should be treated first and will often solve the bed wetting problem.

Rhythmic movement disorder occurs mostly in children who are one year old or younger. A child may lie flat, lift the head or upper body, and then forcefully hit his or her head on the pillow. Rhythmic movement disorder, which also has been called “head banging,” also can involve movements such as rocking on hands and knees. The disorder usually occurs just before the child falls asleep. It is thought to be a form of self-soothing. It can be very upsetting for parents to watch, but it is not thought to be associated with psychiatric problems.

People who experience nocturnal seizures may find it difficult to wake up or to stay awake. Although unaware of having had a seizure while asleep, they may arise with a headache, have temper tantrums, or other destructive behavior throughout the day.

Nocturnal seizures and their mechanisms are poorly understood. The majority of people with nocturnal seizures have idiopathic epilepsy and there is evidence that sleep enhances epileptic discharges in the EEG, though their daytime recordings may appear to be normal. For many people with epilepsy, seizures occur exclusively during sleep. Researchers (Young, et al) estimate 10% of people with epilepsy display seizures exclusively during sleep. Thus, this is a common phenomenon.

Primary sleep disorders such as parasomnias or sleep apnea can mimic, trigger or be caused by seizures. Most nocturnal seizure disorders are attributed to temporal or frontal lobe foci. Nocturnal seizures may present at any time, but the peak age of onset is adolescence. Any nocturnal movement disorder and any tendency to perform bizarre or stereotyped movements in sleep should be evaluated with a fully monitored and video-taped overnight sleep study with a full seizure EEG montage.