Insomnia

Insomnia in children is very common and is characterized by struggles around going to bed, difficulty falling asleep at bedtime or problems staying asleep during the night. Children with insomnia may also wake up very early. Insomnia can occur in children of all ages, from infants to toddlers, preschoolers, school-aged children and adolescents.

Research shows that sleep problems have adverse effects on daytime functioning, including difficulties paying attention, excessive sleepiness and fatigue, behavioral problems such as hyperactivity and poor impulse control, and difficulty regulating emotions. Children's insomnia can also deprive caregivers of sleep, causing stress and disruptions in family life.

Insomnia in children can begin at any time, from infancy through adolescence, and in some cases can develop into a long-term problem. Symptoms can include:

• Bedtime refusal and struggles going to bed
• Frequent "curtain calls" after lights out (such as requests for drinks, hugs or stories)
• Difficulty falling asleep once in bed
• Frequent or prolonged night wakings with difficulty returning to sleep independently
• Waking earlier than desired
• Resistance to an appropriate sleep schedule
• Difficulty napping
• Trouble waking in the morning or getting up for school

In addition, parents or caregivers of children with insomnia often report that the child suffers during the day. Daytime symptoms can include:

• Fatigue, tiredness, sleepiness
• Attention, concentration, or memory impairments
• Problems with social, family, occupational, or academic performance
• Mood disturbances or irritability
• Behavioral problems (hyperactivity, aggression or oppositional behavior)
• Reduced motivation
• Poor decision-making and impulse control
• Low tolerance for frustration

Many times insomnia is a symptom that is caused by something else. Possible causes of insomnia can include:

• Another sleep disorder (such as restless legs syndrome or obstructive sleep apnea)
• Anxiety or stress
• A medical, mental health or developmental condition such as asthma, depression, attention-deficit/hyperactivity disorder (ADHD), or autism
• Certain medications, such as steroids or antidepressants 
• Caffeine, found in many types of soda and energy drinks

If your child seems to be suffering from insomnia, a sleep specialist can evaluate the problem using the following techniques:

• Taking a detailed history of your child's symptoms, including any medical, mental health, or developmental issues
• Doing a complete physical examination
• A sleep log kept by parents, caregivers or the child (if he or she is old enough) for several weeks. Filling out the log helps track your child's sleep patterns and amounts of sleep over an extended period of time.
• Tracking your child's sleep patterns over two to three weeks using a wristwatch-like validated device called an actigraph.
• In rare cases, an overnight sleep study, if the sleep specialist suspects additional problems such as sleep apnea or excessive movements during sleep. (Sleep studies are unnecessary in the vast majority of patients with insomnia.)

The good news is that insomnia is treatable, especially when it is behavioral in nature. For example, some children have become dependent on special conditions to fall asleep, like being rocked or fed or just having a parent present. When they awaken at night (as all children normally do), a caregiver then has to help them fall back asleep. In other cases, the problem may be bedtime resistance by toddlers testing their limits, lack of a relaxing bedtime routine, or an inappropriate or irregular sleep schedule. Changing these habits and behaviors can lead to better sleep for everyone. A sleep specialist can help.

In older children and adolescents with insomnia, behavioral strategies usually include the active involvement of the patient in developing and carrying out the treatment plan. This may include a program developed specifically for insomnia called cognitive behavioral therapy for insomnia or CBT-I.

On rare occasions, treatment with sleep medications in conjunction with behavioral treatment may be appropriate for children with insomnia. This is more often the case in children who have more complex medical, mental health or developmental issues. Providers at Boston Children's Hospital's Sleep Center work with families to select the safest and most effective medications in these situations.

Specialists at Boston Children's Hospital's Sleep Center can help parents address these issues, which can make all the difference in getting a good night's sleep.

Our team of experts provides specialized care to meet the needs of your child.

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