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.
During sleep, the body produces somatotropin, a hormone necessary for growth, and a host of other bioactivating substances.
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?
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.
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.
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!
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.
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.
It is important to know that nightmares (“night terrors”) may indicate epilepsy. In this case, terrible dreams manifest themselves in almost the same way. The child seems to be waking up, but his gaze is frozen, his limbs are trembling, there is no reaction to adults.
In addition, although this is called a “nightmare”, it often happens that the baby does not feel fear, that is, the emotional coloring is absent or smoothed out. In the morning the child is lethargic, depressed, complains of feeling well.
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 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.
Researchers have found that children’s snoring is often associated with hyperactivity, increased anxiety, and nervous excitability. All this may be a consequence of brain hypoxia during sleep.
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.
Interestingly, when interviewing a doctor, children and adults more often indicate sleep disturbances in depressive states, and in anxious states they tend to hide nighttime problems.
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.
Prescribing melatonin to children is a controversial issue. Experts argue that it should be decided on an individual basis. This is a hormonal remedy with its own side effects, especially in childhood.
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. .
Effects of melatonin and bright light treatment in childhood chronic sleep onset insomnia with late melatonin onset: A randomized controlled study. / A., Meijer, AM, Smits, MG, et al. // sleep - February 1, 2017 - 40(2)
Sleep hygiene practices and bedtime resist ance in low-income preschoolers: Does temperament matter? / Wilson, K.E., Lumeng, J.C., Kaciroti, N., et al. // Behavioral Sleep Medicine - September 3, 2016 - 13(5)
Sleep disturbances and serum ferritin levels in children with attention-deficit/hyperactivity disorder. / Cortese S, Konofal E, Dalla Bernardina B, et al // Eur Child Adolesc Psychiatry - 2009 - 18(7)
Iron deficiency anemia in infancy is associated with altered temporal organization of sleep states in childhood. / Peirano PD, Algarín CR, Garrido MI, et al // Pediatric Res - 2007 - 62(6)
Cross-cultural differences in infant and toddler sleep. / Mindell JA, Sadeh A, Wiegand B, et al // Sleep Med - 11(3)