Why the child does not sleep well: causes and diseases that disturb sleep

Sleep dis­or­ders are a com­mon prob­lem in chil­dren. The most sen­si­tive peri­ods are up to four years and ado­les­cence. Some sleep dis­or­ders can fright­en both the child and the par­ents, although they are not con­sid­ered a med­ical prob­lem. And oth­ers may indi­cate dis­eases that need to be treat­ed. Final­ly, lack of sleep affects not only the well-being of all fam­i­ly mem­bers, but also the health of the child him­self. Med­aboutMe tells what are the rea­sons.

Causes of childhood insomnia

Insom­nia or insom­nia is not only a con­di­tion when a per­son does not sleep at all. Sleep defi­cien­cy dis­or­der is also called insom­nia: a child (or adult) falls asleep bad­ly, wakes up often, gets up ear­ly. That is, every­thing where the amount of rest is less than nor­mal is con­sid­ered insom­nia.

• Babies can sleep up to 17 hours a day (and new­borns up to 22 hours, although this sleep is inter­mit­tent).
• School­child­ren need 9–10 hours of sleep per day.
• Ado­les­cents are switch­ing to the norm of adults with a slight plus: they need 8–9 hours.

Most often (in 85%) lack of sleep is a con­se­quence of behav­ioral fac­tors, the same vio­la­tion of the regime. How­ev­er, somat­ic dis­eases and psy­cho-emo­tion­al dis­or­ders, devel­op­men­tal dis­or­ders also affect sleep. It is clear that the lack of night rest aggra­vates the course of the dis­ease, and a vicious cir­cle aris­es.

Insom­nia in chil­dren is divid­ed into types:

• Psy­cho­log­i­cal — when it is dif­fi­cult to fall asleep due to an excess of emo­tions, both neg­a­tive and pos­i­tive.
• Phys­i­o­log­i­cal: it is dif­fi­cult to fall asleep when it is uncom­fort­able to lie down, the house is stuffy and hot, you want to eat or go to the toi­let.
• Patho­log­i­cal — if you feel bad, some­thing hurts, it is very dif­fi­cult to fall asleep.
• Phar­ma­co­log­i­cal — for exam­ple, against the back­ground of tak­ing drugs that stim­u­late brain activ­i­ty.
• Behav­ioral — vio­la­tions of the regime, change of rit­u­als. For exam­ple, when a baby is weaned from a paci­fi­er or moved to his room.

The most com­mon sleep dis­or­der is called restric­tive sleep dis­or­der. It is famil­iar to almost every par­ent — if the child is spin­ning in bed, asks for a drink, then for the toi­let, asks ques­tions, comes up with pre­texts that pre­vent him from falling asleep, resists lay­ing down. Accord­ing to research, this behav­ioral form of insom­nia dis­ap­pears by the age of six, and, alas, it is pos­si­ble to fight it only by strict adher­ence to the reg­i­men, ignor­ing requests, and cre­at­ing rit­u­als before bed­time.

How­ev­er, some­times behav­ioral insom­nia hides oth­er dis­or­ders that pre­vent the child from sleep­ing.

Diseases and sleep disorders in children

What dis­eases and dis­or­ders are man­i­fest­ed by sleep dis­or­ders?

Rickets

In the first year, the most com­mon cause that dis­rupts a child’s sleep is rick­ets. This is in a seri­ous stage of the dis­ease man­i­fest­ed by the cur­va­ture of the bones, and at the ini­tial defi­cien­cy of vit­a­min D increas­es the excitabil­i­ty of the ner­vous sys­tem. More­over, this symp­tom can clear­ly begin to man­i­fest itself at 3–4 months, and some­times even ear­li­er — from one and a half (espe­cial­ly in pre­ma­ture babies).

The child shud­ders when falling asleep, rest­less, shy, irri­ta­ble, his head sweats a lot, because of which he tries to scratch it on the mat­tress. Because of this, hair falls out on the back of the head, a bald patch appears. Ther­a­py is pre­scribed by a pedi­a­tri­cian, select­ing the required dose of vit­a­min D based on the tests.

Anemia

Iron defi­cien­cy ane­mia can also present with sleep dis­tur­bances (Pedi­atric Research). Although most often not imme­di­ate­ly: research indi­cates an asso­ci­a­tion of ane­mia at an ear­ly age with the devel­op­ment of insom­nia in the preschool peri­od.

