Sleep disorders in children is an important issue for parents and pediatricians to be aware of. Parents should also know that sleep problems are quite common in children, especially those who are healthy and growing well. Most can be easily managed at home with little or no intervention by health care professionals.
Most young children (particularly infants) experience normal periods of fussiness or irritability that are associated with sleepiness. When parents become overly concerned about the amount of sleep their children are getting, they may begin to view these normal episodes as signs of a sleep disorder.
A small percentage of children have medical conditions or other factors that are associated with excessive daytime sleepiness. These children have true “sleep disorders” requiring evaluation by a health care professional.
If your child naps well, go to sleep easily at bedtime, and wakes up refreshed in the morning, there is no reason for concern as this is probably an age-appropriate variation of normal. However, if you have concerns or notice that your child does not meet these criteria, discuss it with your pediatrician.
- 1 What causes poor sleep in kids?
- 2 How do you treat sleep disorders in children?
- 3 Signs of sleep disorders in children
- 4 Sleep disorders and their symptoms
- 5 How do children sleep?
- 6 Types disruptions to sleep
- 7 Tips for improving your child’s sleep
- 8 Conclusion
- 9 FAQ’s
What causes poor sleep in kids?
For some children, there is a clear cause of the sleep disturbance such as an underlying medical condition. In other cases, there may be no apparent reason for the poor quality of sleep.
It’s helpful to consider common reasons why sleep patterns can become disturbed including:
- Illness — even mild illnesses such as colds and stomach aches –can affect the ability to fall asleep and stay asleep. Some types of chronic illnesses (such as asthma) can also lead to bad dreams and night terrors (see below).
- Hunger or uncomfortable — if your child falls asleep easily but wakes frequently during the night for food or comfort, then it may indicate that he isn’t getting enough daytime calories to sustain him at night. If he continues to wake and doesn’t want to eat, then take him for a medical evaluation to ensure that there isn’t an underlying sleep disorder such as apnea (see below) or reflux.
- Comfort — young children often need comfort and reassurance at night which can include physical contact with parents. It is important for parents to establish appropriate limits on this behavior so it does not become a source of sleep disturbance. For example, if your child needs you in order to fall asleep but always wakes from nightmares throughout the night, it may be helpful to make other provisions for comfort including the use of a transitional object such as a blanket or stuffed animal.
- Irregular schedule — if your child gets sleepy at different times every day and has problems falling asleep each night, this may indicate a problem with his schedule. It is important to establish a bedtime routine and consistent sleep schedule for better sleep hygiene.
- Enuresis — if your child wets the bed at night, take him to the doctor to rule out an underlying medical disorder such as diabetes or infection.
How do you treat sleep disorders in children?
Before your child starts treatment, he will need a thorough evaluation by a pediatrician or other qualified health care professional. This may include a referral to a pediatric sleep specialist if necessary.
It is important for parents to know that many pediatric sleep disorders can be successfully managed at home with some patience and effort on the part of everyone in the family. Treatment should be aimed at identifying and correcting specific causes of poor sleep which may include:
- Establishing a routine schedule for going to bed at night and naps during the day
- Promoting good sleep hygiene (such as keeping the bedroom dark and quiet)
- Controlling exposure to bright lights (TVs, computers) during the hour before bedtime
- Ensuring appropriate amount of food and drink before bedtime
- Controlling the amount and type of activities (including exercise) during the hour before bedtime
- Protecting against noise disturbances during sleep Some sleep problems require additional treatment such as medications, behavior modification, or environmental changes.
However, it is important to remember that many causes of poor sleep in children do not require any intervention at all including normal puberty, developmental stages such as toddlerhood and adolescence, and temporary stressors such as family moves or a break-up with a friend.
If you have concerns about your child’s sleepy behavior there are a number of interventions that should be considered:
- “Sleep hygiene” — the most common and effective treatment for chronic sleep problems in children is a healthy lifestyle that includes early bedtimes, quiet bedrooms, and adequate exercise.
- Medication — depending upon the diagnosis there are a variety of medications that can be prescribed to induce sounder sleep. Do not use over-the-counter allergy or cold medicines containing antihistamines as they have been shown to interfere with both slow-wave and REM (dream) sleep patterns in normal subjects and may worsen nighttime restlessness and other sleeping disorders.
