Sleep disorders in children

What are sleep disorders?

Sleep disorders is a collective name given to any type of disrupted sleep that a child may experience. The signs and symptoms of sleep disorders may vary depending on the child’s age and stage of development. There is a wide range of different sleep disorders in children including some that are behavioural, others that are obstructive (obstructed sleep apnea), and sleep-related movement disorders. However, in the following post I will be focusing mainly on the type of sleep disorders called parasomnias.

But first, let’s start with some basics

We all know how important sleep is for infants, but what happens when our children grow a little bit order?
According to the American Academy of Sleep Medicine, the recommended hours of sleep required by children are as follows:
Infants 4 – 12 months: 12 – 16 hours
Ages 1 – 2 years: 11-14 hours
Ages 3 – 5 years: 10-13 hours
Ages 6 – 12 years: 9-12 hours
Ages 13-18 years: 8-10 hours

And why is this important? Bear with me and you will find out…

What are parasomnias of childhood?

So, as I mentioned above, one of the types of sleep disorders in children is referred to as parasomnias. These are short-lasting, odd behaviours that a child may experience when they are asleep and often these behaviours will cause parents to be very worried and seek medical attention, just like my friend did the other day when she noticed her child was going through this.
It is important to distinguish between parasomnias that occur in perfectly healthy children and those that occur in children with underlying medical problems (such as developmental delay, psychiatric problems and other medical disorders).

What types of signs and symptoms do we see when a child is suffering from parasomnias?

These odd behaviours tend to occur when a child is at that phase that is between being asleep and awake. Therefore, what we often see is a mix of features – the child may talk or move, as if they were completely awake, and at the same time might by confused and unable to respond to their parents (and this part is often very worrisome for the parents). Moreover, the child usually does not remember the event when they wake up the next morning. These episodes will normally last about half an hour.

What are the main types of parasomnias in childhood?

There are 4 main types of parasomnias:
1. Confusional arousals – episodes during which the child moves around violently in bed but will usually not get up and out of bed. These tend to occur in the first third of the night and in younger children. The episodes usually last about half an hour. If the child is forced to wake up, they are typically confused. They may also be confused on awakening in the morning. Note that these may also occur at the same time with number 2 and 3 below.

2. Sleep terrors – episodes of screaming that usually occur in the first third of the night and last only a few minutes. This is very common in children between the ages 1-5 years but may happen at any age, from infancy to adulthood. They may be accompanied with a fast heart rate and dilated pupils. The child tends to be confused when you attempt to awaken them. The episodes usually last approximately 10 minutes (but they can be longer), and the child does not remember anything by the end of the episode or the following morning. That is why these episodes do not have any long-term psychological implications on the child. The parents, on the other hand, often feel very frustrated and frightened.

3. Sleepwalking – this usually occurs in the first third of the night and in younger children. It is actually quite a common phenomenon, and by the age of 10 years, about 13% of children have experienced a sleepwalking episode at least once in their life. It is more common in families with a history of sleepwalking and in children with a history of sleep terrors. These are one of the few parasomnias that may actually pose the child at risk as he/she may end up wandering outside or falling out of a window.

4. Nightmares – these usually occur in the last third of the night. They may occur both in children and adolescents or adults.

What is the underlying cause behind parasomnias?

The actual biology behind why these sleep disorders occur is unknown. There are several hypotheses that propose a combination of genetic factors and a problem with the brain’s ability to distinguish between an awake-state and a sleep state. Two additional factors that may contribute to parasomnias are certain medications and sleep deprivation. Obstructive sleep apnea, a condition in which a child is unable to breathe properly when asleep due to an obstruction of the area, may also exacerbate such disorders.

Can parasomnias be a sign of a more serious disorder?

This is a very important question. One of the main concerns with parasomnias is that they may be difficult to distinguish from nocturnal (occurring at night) seizures.

How are parasomnias diagnosed?

Usually, an experienced physician will be able to listen to your story and make the diagnosis. If there is uncertainty, he/she may order a polysomnography. These are overnight studies in sleep labs where sensors are placed on the child’s body to record and monitor brain waves, oxygen levels in blood, heart rates, breathing rates, eye and leg movements.
Seizures can be diagnosed with the help of EEG tests (electroencephalography). This is a test that measures electrical activity in the brain through metal discs that are placed on the scalp.

If I am not sure whether it is a seizure or a sleeping disorder – what do I need to do?

If you are not sure whether your child is experiencing a sleeping disorder or a seizure, an important tip I have for you is to try and take a video of the episode and seek medical attention for consultation. Some other important signs to look out for:
– While parasomnias usually occur in the first third of the night, nocturnal seizures can occur at any time of the night.
– Screaming during the seizure episode is less common than in parasomnias.
– Nocturnal seizures typically occur in adolescents while parasomnias occur more commonly in younger children.
– Similarly to most parasomnias, the child is always confused after the event.

Please be aware that younger children, who are typically healthy, may also have febrile seizures throughout the night if they are not feeling well. Read more about febrile seizures in the link here.

I think my child has a parasomnia, how can I help him/her?

If your child has shown signs of parasomnias, there is very little you can do as a parent and it is important to know that these episodes tend to resolve on their own.
A word of important advice – when a child is having sleep terrors or nightmare try not to do anything that may startle them even more. I know it may be very frightening for you but try not to yell or show them how stressed you are. Stay calm, talk to them in a quiet voice. And please, please, do not spill water on them or do any of that sort of stuff.

Here are a few more tips that you may want to pay extra attention to:
– Make sure your child is getting sufficient hours of sleep every night.
– If your child is consuming caffeine, restrict caffeine intake.
– If your child is experiencing sleepwalking – make sure to keep him/her safe by securing tops of staircases, locking outside doors and windows and installing alarms if needed.
– If your child has confusional arousals at the same time every night, seek your medical provider for further help. One management technique is to wake them up 15-30 minutes before the episodes occur to prevent them from occurring.
– Seek further medical attention if you are unsure about the diagnosis or management.

I hope this post was useful to some of you.
I wish you all a very pleasant night and only the sweetest of dreams!