Pediatric Sleep Disorder: Types, Symptoms, and Management

Introduction

Quality sleep is very important for the overall growth of a child. To improve a child's sleep, parents try to form various strategies. Disruptive sleep-related behaviors affect the overall behavior of the child. It affects the child's whole daytime and nighttime schedule. Therefore, an acceptable quality of sleep time and duration is essential. If the child suffers from a sleep disorder, the child appears more moody and irritable and acts more disruptive. Therefore, parents need to encourage good sleeping habits and patterns.

Why Is Sleep Important for Children?

Sleep is essential for children's health and development. Lack of sleep causes several physical, emotional, mental, and psychological issues. Sleep provides rest to the body and brain. Children up to five years of age need an average of twelve hours of sleep, but most children do not get enough sleep.

Following are the signs of sleep deprivation in children:

• Irritability in behavior.

• Feeling sleepy during the daytime.

• Trouble in controlling emotions.

• Behavior changes.

• Memory issues.

• Health issues.

• Problem-solving skills are affected.

• Children act in a more disruptive way.

• Child performance at the school level is affected.

• Depressive feelings and negative thoughts.

• Reduced ability to function.

What Causes Pediatric Sleep Disorder?

Some sleep issues in children have similar causes to those in adults. Obesity is a key risk factor for obstructive sleep apnea, a breathing problem during sleep, in people of all ages. Also, sleep disorders like restless legs syndrome, which can be hereditary, affect both children and adults. Certain medical conditions and anxiety disorders also raise the risk of sleep problems at any age. However, there are also behaviors specific to children that can lead to sleep issues. Trouble sleeping is often due to inconsistent bedtimes and resistance to going to bed up until around age five.

What Are the Symptoms of Sleep Disorders in Children?

Parents need to observe their children's symptoms of sleep disorders. Although children usually feel restless and irritable due to occasional poor sleep, parents should rule out sleep disorders if this becomes a pattern. The following are a few symptoms seen in children with sleeping disorders.

• The child cannot sleep, even lying in bed for hours.

• The child sleeps only for one or two hours, even at night.

• Itchy legs are present during the nighttime.

• The child snores very loudly.

• The child feels anxious and is urged to cuddle in the middle of the night.

What Are the Types of Sleep Disorders in Children?

The American Psychiatric Association defines sleep disorders as problems associated with timing, sleep duration, and sleep quality. Sleep disorders can lead to distress and decreased ability to function. In addition, they are related to typical behaviors and neurological conditions.

1. Child Insomnia: Child insomnia occurs when a child has difficulty sleeping for over three weeks and refuses to go to sleep.

2. Sleep Apnea: A disorder in which the patient’s breathing periodically stops during sleep, mainly due to airway blockage (obstructive sleep apnea). This can result in sleep of low quality and sleeping during the day.

3. Delayed Sleep Phase Syndrome: Delayed sleep phase syndrome is also known as sleepy teen syndrome. It is found in late childhood and early adolescence. Children cannot fall asleep for more than two hours and have difficulties waking up in the morning. It is caused by a disturbance in the child's circadian rhythm and biological clock. Children sleep more on weekends and feel lethargic.

4. Restless Legs Syndrome (RLS): A medical condition resulting in leg restlessness and uncomfortable feelings. But it can interfere with the onset of sleep and subsequent sleep maintenance.

5. Sleep Apnea: A disorder in which the patient’s breathing periodically stops during sleep, mainly due to airway blockage (obstructive sleep apnea). This can result in sleep of low quality and sleeping during the day.

6. Hypersomnia: A child suffering from hypersomnia has a disturbed sleeping pattern. They tend to sleep more during the daytime. Various neurological conditions, such as narcolepsy, can cause hypersomnia. It causes loss of muscle control and frequent dozing. Various conditions, such as delayed sleep phase syndrome and obstructive sleep apnea, can cause it.

7. Parasomnias: These are a series of physical events and experiences while falling asleep. Sleepwalking, sleep terrors, and night walking are commonly seen in children. Some of the features of sleep which are considered pathological include:

   • Sleepwalking: Being awake but not fully conscious, for example, walking or doing other tasks.

   • Sleep Talking: Speaking in sleep and not knowing what one is saying.

   • Night Terrors: These are periods of fear, screaming, and thrashing during sleep, usually with limited or no recollection of the incident.

   • Narcolepsy: A sleep disorder associated with the neurological disorder of the sleep-wake cycle in the brain, causing a person to experience sudden and uncontrollable sleep attacks during the daytime.

8. Obstructive Sleep Apnea: Breathing difficulties faced by the child during sleep. Children suffering from this disorder snore and may frequently awake at night. It is commonly seen in children with enlarged tonsils, adenoids, cleft lip, cleft palate, and developmental defects in the head and neck.