- Counseling — some families benefit from family therapy or counseling to address specific concerns such as an excessive conflict between siblings about going to bed; separation anxiety; fear of the dark; sexual issues; nightmares, or other unusual associations which may exist between sleep and the bedroom.
- Behavioral Therapy — your pediatrician may recommend a program of “positive reinforcement” for children with chronic sleep problems to promote good behavior.
All children are different, but most children’s trouble falling asleep can be successfully managed without medical intervention if parents work together as a team essentially “training” their child to sleep better at night.
The key is patience and understanding that it takes time, consistency, and effort on everyone’s part during treatment. Treatment will often include changes in daily patterns or routines so it is helpful to have support from family members including siblings who are not being directly affected by the sleep disorder.
It is important you consult with your pediatrician before starting any new sleep routine or treatment plan.
Signs of sleep disorders in children
- Daytime sleepiness, irritability, mood swings
- Night awakening with trouble falling asleep
- Restlessness or agitation during the day because of poor quality of nighttime rest
- Impaired performance at school due to poor concentration and memory
- Frequent nightmares or fearfulness during the night
- Falls asleep watching TV, playing video games, etc.
- Can’t be awakened for school; falls asleep in class
- Sleeps excessively during the day; naps more than 1 hour, often after lunch
- Feels tired all the time; no energy
- Being irritable, cranky, having tantrums; acting out
- Has trouble waking up; slow to respond to parents’ call
- Bedwetting (not due to size or age), sleep terrors (intense crying and screaming during sleep)
Sleep disorders and their symptoms
Childhood insomnia is one of the primary sleep disorders. When kids are under a lot of stress, the body releases certain chemicals in response to this which can make it difficult for them to fall asleep. If your child is suffering from insomnia and sleep deprivation, one way that you can help improve their sleep quality is by engaging in relaxing activities with them before bedtime. For example, playing calming games together can help to reduce your child’s stress levels.
- Narcolepsy in children is a chronic sleep disorder that involves uncontrollable episodes of deep sleep which cause a person to suddenly fall asleep at various times throughout the day, regardless of how interesting or repetitive their activity may be. The average age of onset for narcolepsy is between ten and fifteen years old.
- Sleepwalking in children is an episodic behavior during which the child gets up from bed and wanders around while still sleeping or sleep talking. They can accomplish complicated tasks such as dressing, unlocking doors, or pouring a glass of milk. The main concern for sleepwalkers is that they could potentially hurt themselves during their episode because they are not aware of what they are doing nor where they are going.
- Circadian rhythm disorder refers to those rare instances when exposure to sunlight does not normally keep a person’s cycle on track. Similar to jet lag, these children can be chronically tired or sleepy at times that do not agree with their calendar – i.e., if your child consistently feels this way on Saturdays and Sundays then it may be that his/her internal “clock” is running differently than usual.
- Bedwetting (enuresis) in children occurs when a person has not reached the appropriate level of bladder and bowel control to stay dry during the night or at naptime. Bedwetting can be very stressful for both children and their parents because it can disturb sleep, but fortunately, it is one of the more easily treated sleep disorders as most children will overcome this condition as they grow older.
- Night terrors in children are another form of nocturnal parasomnia which involves an episode where a child suddenly wakes up screaming and carrying on as if he/she were being threatened or chased by some sort of sinister creature even though nothing like that ever happened before bedtime. Also, these episodes usually occur during deep sleep, unlike nightmares which are dreamed during REM sleep. Sleep terrors are not associated with children who have problems falling asleep, nor do they seem to be influenced by what the child may have been watching on TV or playing on the computer before bedtime. They also tend to happen more frequently during times of stress and/or transitions in life such as moving from one house to another or starting a new grade at school.
