Child Insomnia

What is insomnia?

Insomnia in children is a common condition characterized by difficulty falling asleep, staying asleep during the night, or low quality sleep. Children with insomnia may also wake up very early in the morning. A child of any age can suffer from insomnia. Toddlers, preschoolers, school-going children, and adolescents are all susceptible to developing insomnia. Studies show that sleep problems significantly disturb daytime functioning, including difficulties paying attention, doing homework, excessive sleepiness and fatigue, behavioral problems such as hyperactivity and unusual behavior, and difficulty regulating emotions. Children's insomnia can also disturb the sleep of caregivers of sleep causing stress and disruptions in daily life.

What are the causes and risk factors of insomnia in children?

Insomnia is mainly a symptom that is caused by something underlying. Major causes of insomnia can include:

• Associated sleep disorders such as restless legs syndrome and obstructive sleep apnea
• Anxiety
• Persistent stress
• Depression
• Asthma
• Autism
• Attention-deficit/hyperactivity disorder (ADHD)
• Caffeine
• Certain medications, including steroids and antidepressants

Other medical, mental health, or developmental conditions can also exacerbate insomnia in a child.

Signs and Symptoms

Insomnia in children can begin at any age. Signs and symptoms of insomnia in children include:

• Bedtime refusal and difficulty going to bed
• Difficulty falling asleep when in bed
• Frequent night wakings
• Waking earlier than normal
• Difficulty napping
• Trouble getting up for school

In addition to these night problems, a child can suffer during the day as well. Daytime symptoms are:

• Fatigue, and tiredness,
• Daytime sleepiness
• Lack of concentration
• Decreased attention span
• Memory problems
• Difficulties with social, family, occupational or academic performance
• Extreme irritability
• Mood disturbances
• Hyperactivity and aggression
• Inability to make decisions
• Low threshold for frustration

Consequences and Complications

Poor sleep and untreated sleep problems cause significant adverse consequences and lead to long-term complications. The major consequences of child insomnia include problems with social and emotional functioning, neurocognitive deficits, poor quality of life, absenteeism, and poor academic performance.

How is insomnia diagnosed?

If your child is suffering from insomnia, a sleep specialist can assess the problem using the following strategies:

• Taking a thorough history of your child's signs and symptoms
• History of any past or present medical, mental health, or developmental issue
• Performing a complete physical examination.
• Tracking your child's sleep routine over two to three weeks using some automated devices

Doctors may also provide you with a logbook to help you keep a record of your child's sleep. All these techniques would help the specialist understand the causes of that insomnia and plan an effective treatment strategy. In rare cases, an overnight sleep study may also be advised by the sleep doctor.

Treatment and Prevention

The good thing is that insomnia is treatable, especially when it is behavioral in the pattern. For example, some children are conditioned to become dependent on special conditions to fall asleep, like being rocked or fed or just having a parent present around. When they wake up at night, a caregiver can help them fall back asleep. In some cases, the problem may be bedtime resistance by toddlers testing their limits, lack of a relaxing bedtime environment, or an irregular sleep routine. Modifying these habits and behaviors improves sleep for everyone. In older children and adolescents with insomnia, behavioral strategies usually include the patient's active involvement in developing and managing their own treatment plan. This may include a program designed specifically for insomnia called cognitive-behavioral therapy (CBT) for insomnia: CBT-I. If the behavioral changes and psychotherapies don't work, treatment with sleep medications in conjunction with behavioral treatment may be effective for children with insomnia. Medications are usually needed in children who have more complex medical, mental health, or developmental problems. The key to preventing insomnia in children is keeping an eye on their sleep quality and quantity. You should keep their bed environment hygienic and sleep-oriented. Playing surroundings and sleeping places should be separated. Regular sleep time should be adopted. In case of further queries and guidance, it is always best to consult a sleep specialist.

References

Lipton, J., Becker, R. E., & Kothare, S. V. (2008). Insomnia of childhood. Current opinion in pediatrics, 20(6), 641-649. https://doi.org/10.1097/MOP.0b013e32831897cb Vriend, J., & Corkum, P. (2011). Clinical management of behavioral insomnia of childhood. Psychology research and behavior management, 4, 69-79. https://doi.org/10.2147/PRBM.S14057 Owens, J. A., & Mindell, J. A. (2011). Pediatric insomnia. Pediatric clinics of North America, 58(3), 555-569. https://doi.org/10.1016/j.pcl.2011.03.011 Owens, J. A., & Moore, M. (2017). Insomnia in Infants and Young Children. Pediatric annals, 46(9), e321-e326. https://doi.org/10.3928/19382359-20170816-02 Nunes, M. L., & Bruni, O. (2015). Insomnia in childhood and adolescence: clinical aspects, diagnosis, and therapeutic approach. Jornal de pediatria, 91(6 Suppl 1), S26-S35. https://doi.org/10.1016/j.jped.2015.08.006