Symptoms and Treatment of Sleep Disorders in Children
The Sleep Study Clinic at Phoenix Children's Hospital addresses several disorders, including:
About 3 percent to 12 percent of children snore, while sleep apnea syndrome affects 1 percent to 10 percent of children. The most common reasons for sleep apnea in children are enlarged tonsils or obesity.
- Symptoms include: Snoring, restlessness, pauses in breathing, frequent awakenings, and daytime sleepiness.
- Consequences of sleep apnea: Failure to thrive, nocturnal enuresis, attention-deficit disorder, behavior problems, poor academic performance, and cardiopulmonary disease.
- Treatment: May include surgery to remove tonsils or continuous positive airway pressure ventilation.
Restless sleep can be a sign of periodic limb movement disorder. Some research has suggested an association between ADHD and periodic limb movement disorder. In some cases, it is caused by iron deficiency.
- Symptoms include: Poor sleep and subsequent daytime drowsiness - particularly limp hands and feet.
- Complications may include: Iron deficiency.
- Treatment: Iron supplementation.
Hypersomnia is a relatively rare sleeping disorder affecting under 1 percent of the population. It is slightly more common in females than in males and typically starts in early adulthood. While we do see some cases, it is very rarely found in children and slightly more commonly in teenagers.
- Symptoms include: Long periods of sleep often in excess of 10 hours, difficult to wake up from a deep sleep, fatigue during the day, feel compelled to nap multiple times even in socially unacceptable places.
- Consequences of hypersomnia: Chronic tiredness, low energy, feeling irritated, trouble remembering, loss of appetite
- Treatment: Most commonly treated with daytime stimulants like amphetamine and modafinil. Other treatments may include antidepressants.
Insomnia in the pediatric population is very different than insomnia in the adult population. Although both involve sleeplessness, the causes vary significantly. Although parents often want to turn to a prescription to treat their child's insomnia, it is much more important to look for any underlying medical or psychological problems that may need to be treated first.
- Symptoms include: Irritability, mood swings, hyperactivity, depressed mood, aggressiveness.
- Consequences of insomnia: Depression and stress.
- Treatment: Medications (sedating antidepressants, melatonin, antihistamines), pre-sleep routine or behavioral changes, relaxation techniques for your child.
Note: Children who have sleep disorders can often show symptoms similar to ADHD (attention deficit hyperactivity disorder). Because of the overlap of symptoms, children with a sleep disorder can be misdiagnosed with ADHD. If your child has symptoms of ADHD or other behavior problems, he or she should be carefully assessed for sleep problems.
- Symptoms include: Same as above.
- Consequences of insomnia and ADHD: Side effects of stimulants used to treat ADHD.
- Treatment: Medication (Clonidine).
Narcolepsy is a chronic sleep disorder resulting from the brain's inability to regulate sleep-awake cycles. At various times throughout the day, children with narcolepsy experience the fleeting urge to fall asleep for periods lasting from a few seconds to several minutes.
- Symptoms include: Excessive and overwhelming daytime sleepiness, sudden ability to move, sleep paralysis, hallucinations upon awakeing or as falling asleep, and suprisingly, insomnia at typical socially accepted bedtimes.
- Consequences of narcolepsy: Can pose special problems for children and adolescents by interfering with their psychological, social and cognitive development and undermining their ability to succeed at school.
- Treatment: Medications (central nervous system stimulants, antidepressants, modafinil, Xyrem), scheduled short naps, improving the quality of nighttime sleep.
Nightmares are most common among preschoolers (children aged 3-6 years) because this is the age at which normal fears develop and a child’s imagination is very active. The child may dream about danger or a scary situation. Nightmares may involve disturbing themes, images or figures such as monsters, ghosts, animals or bad people.
- Symptoms include: Night sweats, screaming, enlarged pupils, heavy breathing, confusion, fatigue, memory loss.
- Consequences of nightmares: Extreme panic, irrational or aggressive behavior, anxiety, paranoia, confusion, irregular routine for sleep, stress, conflict among adults or other children.
