Child Sleep Problems And Disorders
What is a "sleep disorder"?
Sleep disorders involve a number of areas; the amount of sleep you have at night, what affects this amount of sleep, and what affects the quality of this sleep. You may have conditions where you are excessively sleepy, and you may have conditions where your internal body clock or your circadian rhythm is upset, and that will cause problems with your sleep.
What causes a sleep disorder?
In children, the most common causes of sleep disorders are in the category of duration and quality of sleep. In those categories, particularly in the category of quality of sleep, the most common cause would be behavioural issues, and much less - probably about 5-7% - would be problems with breathing when you sleep.
How do breathing problems cause children to have a sleep disorder?
When we talk about problems with breathing, for multiple reasons, most common usually being enlarged adenoids or tonsils, during your sleep, you're obstructed – your air passages obstruct and you actually can't breathe. And nature has phenomenal alarm mechanisms built in so that when your body senses that you can't get enough oxygen or your carbon dioxide levels are going up, you automatically wake up. You arouse so that you can change your body position or do something to get air into your body. Now, you can imagine if you're having difficulties like that at night with breathing, you can wake up multiple times and these don't have to be, necessarily, where you wake up and look around, these might be fractions of a second where you are rousing to just read just your airway in order to breathe. And that's going to affect your quality of life – okay? – your quality of sleep which will affect your quality of life.
What is a "behavioral" sleep problem or disorder?
A behavorial sleep problem is probably the most common sleep problem that children have. Only about three to five percent of children have problems with breathing at night. 75% of sleep problems that kids have are behavioral. Now, it's all got to do with habit and routine, and sleep-onset associations. A child that has “bad” sleep-onset associations will wake up in the middle of the night and require those associations again, and that obviously is a problem. Now, when we talk about behavioral problems in children, the technical term is “behavioral insomnia of childhood.” Insomnia meaning “unable to fall asleep,” and it's behavior-related, and it's related to kids. We break those down into three different subtypes. We have the behavioral insomnia of childhood-sleep onset association type. Now, that would be the child that's used to being nursed, and the music, and the TV, and being rocked, and held, and whatever – the whole list of things in order to help them fall asleep. Then, you have the limit-setting type. That's usually with the older child, that says, “I don't want to go to sleep.” Or they get put into bed, and say “I need a drink of water. Oh, can Mummy give me one more kiss? I need the light on. Etc etc. Making all these excuses to not go to sleep. That would be limit-setting type. Then, the third category is just both of them smushed together as what we call combined type, because it can happen like that. These are all behavioral. The way to deal with them is to change the behavior, and changing the behavior is really changing habit.
Are all children at risk for developing a behavioral sleep problem?
Every child is at risk of behavioral sleep problems. They can be prevented by introducing good sleep hygiene from the beginning, and if behavioral sleep problems do occur, they can be treated with behavioral modification techniques. Every child is at risk.
Can a child naturally grow out of a behavioral sleep problem?
Children can grow out of sleep problems but at a cost. If children are waking up frequently at night and that's the sleep problem then you should be concerned about giving your child enough time; then they might outgrow it. The question is how long is it going to take and if your family can wait the five, six, seven, eight years or even more for them to outgrow it. If so then that's fine. The cost of course is what and how it has affected the families quality of life with a child that's waking up multiple times during the night and how it has affected the child's quality of life in terms of the daytime functioning. The other thing is that children that have sleep problems have about a 30% chance that they will continue to have problems with sleep for the rest of their lives. So there is a risk, even if they appear to not wake up frequently in the middle of the night as they get older, maybe problems of going to sleep or developing problems of insomnia will occur.
What are the most common sleep problems for teenagers?
The most common sleep problems that teenagers have are what we call "sleep phase disruption" or "delayed sleep phase syndrome." And that is when they naturally actually become tired much later than usual and it's sort of part of a transition physiology. So teenagers need just over 9 hours of sleep at night but they only become sleepy much later, maybe 11: 11:30. So the problem is they only feel tired late at night and they are IMing and that's stimulating them so, and they have homework to do which they leave to the last minute. So they probably only go to bed at midnight. And they have to be up at some ridiculous hour like 6:00 or 7:00 to get to school, so they are very sleep deprived during school and the majority of teenagers are sleep deprived period. Now when it comes to the weekend is they go out Friday night at get in late, but they sleep in and they sleep in until 2:00 or 3:00 in the afternoon on Saturday. So now they have kind of caught up on their sleep loss. So come Saturday evening they are not tired, so they only go to bed at 100: or 2:00 in the morning on Sunday morning. And so they sleep in on sunday afternoon, and so they then are not tired on Monday and have to wake up early in the morning. So these kids lock themselves into a situation where they are constantly sleep deprived.
What is "psychophysiological insomnia"?
That is when you are lying in bed and you want to go to sleep. Your mind is racing and you think "oh my gosh I should be asleep by now. I can't fall asleep. I can't fall asleep." Eventually you become so activaly trying to fall asleep that you cannot. That is psychophysiological insomnia. Somebody once said "Sleep is like a dove" If you gently reach out your hand to it, it will alight, but if your reach out and grab it, it will fly away. In a sense, that is kind of what it is, so the teenager lies there in bed, lying there with their eyes wideopen, "they can't sleep, they can't sleep" so they become anxious that they can't sleep, and in doing so keep themselves awake. The next night they go to bed and say "I don't think I'll be able to fall asleep tonight." So, psychophysiological insomnia is just a cycle that repeats itself.
What is the treatment for psychophysiological insomnia?
The treatment there is – what we call stimulus control – is to reduce and to take out a whole lot of stimuli that would keep the teenager from being awake and from their mind being active. And if the lie in bed for a long period of time, that they feel like "I should be asleep by now," then they have to get out of bed a break the association, because that's the key. You want to break the association with lying awake in bed.Treatments are to remove the clock, and not associate activities with bed. Don't do your homework on your bed, don't chat on the phone on the bed, don't IM on the bed. Bed is for sleeping, so you break the kind of association with activities in your bed. And so in a sense what you do is you're retraining them.
