What Causes Sleep Disturbances in Kids?

Reviewed on 3/30/2022

A couple sleeping in bed holding a small child
Causes of sleep disturbances (sleep disorders) in children include insomnia, delayed sleep phase syndrome (DSPS), hypersomnia (narcolepsy), parasomnias, movement disorders (restless legs syndrome, periodic limb movement disorder), obstructive sleep apnea (OSA), and behavioral and mental health disorders (autism spectrum disorder, attention deficit hyperactivity disorder [ADHD], anxiety and mood disorders).

Sleep disturbances, also called sleep disorders, are characterized by problems with the quality, timing, and amount of sleep, which can cause stress and reduced functioning. Sleep disturbances can be associated with both physical and mental health problems, and can also worsen pre-existing conditions.

Sleep disturbances that are common in kids include: 

  • Insomnia: The most common type of sleep disorder that involves problems falling asleep or staying asleep at least three days per week despite adequate opportunity to do so
    • Causes of insomnia in kids include:
      • Sleep associations such as refusal to go to bed or difficulty falling asleep without the help of a parent or object, like a favorite toy or blanket
      • Behaviors before bedtime such as too much screen time, especially in the bedroom, or not enough of a bedtime routine with calm, quiet activities
      • Emotional issues such as stress, anxiety, depression
      • Environmental factors such as a hot or noisy sleeping environment
      • Medical conditions such as asthma or other sleep disorders including sleep apnea or restless legs syndrome 
      • Illness such as colds or ear infections or others that cause pain, stress, or difficulty breathing
      • Recent surgery or pain
      • Medications such as antidepressants or drugs used to treat attention deficit hyperactivity disorder (ADHD
      • Caffeine 
      • Irregular sleep habits
      • Genetics
      • May not have a known cause
  • Delayed sleep phase syndrome (DSPS, also called “sleepy teen” syndrome)
    • An exaggerated form of the normal shift in circadian rhythm that occurs during late childhood or early adolescence (a type of circadian rhythm disorder)
    • Children may be unable to fall or stay asleep until two or more hours past their normal bedtime, resulting in difficulty waking up in the morning in time for school or other activities
    • There is also a tendency to sleep much later than normal on the weekends
    • Causes of delayed sleep phase syndrome in kids include:
      • Being a natural “night owl” 
      • Genetics
      • Early school start times 
      • Late evening activities
      • Caffeine consumption
      • Screen exposure late in the day
      • Lack of exposure to morning light
  • Hypersomnia
  • Parasomnias
    • Undesirable physical events (movements or behaviors) or experiences (emotions, perceptions, dreams) that occur during sleep
    • Non-rapid eye movement (NREM)-related parasomnias include confusional arousals, sleepwalking, sleep terrors, and sleep-related eating disorder
    • REM-related parasomnias include sleep paralysis and nightmare disorder
    • Other parasomnias are not associated with a particular state of sleep and include: exploding head syndrome, sleep-related hallucinations, sleep enuresis (bedwetting), parasomnia associated with medical disorders, parasomnia due to a medication or substance, and unspecified parasomnia
    • Causes of and risk factors for parasomnias in kids include:
      • Age: some problems are worse in childhood such as sleepwalking or bedwetting
      • Genetics
      • Stress
      • Certain medications
      • Other sleep disorders, such as sleep apnea
  • Movement disorders
    • Characterized by movements that disturb sleep
    • Patients may or may not be aware of these movements
    • Some types of sleep-related movement disorders include:
    • Causes of movement disorders in kids include:
      • Low iron levels
      • Diabetes
      • Certain medications
      • Spinal cord injury
      • Multiple system atrophy (a rare neurological disorder)
  • Obstructive sleep apnea (OSA) 
    • Characterized by abnormal breathing during sleep
    • Snoring may be normal or abnormal
      • Causes of and risk factors for obstructive sleep apnea in kids include:
        • Family history of OSA
        • Male sex: two times more common in males than in females
        • Overweight/obesity 
        • Airway abnormality 
        • Medical conditions such as Down syndrome or cerebral palsy
        • Problems of the mouth, jaw, or throat that narrow the airway
        • A large tongue
  • Behavioral and mental health disorders

What Are Symptoms of Sleep Disorders in Kids?

Symptoms of sleep disorders in kids depend on the specific disorder. 

