Sleep problems in children

An unpleasant sensation in the legs, the urge to move them and growing pains are all symptoms of restless leg syndrome. The exact prevalence of this issue among children is not known, but limited studies indicate it to be about 2%. Dopamine dysfunction, genetics and iron deficiency are said to play a role in this sleep disorder. Diagnosing restless leg syndrome in children is even more difficult because kids can be quite vague about their symptoms, and this could mean that parents miss the early signs or neglect the issue.

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In delayed sleep phase disorder, a person’s circadian rhythm is delayed by approximately two hours—that is, the person sleeps at least two hours after the conventional bedtime. This disorder is more common among children closer to the adolescent phase and has a prevalence of 7-16%. This problem is usually diagnosed when a sleep log or journal, or even a timetable, is maintained. Not only does this sleep problem lead to difficulty waking up, tardiness, daytime sleepiness especially during school hours, but can also affect the child’s cognitive and metabolic functions.

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Behavioural insomnia of childhood refers to a child's inability to fall asleep and/or stay asleep. It affects 10-30% of all children. There are two types of this kind of insomnia:

• Sleep-onset association type: Where the child is unable or unwilling to fall asleep or go back to sleep in the absence of specific conditions.
• Limit-setting type: Where the parents don't set appropriate limits and the child is unable or unwilling to fall asleep unless he or she gets his or her way. This may include not being able to sleep unless they're rocked or allowed to sleep with parents, etc. 

This type of sleep issue can be disruptive and impair the child’s development. It can only be resolved when the parents set appropriate boundaries and allow children to be self-soothing sleepers at an early age.

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Sleepwalking, sleep talking, confusional arousals (waking up disoriented or confused), sleep terrors and nightmares are known as parasomnias—they affect 50% of children.

Parasomnias are undesirable events associated with sleep. They usually occur during sleep-wake transitions. Confusion, automatic behaviours, difficulty waking up, amnesia and rapid return to sleep are common symptoms associated with parasomnias.

Studies show that parasomnias usually resolve by the time a child reaches adolescence, but in 4% of cases, there may be a recurrence of these issues. Proper sleep and psychological therapy may be required in severe cases.

Obstructive sleep apnea, or OSA, is characterized by upper airway obstruction which disrupts both oxygen intake and normal sleep patterns. The prevalence of OSA in children is 1-5%. It may occur in adults due to the relaxation of soft tissues like the tongue and palate while sleeping, but in children, the main cause of OSA is enlarged tonsils and adenoids.

OSA in children usually occurs between two years and eight years of age, which coincides with peak tonsil growth. This is also the reason why children are more prone to tonsillitis at this age, and this infection can make OSA worse. Snoring is one of the chief symptoms of OSA, but it’s also prevalent in 27% of children and this can make the diagnosis of OSA difficult.

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Snoring occurs when a person’s airways are blocked, and it is associated with disrupted sleep, daytime sleepiness, fatigue and decreased oxygen levels in the body. About 27% of all children experience snoring during their childhood years. Snoring is usually linked to other health problems, like obstructive sleep apnea, obesity, and respiratory infections. So, it’s important to consult a paediatrician if your child snores.

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Toddlers aged one to two years require about 11-13 hours of sleep every day, and their daytime naps usually start to recede. By the time they are 18 months old, most toddlers nap only once during the day, and this nap may last for an hour to three hours. Too less or too much of sleep or nap-time might indicate a sleep problem, and napping too close to bedtime is not recommended at all.

This age is quite ripe for sleep problems in children. Increased motor, cognitive and social skills may lead to a sense of independence and curiosity, which can interfere with sleep. Not only is your baby developing an imagination at this time, but he or she can also get out of their cot easily to solve personal crises like separation anxiety. Daytime sleepiness, apart from movement and conversations during the night, are sure-shot signs of sleep problems at this age.

Children aged 6-13 years need 9-11 hours of sleep every night, but they may in fact sleep less depending on their daily activity levels.

There is usually a gradual increase in homework, sports and other activities during this age. Many children also develop hobbies. This may also affect their sleep patterns.

Television, internet and digital devices also take up more of the children's time now. Blue light emissions from digital devices can also delay or disrupt sleep.

Resistance to bedtime, difficulty falling asleep, anxiety and other problems may interfere with sleep at this age.

Poor or inadequate sleep can lead to mood swings, daytime sleepiness, attention deficit hyperactivity disorder (ADHD), and cognitive impairments that may become evident in schoolwork and academic results.

While you don't need to be harsh, gently explaining to your child why he/she needs 9-11 hours of sleep—and the complications they may arise if they do not sleep enough—may work.

Preschool children usually require 11-13 hours of sleep every day, but their need to nap during the daytime reduces a lot. Their daytime nap between the ages of three years and five years might last for 30 minutes to an hour. Any more or any less may indicate a sleep issue. 

With further development of motor skills, difficulty falling asleep, waking up and moving around in the middle of the night, and other sleep-disrupting issues may turn up. Your preschooler baby is also likely to have an active imagination, which is why nighttime fear and nightmares are quite natural. However, chronic nightmares, sleep terrors, sleep talking and sleepwalking are serious sleep problems that may come up at this age and require proper medical attention.

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Most babies start developing circadian rhythms between four to six months of age, which means less nighttime feeding and changing for you.

Roughly 70-80% of babies learn to sleep through the night by the time they are nine months old. By this age, they sleep nine to 12 hours a day—a large part of which is through the night, with 30- to 50-minute naps during the day as they get closer to the 12-month mark.

As they grow older, babies learn more sleep cues and you can tell when they are sleepy through these cues. It’s best to put them down to sleep when they show these signs instead of letting them fall asleep in your arms. This teaches babies how to fall asleep by self-soothing, instead of depending on your touch. 

This not only helps them developmentally but also ensures that you enjoy the perks of having a less clingy and well-adjusted child. Developing this type of sleep security at this age can also help to avoid sleep problems and disorders. Sleep-secure infants also have less separation anxiety and illnesses. You can help this development along by keeping the baby active during the day, and dimming the lights and creating a safe and sleepy environment at night.

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As you might know, newborn sleep is around the clock and disrupted only by the need to be fed, changed and nurtured. This means a newborn sleeps for 10-18 hours of the day, but there’s no regular schedule for this. Each time the baby sleeps, he/she could be asleep for anywhere between a few minutes and several hours.

Muscle movements like twitching, smiling, sucking and restlessness are normal, especially during NREM sleep. Newborns usually fall asleep very quickly, and show signs like becoming fussy, rubbing their eyes and yawning before falling asleep. Sudden infant death syndrome or SIDS is a huge risk, so maintaining proper safety during these sleep hours is very important.

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