Sleep disorders in children – all you need to know

There is one constant struggle with most parents — to get their child to sleep on time. However, apart from throwing tantrums at bedtime (so playtime can be extended), sleep troubles in children is a real worrisome issue. Sleep problems do not interfere with the normal growth and development of the child, but could be indicative of behavioral problems, anxiety disorders or other physiological issues. Here, Dr Preeti Devnani, sleep specialist, throws some light on child sleep problems. Here are ways to find out if your child is suffering from any anxiety disorder. Also Read - Still tired after 8 hours of sleep? 6 possible reasons

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Remember children do suffer from sleep problems and the earlier it is detected, the better. Also Read - Pediatric bipolar disorder? Read the warning signs for early effective treatment

Here are few signs that indicate that your child isn t sleeping enough:

Excessive yawning

Drooping eyelids

Decreased participation in family activities

Fatigue

Attention deficit- picked up by teachers

Poor academic performance

These are the first signs that should make you, as a parent, worried. These signs indicate that either your child isn t able to have an eight-hour of shut-eye, or there might be other problems (stress, anxiety, bullying) that make sleeping difficult. Like, adults, children too exhibits some symptoms that could indicate the problem early. Here are 10 ways to help your child sleep better.

The silent symptoms

While snoring is thought to be the most common of all the problems, here are few other symptoms of sleep problem that exists in children.

Bedwetting: If your child is only wetting at night, then it s considered as primary nocturnal enuresis. In fact, Danish researchers have found that sleep deprivation causes healthy children, aged between 8 to 12 years, to urinate more frequently and excrete more sodium in their urine. This also alters the regulation of the hormones important for excretion, and leads to higher blood pressure and heart rates. So it is definitely a matter of concern if an otherwise healthy child starts to wet the bed at night. Here are expert tips on dealing with bedwetting in children.

Abnormal behaviour while sleeping: Too much tossing and turning, talking, laughing or waking up in the middle of the night could again indicate a problem.

Sleep walking: Sleepwalking, medically known as somnambulism, is a condition that causes a person to perform activities like walking, talking, sitting up or even urinating while sleeping without having any memory of being engaged in these activities. It occurs within the first hour or two hours of sleeping, and the phase lasts for approximately 10 to 15 minutes.

Bruxism: Many children suffering from bruxism grind their teeth during their sleep in the night. This continuous grinding can eventually remove critical portions of healthy enamel from the chewing surfaces of the teeth and may cause facial pain. Although, thought to be an oral problem, this is actually a hidden sign that your child is suffering from a sleep problem.

Impaired growth: Low body weight, lack of appetite and inability to reach developmental milestones on time is a sign of sleep disorders. Know more about growing pains in children.

Recurrent infection: Seasonal cold, cough, flu and repeated viral infections are also indicative enough of sleep trouble, as sleep is essential in building your child s immunity.

Types of sleep problems

The different types of sleep problems that a child can suffer from could be:

Pediatric obstructive sleep apnea: A child can snore, breathe through the mouth, suffer from bedtime enuresis and impaired growth. At times, enlarged tonsils or adenoids could also contribute to the problem. Here are three exercises that can help your child stop snoring.

Insomnia: There are two types of insomnia a child could suffer from:

Sleep-onset association type of Behavioral Insomnia of Childhood: This type of insomnia causes frequent and prolonged night awakenings that require caregiver’s intervention to help the child return to sleep.
Limit-setting type of Behavioral Insomnia of Childhood: This is characterized by noncompliant bedtime behaviors that result in delayed sleep onset without prolonged night awakenings. The behaviors include refusal to go to bed, verbal protests and repeated demands at bedtime. These behaviors persist during nap time and night time awakenings.

Hypersomnia: This condition indicates excessive daytime sleepiness due to less sleep in the night. However, it is rare in children.

Restless leg syndrome: This could mimic the signs of growing pains and could be indicative of ADHD or linked to iron-deficiency or even childhood anemia.

Insufficient sleep syndrome: As the name suggests, this means lack of enough sleep. Your child might find it difficult to sleep enough, and that could lead to other developmental problems.

Treatment

The key to appropriate treatment and therapy is identification of the exact sleep issue or sleep problem. This may entail a detailed history and examination by the treating physician and may require a polysomnography or a sleep study.

If the situation is related to pediatric sleep apnea, the first line of treatment is ENT evaluation and identification of enlarged tonsils and adenoids. Following which a positive pressure therapy or CPAP may be required in residual cases.

Dental devices and orthodontic evaluation may be recommended if your child suffers from bruxism.

Most of the pediatric cases are related to insufficiency sleep syndrome or sleep procrastination. This will result in the education of the parent and child on the importance of good sleep hygiene, stimulus control and adequate total sleep time.

If you are dealing with a case of Restless Leg Syndrome or Periodic limb movement disorder, identification of underline causes of iron deficiency, anemia are recommended.

At times, the patient may represent abnormal sleep pattern or parasomnia, in such cases a detailed history is recommended and in addition evaluation may include a sleep study along with video monitoring to exclude other mimicking condition such as epilepsy.

In case of behavioral insomnia such as limit setting and sleep-onset association, correct sleep therapies and cognitive behavior therapy, including parents’, in the program is of paramount importance.

Why help is necessary to treat sleep troubles

Early identification of pediatric sleep problem can have an impact on the child s wellbeing into adulthood. Sleep deprivation can have an impact on almost every system of the body, including cardiovascular, metabolic, insulin resistance and immune functions and helps ensure healthier adulthood. If early intervention is not implemented, children with poor sleep habits will continue to maintain this as adults. Pediatric sleep apnea will lead to adult sleep apnea, in fact with worsening severity with an increase in body mass index and obesity. Chronic sleep deprivation from insufficient sleep syndrome and improperly treated delayed sleep phase syndrome will accumulate over time and lead to further health implications.

Here’s what you can do to help your child sleep better

Be a role model- stop the use of electronics at bedtime, and go to sleep every night at the same hour.

Ensure your child eats, exercises, and gets enough sunlight exposure, all this is necessary for maintaining a good sleep pattern.

Take clues from your child s behavior and go to sleep when she is sleepy, delaying it can lead to problems in getting enough sleep through the night.

Decide on where your child is going to sleep and maintain consistency.

Keep the daily sleep schedule undisturbed. Put your child to bed when drowsy but awake.

Set up a consistent bedroom environment, dim the lights, sing lullabies and stay away from television.

Establish appropriate sleep associations that are more acceptable such as special blankets, toys, etc., these tricks usually help baby to fall asleep without much fuss.