Symptoms of insomnia in kids include:

  • Difficulty falling asleep or staying asleep
  • Variable sleep
  • Daytime fatigue or sleepiness
  • Forgetfulness
  • Inability to concentrate
  • Irritability
  • Anxiety
  • Depression
  • Decreased motivation or energy
  • Increased errors or accidents
  • Persistent worry about sleep

Symptoms of delayed sleep phase syndrome in kids include:

  • Extreme daytime sleepiness
  • Insomnia (see above)
  • Tiredness
  • Decreased alertness
  • Problems with memory and decision-making
  • Headache

Symptoms of hypersomnia in kids include:

  • Excessive daytime sleepiness (EDS)
  • Sudden muscle weakness (cataplexy)
  • Transitioning from being awake to being asleep (hypnagogic hallucinations)
  • Sleep paralysis
  • Frequent short naps during the day
  • Difficulty sleeping at night 
  • Night-time compulsive behaviors such as eating and nocturnal smoking 
  • Obesity

Symptoms of parasomnias in kids include:

  • Sleepwalking 
  • Act in a way that is strange and confused on waking up
  • Night terrors
  • Acting out vivid dreams during sleep: may be violent and can cause injury to the patient
  • Nightmare disorder
  • Sleep paralysis
  • Sleep talking
  • Bedwetting (enuresis)
  • Groaning
  • Hearing a loud imaginary noise just before falling asleep or awakening
  • Binge eating and drinking in the night with minimal or no memory of the binge

Symptoms of sleep-related movement disorders in kids include:

  • Overwhelming urge to move the legs
  • Itchy, crawling, burning, creepy, throbbing sensation in the legs
  • Trouble sitting still for long periods of time
  • Daytime sleepiness
  • Irritability
  • Depression 
  • Anxiety
  • Memory problems 
  • Short attention span 
  • Fatigue

Symptoms of obstructive sleep apnea in kids include:

  • Morning headache
  • Loud snoring
  • Fatigue
  • Daytime sleepiness
  • Restless sleep
  • Awakening with choking, gasping, or smothering
  • Dry mouth or sore throat
  • Frequently waking to urinate
  • Awakening unrested, groggy
  • Low energy
  • Difficulty concentrating
  • Memory problems
  • Dry mouth or sore throat

QUESTION

Why do we sleep? See Answer

How Are Sleep Disorders in Kids Diagnosed?

Sleep disorders in kids are diagnosed with a patient history and physical exam. Tests or procedures that may be used to diagnose sleep disorders or to rule out other underlying conditions include: 

  • Daily sleep log
  • Sleep study (polysomnography)
  • Multiple sleep latency test
  • Blood tests

What Is the Treatment for Sleep Disorders in Kids?

Treatment for sleep disorders in kids depends on the disorder. 

Treatment for insomnia in kids includes:

  • Cognitive behavioral therapy for insomnia (CBT-I)
  • Sleep education 
  • Sleep restriction or sleep compression  
  • Stimulus control 
  • Sleep hygiene 
    • Avoiding daytime naps
    • Removing clocks from the bedroom
    • Developing a quiet, relaxing bedtime routine and sleep environment
  • Daytime habits
    • Get physical activity
    • Spend time in bright, natural light during the day
    • Regular mealtimes
  • Relaxation exercises 
  • Sleep medications or herbal supplements
    • Rarely used in children because of side effects

Treatment for delayed sleep phase syndrome in kids includes:

  • Light therapy
  • Light restriction (dark therapy)
  • Adjusting sleep schedules
  • Chronotherapy
  • Sleep deprivation/phase advance
  • Melatonin
  • Sleep hygiene
    • Maintaining consistent sleep schedules on weekends and weekdays
    • Avoiding daytime naps 
    • Avoiding caffeine
    • Having a calm and sleep-inducing bedtime routine 
    • Turning off electronic media an hour before bedtime

Treatment for hypersomnia in kids includes:

  • Behavior changes
  • Avoid caffeine
  • Medications
    • Stimulants
    • Medications to treat cataplexy
    • Histamine H3 antagonists/inverse agonists 

Treatment for parasomnias in kids includes:

  • Many times, parasomnias in kids don't need any treatment because they usually go way over time and are rarely a problem by adolescence
  • Behavioral cognitive therapy
  • Relaxation 
  • Hypnosis 
  • Creation of safe environment
  • Medications (not used often in children)

Treatment for movement disorders in kids includes:

  • Behavioral changes
  • Exercise
  • Stress reduction techniques
  • Reduce or avoid caffeine and alcohol consumption
  • Massage legs or soak in a hot bath
  • Medications

Treatment for obstructive sleep apnea (OSA) in kids includes:

  • Removal of tonsils or adenoids 
  • Nasal sprays or other medicines for mild OSA
  • Continuous positive airway pressure (CPAP) 
  • Adjusting sleep position (to stay off the back) 
  • Weight loss
  • Dental devices 

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Reviewed on 3/30/2022
References
Image Source: iStock Images

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