Pain

Bone growth pains in chil­dren, heart­burn and gas­troe­sophageal reflux, bow­el prob­lems — any­thing that can cause pain will inevitably dis­rupt sleep. There­fore, some­times, before look­ing for the cause in the reg­i­men or oth­er dis­eases, it is worth talk­ing with the pedi­a­tri­cian about the avail­able diag­noses or ask­ing the child if some­thing hurts. Chil­dren may per­ceive pro­longed and habit­u­al pain as part of nor­mal well-being.

About the signs of a growth spurt, which are accom­pa­nied by a mass of rea­sons for sleep dis­tur­bance — from emo­tions to hunger — read in this arti­cle. The good news is that this will pass once the boom peri­od is over!

Neurological disorders

Vio­la­tions of the func­tions of the cen­tral ner­vous sys­tem inevitably entail sleep dis­tur­bances. More­over, they can man­i­fest as both insom­nia and hyper­som­nia (patho­log­i­cal drowsi­ness), night­mares, sleep­walk­ing, etc.

In this case, it is impor­tant first of all to iden­ti­fy the eti­ol­o­gy of sleep dis­or­ders, to check for the pres­ence of epilep­tic activ­i­ty. This is done by a neu­rol­o­gist.

What rea­sons should be the rea­son for a neu­ro­log­i­cal exam­i­na­tion?

• Per­sis­tent bed­wet­ting over the age of four.
• Sleep­walk­ing: talk­ing, mov­ing, sleep­walk­ing.
• Fre­quent night­mares.

Night­mares require increased atten­tion, espe­cial­ly if the child does not wake up dur­ing them or does not respond to attempts at com­fort, does not under­stand what is hap­pen­ing.

Sleep dis­or­ders in young chil­dren include prob­lems falling asleep and stay­ing asleep for long peri­ods of time. Behav­ioral insom­nia is more com­mon in chil­dren than adults

sleep apnea

Sleep apnea is a prob­lem with breath­ing dur­ing sleep. In very young chil­dren, it can cause res­pi­ra­to­ry arrest or death (a rare but exist­ing sud­den infant death syn­drome, SIDS).

In old­er chil­dren, apnea leads to tem­po­rary hypox­ia, lim­it­ing the sup­ply of oxy­gen to the brain tis­sue. This also affects the well-being of adults, and for a child it can become a seri­ous devel­op­men­tal con­straint.

If the baby snores (and this is not uncom­mon, for exam­ple, with ade­noids in a child), you need to exam­ine him as soon as pos­si­ble and begin to solve the prob­lem. You also need to know that snor­ing can be qui­et, peri­od­ic, you will not hear it from the next room. But in the morn­ing, the child, despite the full dura­tion of sleep, will seem tired, sleepy or irri­ta­ble, capri­cious.

Migraine

Child­hood migraines are rare. As a rule, the num­ber of com­plaints asso­ci­at­ed with them increas­es at school age, and the peak occurs dur­ing ado­les­cence. Research shows a link between sleep dis­tur­bances and migraine headaches. Lack of night­time rest can cause attacks, and vice ver­sa: an ear­ly aura before a migraine can dis­turb sleep.

Anxiety disorder and depression

If depres­sion is more often observed in old­er stu­dents, then anx­i­ety dis­or­der can also be in the preschool peri­od.

Sleep dis­or­ders are one of the diag­nos­tic cri­te­ria for depres­sion in both adults and chil­dren. The child can prac­ti­cal­ly stop sleep­ing, or vice ver­sa, be patho­log­i­cal­ly drowsy.

With anx­i­ety dis­or­der, 9 out of 10 chil­dren have sleep dis­tur­bances. Most often — night­mares, con­stant awak­en­ings, unwill­ing­ness or inabil­i­ty to fall asleep nor­mal­ly, sleep alone. Recent stud­ies have found a bi-direc­tion­al rela­tion­ship between anx­i­ety and sleep dis­tur­bance (which is pret­ty obvi­ous): the greater the anx­i­ety, the worse the sleep. The worse the sleep, the stronger the anx­i­ety.

autism spectrum

Sleep dis­or­der in chil­dren with autism (ASD) occurs in 50–80% of cas­es. Per­haps some sit­u­a­tions are sim­ply not diag­nosed. One of the fea­tures of the influ­ence of RAS is a decrease in the pro­duc­tion of the sleep hor­mone mela­tonin and an abnor­mal release of the neu­ro­trans­mit­ter GABA. That is, the basic rea­son is the imbal­ance of the body.