9. Circadian Rhythm Sleep Disorders: Disturbance in the circadian rhythm regulating sleep, such as difficulty sleeping or waking up at a particular time. This includes:

   • Delayed Sleep Phase Disorder (DSPD): Society considers delayed sleep onset and early morning wake-up times unfavorable.

   • Advanced Sleep Phase Disorder (ASPD): Lack of sleep, in other words, going to sleep earlier than intended or waking up earlier than wanted.

What Are the Diagnostic Tests for Pediatric Sleep Disorder?

The child’s doctor will consider their medical and sleep history to choose the best test. These tests include:

• Sleep Study: This overnight test, called a polysomnogram (PSG), is conducted in the sleep lab to observe how the child sleeps. It aids in diagnosing sleep apnea and other disorders. During the test, parents have the option to remain with their child.

• Electroencephalogram (EEG): This test monitors the brain's activity during sleep, including sleep stages and wakefulness episodes.

• Multiple Sleep Latency Test: Used to investigate unexplained sleepiness and diagnose narcolepsy, it measures how quickly the child falls asleep during a series of naps by monitoring brain activity and eye movement.

• Actigraphy: This test assists in diagnosing obstructive sleep apnea and insomnia. The child wears a watch-like device that tracks sleep and wake patterns.

• Blood Test: This can identify iron deficiencies associated with periodic limb movement disorder and restless legs syndrome.

What Precautions Should Be Taken to Prevent Sleep Problems in Children?

Here are some simple ways to help children sleep better:

• Establish a regular bedtime routine, so children sleep and wake up simultaneously every day.

• Ensure the room is dark, quiet, and cool for sleeping.

• Keep electronic devices out of the bedroom.

• Limit caffeine intake for younger children and teenagers, especially in the afternoon and evening.

• Encourage physical activity earlier in the day to establish normal sleep-wake patterns.

• Avoid using the room for time-outs or punishment.

• Reduce or eliminate daytime naps to encourage earlier bedtime.

• Use calming music or devices to ease any nighttime fears children may have.

These habits can help prevent sleep problems, even in children with medical conditions that affect sleep.

What Should Parents Do to Improve Their Child's Sleep?

Parents play a very important role in improving a child's health. For example, if a child is having difficulty sleeping, parents can follow the following tips to improve their child's sleep.

• Parents should try to relax their child before sleeping, such as by having a warm bath, reading quietly, and dimming the light.

• Parents should always try to set a sleep time routine.

• Parents should try to spend time with their children before the child falls asleep.

• Parents can consider rewarding children for waking up early and going to bed at a preferred time.

How Are Pediatric Sleep Disorders Managed?

Childhood sleep disorders can disrupt family dynamics and lead to cognitive and behavioral issues. Early recognition and effective management are key to preventing these complications. Below are various strategies and treatments for different types of childhood sleep problems:

• Behavioral Insomnia: Behavior subtypes of childhood insomnia affect 10 to 30 percent of children and often stem from inconsistent parental limit-setting and improper sleep-onset associations. Treatment involves extinction techniques and parent education to establish healthy sleep habits. Hypnotic medications are not recommended for this type of insomnia.

• Obstructive Sleep Apnea (OSA): OSA affects one to five percent of children and requires polysomnography for diagnosis; history and physical examination alone may not be sufficient.

  • Adenotonsillectomy is the primary treatment for OSA in children, addressing enlarged tonsils and adenoids.

  • Nasal continuous positive airway pressure (CPAP) is the secondary treatment for children who do not respond to surgery or if surgery is not an option.

• Restless Legs Syndrome (RLS): RLS can be challenging to recognize and is associated with attention-deficit hyperactivity disorder (ADHD).

  • Management includes addressing, if present, iron deficiency and identifying and eliminating triggering factors.

• Parasomnias: Parasomnias, which affect up to 50 percent of children, often resolve independently by adolescence. Treatment involves parental education, reassurance, safety precautions, and addressing underlying conditions.

• Delayed Sleep Phase Syndrome (DSPS): DSPS typically emerges during adolescence and is characterized by a preference for staying late (night owl). Treatment includes promoting good sleep hygiene, using nighttime melatonin supplements, and exposure to morning bright light.

• Sleep Deprivation: Sleep deprivation is a growing concern, affecting 68 percent of high school students. Addressing sleep deprivation includes prioritizing sleep hygiene and implementing healthy sleep habits.

Conclusion

The sleeping disorder makes the child feel restless and drained. Therefore, it is essential to find and treat the causes of these problems. Parents should observe the child and try to understand the root cause. Parents should make their children comfortable while talking to them. Parents should consider seeing a doctor if the attempts to improve a child's sleep are not working. Pediatricians can diagnose the underlying medical issues, treat them, and plan to improve sleep implementation at home.