- Parasomnia is a broad term that means abnormal activity during sleep – i.e., sleepwalking, talking, breathing abnormally, having night terrors or nightmares, etc. There are many different types of parasomnias but the most common ones include:
- Confusional arousal – episodes where a person suddenly wakes up confused and unable to understand what’s going on around them
- Sleepwalking – Sleepwalking in children is usually hereditary but if your child exhibits frequent sleepwalking behaviors then you should talk to their pediatrician. Sleepwalking occurs during deep delta sleep so it commonly affects kids who are four to eight years old. Also, night terrors tend to happen in children who are six years old or younger while nightmares usually affect older kids.
- Night terrors – sudden awakening during a deep sleep with screaming, crying, intense fear, etc. This can also cause the child to get inadequate sleep.
- Gastroesophageal reflux (GER) involves the abnormal flow of stomach acids into the esophagus which can lead to acid reflux or heartburn in infants and children. This is because an infant’s lower esophageal sphincter may be weaker than usual until they are six months old, so it tends to allow the acidic contents in their stomachs to move back towards their mouth instead of staying down in the belly where they belong.
- Restless legs syndrome in children is a condition where those who experience it feeling an overwhelming urge to move their legs as soon as they sit still for too long. Some people liken this feeling to being uncomfortable wearing socks, while others say they have the sensation of having ants crawling around in their shoes. But regardless of what it is called or how one perceives it, restless leg syndrome can cause children to begin fidgeting and making motions with their legs which eventually disrupts everyone else’s sleep.
How do children sleep?
Mostly on their stomachs with 1 to 4 episodes of waking up for 1-2 minutes every night
- 3–6 months – child falls asleep through the night (7–10 hours) while continuing to sleep primarily on their stomachs (99%)
- 6–12 months – usually transition to sleeping on their backs, but around 7% continue to occasionally sleep on their stomachs
- 1 year old – average total nighttime sleep is 10+ hours per day and only 2-3% of younger children still have some nighttime wakening to go to the bathroom.
Beyond the first birthday
- 2-3 years old – average total nighttime sleep is 10.5 hours per day, but they still have a 19% chance of waking up in the middle of the night for 1 to 3 minutes
- 3–5 years old – average total nighttime sleep is about 11 hours per day and most children (75%) no longer wake up at night to go to the bathroom
- 5-6 years old – average total nighttime sleep is around 11.25 hours with only 8% wakening during the night
- 6–13 years old – will fall asleep independently, boys tend to get an hour more of sleep per night than girls (in terms of duration) and they also experience slightly less frequent sleep disturbances
Caffeine, alcohol, and nicotine can all prevent a child from getting a good night’s sleep because they have stimulant effects. These substances could also cause changes in breathing patterns during the night so it’s especially important to avoid giving children any of these before bedtime.
In addition, food consumption within four hours of going to sleep is associated with more nighttime waking, so parents should help their children and adolescents avoid large meals just before bedtime.
Types disruptions to sleep
Sleep apnea in children and adolescents is considered a form of sleep disorder where breathing is interrupted multiple times during the night. The most common cause of sleep apnea is enlarged tonsils and adenoids. If children with this condition are overweight or obese, that also tends to exacerbate the problem.
There are two types of sleep apnea:
- Central – caused by a blockage in the brainstem which inhibits its ability to properly send signals to the muscles for proper respiratory effort; often associated with neurological disorders such as cerebral palsy
- Obstructive – occurs when there’s an obstruction between the mouth and throat which makes it difficult to breathe; may be due to obesity, enlarged tonsils/adenoids, etc.
Night terrors are often experienced by children as they enter the first stage of deep sleep. During this stage, most people are hard to wake up because their sympathetic nervous system is activated (which is responsible for the “fight or flight” response).
Symptoms can usually be differentiated between nightmares and night terrors based on how long they last. Nightmares usually occur during REM sleep which means that even if someone wakes a child with a nightmare up, they’ll likely still remember it in the morning.
However, since children experiencing night terrors are in slow-wave sleep when it happens, they usually won’t remember anything about what happened once they wake up.
Restless leg syndrome
Restless legs syndrome is a condition where the brain signals to move your legs because they’re uncomfortable. However, while it’s most common in adults, this condition can also affect children and usually starts around 10 years of age. It tends to run in families and along with other neurological conditions such as Parkinson’s disease or restless arm syndrome. In addition, iron deficiency could be a potential cause.