- Treatment: Use a security object such as a favorite stuffed animal or a blanket to help a child feel relaxed and safe in bed, leaving a low nightlight on in your child’s bedroom, follow a regular and mellow routine before bedtime, talk to your child about what is stressing him or her out.
In a child with REM sleep behavior disorder (RBD), the paralysis that normally occurs during REM sleep is incomplete or absent, allowing the child to "act out" his or her dreams. RBD is characterized by the acting out of vivid, intense and violent dreams. It is most often found in males, but overall is a very unusual diagnosis in children.
- Symptoms include: Talking, yelling, punching, kicking, sitting, jumping from bed, arms flailing, and grabbing while asleep.
- Consequences of RBD: Injuries are not uncommon and include bruises, lacerations or fractures involving the individual or bed partner. The violence of the sleep-related behavior is often nothing like the child’s personality while awake. Daytime aggressiveness and intense dream activity may also occur.
- Treatment: Medication (clonazepam, tricyclic antidepressants, anitepileptics, melatonin).
Sleep paralysis is a temporary phenomenon which occurs either just after waking up from sleep or before going into deep sleep where, for a certain period of time, there are delayed or limited responses to brain commands. Eventually the brain restores order and normal body functions return, thus ending of the period of paralysis. While associated with narcolepsy, it is also seen as an independent, normal feature of sleep. It also runs in some families.
- Symptoms include: Lack of energy, irritability, mood swings.
- Consequences of sleep paralysis: Stress and strain on brain and body.
- Treatment: Children must follow fixed routines of rest, recreation and meals.
Recent findings show children with sleep apnea are at greater risk for nocturnal enuresis (bed wetting) than children without sleep apnea. Although it is very common, children with sleep apnea may wet the bed because they do not get restful sleep and therefore have a decreased arousal response that prevents them from awakening when their bladders are full.
- Symptoms include: Urination in bed, fullness of the bladder.
- Consequences of enuresis: Behaviors like remorse, embarrassment, guilt, irritability.
- Treatment: May be as simple as fluid restriction after 6 PM or repeating toilet training, but occasionally involves the use of medications that help decrease the need to urinate at night.
Otherwise known as sleep talking, this condition refers to talking aloud while asleep. It can be quite loud, ranging from simple sounds to long speeches, and can occur many times during sleep. Listeners may or may not be able to understand what the person is saying. It is very common and is reported in 50 percent of young children, with most of them outgrowing it by puberty.
- Symptoms include: Talking during sleep, child usually does not remember doing this.
- Consequences of somniloquy: Disruption of others’ (parents, siblings, or other kids) sleep quality.
- Treatment: Sleep talking rarely requires treatment; however, severe sleep talking may be the result of another more serious sleep disorder or medical condition, which can be treated.
Otherwise known as sleep walking, somnambulism is characterized by walking while asleep. On occasion, nonsensical talking may occur while sleepwalking. The person's eyes are commonly open, but have a characteristic glassy "look right through you" characteristic. This activity most commonly occurs during middle childhood and young adolescence. Approximately 15 percent of children between 4 and 12 years of age will experience sleepwalking.
- Symptoms include: Walking during sleep, child usually does not remember the event.
- Consequences of somnambulism: Disruption of others’ (parents, siblings or other kids) sleep quality.
- Treatment: Relaxation techniques, lock doors and windows, remove obstacles that might cause injury.
A child or teenager who remains awake at least two hours past their usual bedtime because they are unable to fall asleep may have delayed sleep phase syndrome (DSPS). DSPS usually starts during the teen years and affects about 7 percent (1 out of 15) of teens.
- Symptoms include: Trouble falling asleep at a usual bedtime, difficulty waking up in the morning, daytime sleepiness.
- Consequences of DSPS: Lack of sleep can affect thinking, judgment and organizational skills.
- Treatment: Improve sleep habits and hygiene, change the internal clock, bright-light therapy, use of melatonin.