What is insomnia?
Insomnia is a sleep disturbance in which children have trouble
falling asleep or staying asleep at night. Sometimes the complaint is one of
waking up too early. While older children may complain of this on their own,
often it is the parent of the youngster who brings this to attention. Insomnia
complaints are generally associated with a feeling of non-restorative sleep and
impairment in daytime functioning.
Insomnia can be classified based on duration (short or long
term), severity and frequency of the problem. Short-term insomnia may occur for
just a few days to weeks and is caused by factors that will usually easily pass
(eg, sickness, a short-term medication your child is taking). Long-term insomnia
occurs three times a week for a month or longer and may be caused by factors for
which you would seek medical advice for your child (eg, depression, anxiety,
pain, medical problems). Sometimes, there may be no obvious reason at all. In
children, bedtime resistance and dependency on a parent to initiate sleep is
also considered as form of insomnia with behavioral causes at the root of the problem.
What are the symptoms of insomnia?
Symptoms of insomnia include:
- Being sleepy during the day
- Making errors or having accidents
- School or disciplinary problems
- Irritability/mood swings
- Depression
- Hyperactivity
- Decreased attention span
- Aggression
- Memory problems
- Tension/worry about going to bed and being able to fall asleep
- Sleep problems – difficulty falling asleep or staying asleep or waking
up too early in the morning
What causes childhood insomnia?
There are a number of possible causes of insomnia, including:
- Stress. Yes, kids, just like adults can suffer from stress. So don’t
hesitate to show interest in your child’s life and build trust so they feel
comfortable sharing their worries with you. Ask how things are going at
school. Is your child being bullied by someone? Is everything under your own
roof running smoothly (ie, is there arguing, fighting between siblings,
marital or financial problems; has there been a death in the family, a
recent job change; has the family recently moved)? Children worry more than
you might think and excess worry and stress can lead to insomnia.
- Use of caffeine or other stimulants. Remember even some clear sodas
and most energy drinks have caffeine. Nicotine and alcohol interfere with
sleep as well.
- Side effects of certain medications. For example, drugs used to
treat attention deficit hyperactivity disorder, antidepressants,
corticosteroids, and anticonvulsants can cause insomnia.
- Medical, psychiatric and other sleep disorders. Uncontrolled
nighttime asthma, a stuffy nose from allergies or itchy skin from eczema can
get in the way of good sleep. If these conditions are chronic, they may be
easily ignored until they have an acute flare up. Other medical disorders,
including fibromyalgia, muscle cramps, growing pains, heartburn, and thyroid
disease can all cause insomnia. Be sure to have your child’s physical health
examined as a possible cause of insomnia. Sleep disorders such as
obstructive sleep apnea (associated with snoring) and restless legs syndrome
may interfere with your child sleep. Neurodevelopmental disorders, such as
autism, mental retardation, and Asperger’s syndrome, can also be a cause of
insomnia. Finally, psychiatric conditions like depression or bipolar
disorder can be associated with poor sleep.
- Environmental factors. Noise, heat, cold and light conditions in the
bedroom can interfere with sleep. Make sure the bed and mattress are
comfortable and the bedroom is organized to reduce environmental
interference. This includes restrictions on the use of electronics in the bedroom.
How is insomnia diagnosed?
There is no specific test for insomnia. The diagnosis is based
on symptoms and the exclusion of other medical problems, psychiatric problems
and sleep disorders.
How is insomnia in children treated?
Treatment methods for insomnia in children can involve any of the following:
- Institute good sleep hygiene habits. Good sleep hygiene habits
include: restricting time spent in bed to simply sleeping (no reading, doing
homework or watching TV in bed); maintaining a regular sleep schedule (going
to bed and waking up at the same time each day including weekends and
holidays); avoiding caffeinated products 4-6 hours before bedtime
(caffeinated products include coffee, tea, colas, some non-cola pops, energy
drinks, and chocolates); avoiding tobacco and other drugs; maintaining a
bedroom that is quiet, calm, comfortable (< 75°
F), and dark (a nightlight is acceptable for children afraid of a dark
bedroom); and establishing a bedtime routine that does not include
stimulating activities within an hour of bedtime (such as TV watching, heavy
homework, or computer gaming).
- Teach children how to relax. Deep breathing, positive mental imagery
while lying in bed (such as visualizing the sun’s caressing rays beachside
or breathing in fresh, cool mountain air), and other relaxation techniques
(eg, quiet abdominal breathing) can be a helpful aids to falling asleep.
- Remove clocks from the bedroom. It may be best to remove all clocks
from the bedroom – or at least turn their face away from the bed so that
your child does not see it while trying to sleep. Watching the clock while
trying to sleep can cause anxiety and make it harder to fall asleep.
- Set bedtime to obtain the usual amount of sleep. Set bedtime so that
your child gets his or her usual amount of sleep – the typical 9 to 11 hours
per night depending on your child’s age. (Children between the ages of 6 and
12 need about 10 to 11 hours of sleep each night; teens need about 9 hours
of sleep each night.)
- Get up out of bed instead of tossing and turning. It is better for
your child to get up and engage in a very calm activity for 15-20 minutes,
such as reading, rather than stay in bed and toss and turn if he or she
can’t sleep. After staying out of bed for 20-30 minutes or so, return and
attempt to sleep. After a 15-20 minute attempt and no success, get up again
and try the relaxing activity again. Repeat the cycle as necessary.
- Consider behavioral therapy. Specialists in behavioral and cognitive
therapy are sometimes needed to work with the child and family to help with
non-drug psychological methods. These methods are very helpful and generally
better for the child in the long term. Your sleep specialist is a good
source for more information in this regard.
A word on medications. Medications are usually not
recommended for children and adolescents with insomnia and are used only in very
special circumstances. It is much more important to look for any underlying
medical or psychological problems that may need to be treated first. Another
issue with insomnia medications and sleeping pills and aids is that many have
not been approved by the FDA for use in children. It is important to work
closely with your doctor regarding medication issues, and this includes
over-the-counter drugs, supplements (eg, melatonin), and herbal products you
might be considering giving your child.
Additional Sleep Information and Suggested Readings
Mindell, JA and Owens, JA. A Clinical Guide to Pediatric
Sleep: Diagnosis and Management of Sleep Problems. Philadelphia, PA:
Lippincott Williams and Wilkins, 2003.
http://www.sleepeducation.com and other educational links on the
American Academy of Sleep Medicine website http://www.aasmnet.org.
The National Sleep Foundation at http://www.sleepfoundation.org.