Sleep Disturbance in Children

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Table of Contents

Different Presentations of Sleep Disorders
Pathophysiology
Differential Diagnosis
Pertinent Subjective and Objective Data
Management Plans
Advice to Parents
Reference

Some sleep disorders during infancy and early childhood may be caused by specific behaviors, whereas others are because of neurological or medical issues. Contributing factors may include parental inability to set limits and maladaptive sleep onset associations. Children who resist or refuse to go to bed due to limit-setting issues may experience behavioral sleep problems. The above occurrence is most common in toddlers and older kids. It is caused by a lack of consistency in nighttime routines and the enforcement of defined restrictions. Bedtime resistance is common in young children and is often transient. Behavioral causes of sleep disorders are primarily associated with young children aged five years and below; however, the condition can last throughout middle childhood.

Sleep onset associations, such as being rocked or fed as an infant or toddler, might result in slow sleep onset and protracted night arousal, necessitating parental assistance. Any disorder that alters the craniofacial or pharyngeal anatomy predisposes the child to obstructive narcolepsy is considered a medical problem associated with sleep disturbances in children (Leschziner, 2019). Cerebral palsy, autism spectrum disorder, and other neurological disorders are linked to neurobehavioral and circadian sleep disruption.

Different Presentations of Sleep Disorders

There are many presentations of sleep disorders: firstly is about parasomnias, which are unpleasant physical events or feelings that happen at the start of the doze, throughout the nap, or when waking from a snooze. They include nightmares, sleep paralysis, and sleep enuresis (Shibeika & Al-Jewair, 2019). Confusional arousals are similar to nocturnal episodes, and they are characterized by confusion, disorientation, grogginess, and agitation upon awakening from sleep (Leschziner, 2019). Sleep terrors are episodes of arousal from sleep that are accompanied by autonomic system responses such as tachycardia, sweating, dilated pupils, and intense fear and screaming.

Secondly, enuresis is defined as uncontrollable urination during sleep twice a week for at least three months in children over five. Enuresis can be primary if the child has never been dry for six months or secondary if it has been dry but not bedwetting at least twice a week. Thirdly, breathing-related sleep disorders, such as Obstructive Sleep Apnea (OSA), cause a child’s breathing to be disrupted as they sleep (Leschziner, 2019). OSA is characterized by periods of persistent airway blockage while sleeping, resulting in partial or complete cessation of airflow at the nose or mouth. It is common in children with enlarged tonsils and adenoids, obesity, and craniofacial anomalies. It also affects children with neuromuscular disorders such as muscular dystrophy, which cause muscle weakness. Central Sleep Apnea is the repeated cessation or decrease in airflow and ventilatory effort while sleeping (Shibeika & Al-Jewair, 2019). The etiology can be either primary or secondary. Cheyne-stokes breathing is an example of secondary central sleep apnea.

Fourthly is rhythmic movements associated with sleep where children frequently use rhythmic movements such as bruxism, body rocking, headbanging, and head rolling to self-soothe. This can happen at the start of sleep or after arousals during the night. Fifthly is the syndrome of restless legs, which is the desire to move one’s legs accompanied by unpleasant sensations in the lower extremities. Increased leg movement alleviates the discomfort and urges to move.

Pathophysiology

The first step in treating child sleep disorders is developing expectations about typical pediatric sleep. Behavioral modification methods may be able to help with some of the problems. The Clinics have teams of behavioral psychologists certified in treating sleep issues who work with children and their families. In addition, there are platform pediatric and adult sleep experts with experience in pediatric sleep disorders (Leschziner, 2019). In some disorders, regular awakenings, positive thinking, and other measures may be helpful. A doctor may prescribe medications or supplements to address a particular sleep problem or other illness.

Differential Diagnosis

Delayed sleep-wake cycle disorder is a condition that disrupts the body’s internal mechanism. It occurs when a sleeping pattern lags behind a regular sleep routine by two hours or more, causing one to sleep later and wake up later (Shibeika & Al-Jewair, 2019). Idiopathic hypersomnia is described as a condition characterized by excessive daytime sleepiness. Self-stimulatory or self-injurious behavior, such as head banging, is typical in children with developmental delay (Leschziner, 2019). Frequent nightmares may be linked to psychiatric disorders such as bipolar disorder, anxiety, or posttraumatic stress disorder. In child abuse, children who have been subjected to emotional, sexual, or physical abuse may experience nighttime terrors.

Pertinent Subjective and Objective Data

The subjective data include difficulties in falling asleep and getting up earlier than usual and problems in sleeping without the assistance of a caregiver. Moreover, excessive daytime sleepiness and its consequences concentration are impaired. Others include irritability, being prone to mistakes or accidents, challenges with behavior, aggression, impulsivity, and hyperactivity (Leschziner, 2019). In addition, complaints about sleep dissatisfaction and reluctance to adhere to a reasonable schedule are also issues.

The first objective is a complete and detailed sleep history, bedtime schedule, presence of a set bedtime, consistency of respite, and caregiver enforcement. The second objective is routines for rest, which includes evening activities such as watching television, playing video games, and participating in sports. The time at which the bedtime routine begins, and the practice’s length and location are all factors to consider (Leschziner, 2019). Thirdly, it is about the environment and sleeping arrangements, including bedroom space and location, co-sleeping, bedroom sharing, and bedding type. Lastly, there is always a specific time for waking up in the morning: however, one experiences difficulties.

Management Plans

Behavioral or non-pharmacological therapy, the overall therapy to eradicate faulty sleep onset connections and minimize undesired evening behaviors, is the first strategy to manage the above issues. Developing a regular nighttime regimen that excludes engaging activities will help achieve this (Leschziner, 2019). Others include making new sleep associations, improving their self-soothing abilities, reducing parental attention to problem behavior, and reinforcing appropriate behaviors with positive support. Teaching techniques for self-relaxation and cognitive behavior strategies are also necessary.

Secondly is the application of pharmacologic therapy since melatonin is the most well-studied pharmacologic intervention. Thus, it may be prescribed for mentally delayed children who have sleep issues. A standard dose varies from 1–10 mg and is administered 30-1 hour before intended bedtime. Antihistamines are the most often utilized sedative in children and can cause tolerance (Leschziner, 2019). Moreover, surgery or adenotonsillectomy is recommended for children with obstructive sleep apnea to remove enlarged tonsils and adenoids. However, if the child has unusual facial anatomy, surgery is not recommended.

Advice to Parents

Parents are advised to put their infant or child into practice. Starting around 10-12 weeks, children should be laid to bed while drowsy but awake. This prevents the development of sleep associations such as rocking or being held. Thus, allow the child to sleep in the parent’s room. Ideally, the baby should sleep in one’s room alone in a crib, bassinet, or other infant-specific structure for at least six months and possibly up to a year. This could help to lower the risk of sudden infant death syndrome. However, toddlers should not be allowed to sleep in adult beds. A baby can become entrapped and suffocate between the slats of the headboard, the mattress, and the bed frame, or the mattress and the wall. If a sleeping parent rolls over and accidentally covers the baby’s nose and mouth, the baby can suffocate.

Reference

Leschziner, G. (2019). The nocturnal brain: Nightmares, neuroscience, and the secret world of sleep. St. Martin’s Publishing Group.

Shibeika, D., & Al-Jewair, T. (2019). The association between temporomandibular joint disorders and sleep disorders in adults: A systematic review. Sleep Medicine, 64, S8.

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