This prob­lem is dif­fi­cult to solve with behav­ioral mea­sures. Although bed­time rit­u­als, rou­tine, and dark­ness in the room con­tribute to increased pro­duc­tion of mela­tonin, it can still be lack­ing. In this case, the issue of pre­scrib­ing drugs to com­bat insom­nia is being decid­ed. Experts (study in Sleep) point to improved sleep in chil­dren with ASD when tak­ing min­i­mal dos­es of mela­tonin.

Attention Deficit Hyperactivity Disorder

A fair­ly nat­ur­al fac­tor in sleep dis­tur­bance is the ADHD syn­drome. And it is also clear that the worse the sleep, the less resources for con­cen­trat­ing atten­tion and nor­mal­iz­ing the activ­i­ty of the child.

How­ev­er, few peo­ple know that sleep dis­or­ders can mim­ic the symp­toms of ADHD, lead­ing to mis­di­ag­no­sis and treat­ment.

In both cas­es, you need to improve sleep: this will reduce signs of inat­ten­tion, exces­sive activ­i­ty and impul­siv­i­ty.

Var­i­ous ques­tion­naires are used to assess sleep dis­or­ders in chil­dren: the Sleep Dis­tur­bances Scale for Chil­dren, the Child Sleep Ques­tion­naire, the Chil­dren’s Sleep habits Ques­tion­naire, and the BEARS Bed­time prob­lems scheme.

In com­bi­na­tion, they assess behav­ior when going to bed, sleepi­ness dur­ing the day, the num­ber of night awak­en­ings, and the pres­ence of snor­ing.

When to go to the doctor and what is done for diagnosis?

Chil­dren’s sleep dis­or­ders are a task with a touch of parental sub­jec­tiv­i­ty. Some­one makes an appoint­ment with a doc­tor after a cou­ple of nights with insom­nia, some­one does not go to a spe­cial­ist for months. When to go?

Experts advise seek­ing help if a child has three prob­lem­at­ic nights per week that are not asso­ci­at­ed with an infec­tious dis­ease (SARS, flu, etc.) or a change in bed­time rit­u­als, mov­ing, and so on. That is, with­out obvi­ous and inde­pen­dent­ly cor­rectable rea­sons.

The doc­tor at the con­sul­ta­tion will ask the par­ents and, if pos­si­ble, the child, exam­ine, get acquaint­ed with the case his­to­ries. To exclude somat­ic patholo­gies as the caus­es of insom­nia, blood, urine, feces (for worm eggs) are per­formed, if nec­es­sary, ECG, EEG (includ­ing dur­ing sleep), and oth­er exam­i­na­tions.

Medicines for insomnia in children

In child­hood, it is always rec­om­mend­ed to car­ry out behav­ioral cor­rec­tion in the first place before start­ing phar­ma­cother­a­py. The use of sleep med­ica­tions in chil­dren requires more research due to the increased risk of side effects and com­pli­ca­tions.

This is rather weak con­so­la­tion in the case of severe insom­nia and the inac­ces­si­bil­i­ty of behav­ioral ther­a­py for a child. In phar­ma­cother­a­py, quite seri­ous drugs are used — ben­zo­di­azepines, anti­de­pres­sants, antiepilep­tic drugs, anti­his­t­a­mines.

Of the con­di­tion­al­ly “soft” drugs, place­bo-con­trolled stud­ies con­firm the effec­tive­ness of mela­tonin in the speed of falling asleep and the dura­tion of sleep. Although a num­ber of sci­en­tif­ic works prove that even in chil­dren with ADHD and ASD with­out behav­ioral cor­rec­tion, this drug helped to reduce the time to fall asleep by only 5–7 min­utes, which once again proves that the mode and con­di­tions of falling asleep are impor­tant for any caus­es of sleep dis­or­ders in chil­dren.

In any case, before you start giv­ing some­thing to your child — from “sooth­ing herbal prepa­ra­tions” to med­i­cines, you must first of all make an appoint­ment with a doc­tor and find out if there are any under­ly­ing caus­es of the dis­or­der, oth­er meth­ods of cor­rec­tion, and whether these reme­dies are suit­able for your child. .