Childhood sleep issues are common. There are various types of sleep disorders that affect children, some of which are behavioral in nature and some of which result in abnormal findings on a sleep study. Sleep disorders in children can be difficult to diagnose due to the variations in sleep habits among children at different stages of development; what may be abnormal for an older child may be typical for a younger child.
Additionally, sleep disorders in children may be hard to define because others may tolerate sleep behaviors that may be troublesome to some parents. Sleep disorders that are behavioral in nature are far more common than those that can be identified on a sleep study.
[Related: Managing Toddler Sleeping Problems]
Normal Sleeping Patterns In Children
What qualifies as a normal sleep pattern for children, especially infants, is quite different from that of adults. Sleep is broken down into two stages:
- NREM, Non-Rapid Eye Movement. During this stage the body graduates from drowsiness to deep sleep. Your muscles are relaxed and you may become disoriented or confused if you are suddenly woken up while in deep sleep.
- REM, Rapid Eye Movement. This stage is the more active of the two. While the body is not active, the mind is. During this stage, breathing and heart rate may be irregular and the body is basically paralyzed, while the brain is active and dreaming.
As we sleep, our sleeping cycles go through the two stages. As we grow and mature, the percentage of time spent in each stage and the intervals in which the stages change varies. Infants, for example, conduct nearly half of their sleep in the REM stage, whereas adults spend only about 20 percent of sleep in that stage. Additionally, young infants are typically asleep longer than they are awake. Periods of wakefulness begin to become greater as a child ages. Typically, a child will get an average of 10 hours of sleep per night.
- For newborns sleep is divided fairly equally for day and nighttime hours.
- By age one, sleep is predominantly done at night with one or two naps during the day.
- By age four, most children have given up on the daytime nap and get their greatest number of sleep hours in one solid block of time during the night.
[Related: The Five Stages Of Sleep]
Types Of Sleeping Disorders In Children
There are many types of sleep disorders in children. Some may be behavioral in nature and others can be due to an immaturity within the central nervous system during childhood. Some may be outgrown as the child matures and others, such as sleep apnea or narcolepsy, can be present throughout adulthood. Types of sleep disorders include:
- Parasomnias, which occur in episodes and are usually outgrown as the child ages.
- Night terrors, which typically occur about 90 minutes into NREM sleep. The child suddenly screaming and jolting upright characterizes these occurrences. They can last up to thirty minutes, during which time the child is usually inconsolable.
- Sleepwalking, and/or sleep talking, is characterized by the child sitting upright with the eyes open, but being unable to see. The child will likely be restless and sometimes get out of bed to wander the house. Talking is usually unintelligible.
- Bedwetting typically occurs during NREM sleep and can be primary, meaning that the child has never had a dry night or secondary, meaning the child used to be dry at night and is not currently. Primary bedwetting is usually due to immaturity of the bladder and can have ties to family history, while secondary bedwetting may be linked to a medical condition or emotional distress.
- Obstructive Sleep Apnea is believed to affect nearly 3 percent of children. The symptoms associated with obstructive sleep apnea include snoring, difficulty breathing while sleeping and breathing through the mouth.
- Narcolepsy is not very common, but onset can start in childhood or adolescence. People with narcolepsy have an overwhelming urge to fall asleep and often do at odd times such as during a conversation or in the classroom.
Secondary Sleep Disorders
- Difficulty falling asleep
- Difficulty maintaining sleep
Symptoms Of Sleeping Disorders In Children
Children with sleeping disorders will most likely experience sleepiness during the day. Symptoms include:
- Falling asleep in the classroom
- Falling asleep while talking with someone
- Falling asleep when being driven in a car
- Falling asleep while watching television
- Falling asleep while reading
Diagnosing Sleeping Disorders In Children
Typically, a pediatrician will diagnose your child’s sleep disorder, but you may also be referred to a sleep specialist and need to undergo a sleep study. A sleep study will likely be used to diagnose obstructive sleep apnea. Parents may also find it helpful to speak with the child’s teacher or school counselor if behavioral or attention problems are present at school. Both doctors and school personnel will likely need the following information to make a diagnosis and begin an intervention:
- Review of the child’s usual sleep patterns
- Bedtime routines
- Bedtime and wake up times.
- If the child has difficulty falling asleep
- If the child has difficulty staying asleep
- Incidence of nightmares
Sleeping Disorder Treatments In Children
Each type of sleep disorder has its own specific treatment. However, many disorders may benefit from a consistent bedtime routine. Others need specific intervention, which includes:
- Making sure the child is safe and comfortable, but not woken up may treat night terrors. Extreme night terrors may need some type of intervention from a doctor.
- Taking safety precautions for children who sleepwalk. For example, locking all doors and windows and having the child sleep on the first floor if possible. In addition, waking the child upon scheduled intervals can lessen episodes.
- For primary bedwetting, the child may benefit from restricting fluids before bedtime, a bedwetting alarm, bladder control training or in some cases medication. Secondary bedwetting, which can be caused by emotional distress, may require counseling.
- Obstructive sleep apnea in children may be treated with the removal of the child’s tonsils and adenoids. If this does not work, the child may need the assistance of a CPAP machine to ensure proper breathing while sleeping.
- Ensuring the child gets a full 12 hours or more of sleep every night may alleviate narcolepsy.
When a sleep disorder is present in childhood, not only is the child irritable and tired, but also the whole family gets affected. If you suspect that your child has a sleep disorder, it is important to bring the symptoms to the attention of your pediatrician. From there, your pediatrician may recommend that your child see a specialist. Your doctor will likely attempt to rule out any underlying medical conditions that may be causing your child’s sleep disturbance. Seeking the help and support of your doctor can get your family on the road to normal sleep once again.
Some sleep disorders are mild and easily treated, while others are far less common and may require medical intervention. If your child has a sleep disorder, he or she may be experiencing a problem at school that you may not have realized is a result of his or her sleep disturbance. Often times, difficulty with attentiveness and behavioral problems in school are attributed to sleep disturbance. Sleep disorders in children can have the following side effects:
- Impulse control difficulties
Sleep disorders in children are common. Many of them can be treated easily and are often outgrown as the child matures. However, some if left untreated can develop and continue into adulthood and have log-term effects. If you suspect your child has a sleep disorder, contact your family doctor or pediatrician to have the child’s symptoms evaluated.