Tips for improving your child’s sleep
You can improve your child’s sleep by adhering to good sleep hygiene which includes the following tips:
- Establishing a fixed bedtime routine of bathing, brushing teeth, reading books, etc.
- Make sure the bedroom is dark, cool, and comfortable
- Ensuring that your children get plenty of physical exercise during the day
- Avoiding heavy meals late in the evening/at night
- Avoiding caffeinated drinks for at least six hours before bedtime
- Removing all electronic devices from the bedroom so that your child isn’t stimulated by bright screens late in the evening
- Comforting your child when they experience nightmares or night terrors to ensure they don’t become afraid of going to sleep
- Ensuring that your child gets enough sunlight during the day so that melatonin can be produced properly to help them fall asleep at night
- Avoid using sleep aids such as over-the-counter medications, prescribed sleep medicine, and herbal supplements without consulting with a doctor first.
There are also medical treatments that can be used for kids with sleep disorders. For example, adenoidectomy or tonsillectomy could be helpful if your child has sleep apnea due to enlarged tonsils or adenoids. However, it’s important to note that most pediatricians usually recommend taking a conservative approach before resorting to surgery since it can have some side effects.
Sleep disorders in children are often caused by other medical problems such as heart disease, respiratory issues, or neurological conditions. However, there are also some sleep disorders that may not be considered a direct complication of another condition such as night terrors and restless leg syndrome.
Although most sleep disorders can’t always be cured completely, it’s still important to talk to your doctor or a sleep specialist if your child experiences symptoms like frequent nightmares and/or night terrors because they could reflect underlying psychological issues.
In addition, getting enough sunlight during the day helps promote melatonin production at night which helps with sleep quality. Therefore, make sure you protect your child from bright light sources like computer screens for about six hours before their regular bedtime to ensure good nighttime rest and avoid poor sleep.
How do I know if my child has a sleep disorder?
Like adults, kids may suffer from sleep disorders such as insomnia or narcolepsy. However, there are some children who don’t seem to experience much difficulty sleeping so it’s difficult for parents to know if their child has a sleep disorder.
It’s important to note that nightmares usually occur during REM sleep while night terrors happen when the child is sleeping at a stage called “delta sleep.”
Therefore, night terrors tend to affect children who are six years old and younger while nightmares usually occur in older kids. In addition, restless leg syndrome could potentially happen to anyone regardless of age.
What are three common sleep problems in early childhood?
Night terrors, nightmares, and sleepwalking are all common childhood problems that parents should be aware of. Night terrors tend to occur in children who are six years old or younger while nightmares affect older kids. Sleepwalking occurs during deep delta sleep so it often happens to children between the ages of four to eight years old.
How do I know if my child has a sleeping disorder?
Symptoms of sleep disorders in children are similar to those that adults experience. For example, some kids may have difficulty falling asleep or staying asleep throughout the night. In addition, restless leg syndrome can make it difficult for kids to sit still during the day because their legs tend to twitch and jerk around involuntarily.
Kids with severe sleep disorders such as sleep apnea may sometimes start to breathe through their mouths at night. However, this symptom can also occur in kids who aren’t suffering from any medical condition. It’s important to talk to your doctor if your child exhibits frequent snoring or signs of breathing disruptions when they’re sleeping.
What causes sleep problems in toddlers?
Some toddlers may suffer from sleep problems such as insomnia or night terrors. Toddlers usually get about 10 – 13 hours of sleep each day but if your child is having difficulty sleeping you should talk to their pediatrician. It’s possible that your toddler isn’t getting enough exposure to natural sunlight throughout the day (which can help promote melatonin production at night) or they may have a condition such as obstructive sleep apnea. In addition, restless leg syndrome is also common in kids who are three years old and younger.
Can a 2-year-old have a sleep disorder?
Night terrors, restless leg syndrome, and sleepwalking are all common in kids who are three years old or younger so it’s not unusual for a child who is two years old to experience any of these. However, night terrors tend to affect children who are six years old or younger while nightmares usually occur in older kids. Therefore, make sure you consult your child’s pediatrician if you notice that he/she is getting poor sleep.