Help for Kids with Sleep Disorders

Daytime drowsiness is the usual result when adults don’t sleep well. For children, it may be just the opposite. From after the toddler years until just before adolescence, children enter a phase of maximum daytime alertness that can sometimes mask the need to take a nap. Instead of appearing sleepy, these children may be hyperactive and have short attention spans and poor memory.

"There is a subset of hyperactive children that may actually have sleep problems," says Cesar C. Santos, M.D., chief of pediatric neurology at Wake Forest University Baptist Medical Center. "They may behave that way to stay awake."

The relationship between sleep disruption and behavior has been documented in an English study that has not been duplicated in the United States. Santos says he sees it regularly among his patients, however.

"When we treat their sleep problems their hyperactivity and other symptoms improve," he says.

Children, who need an average of eight hours of sleep a night, have some of the same sleep problems as adults. However, they often require different treatments. An evaluation begins with a sleep history and can include an overnight stay in a sleep laboratory.

Sometimes sleep problems are temporary and can be due to stress. Insomnia, for example, can result from moving to a new neighborhood, changing schools, witnessing family fights, or when parents divorce or change jobs.

Other sleep problems may require surgery or medications to treat. Obstructive sleep apnea, for example, is a temporary blockage of air in and out of the upper airway. As the body relaxes in sleep, the airway becomes smaller and can be blocked in some children by enlarged tonsils and adenoids. The child will snore loudly and then gasp for air.

Because the frequent interruptions in breathing are linked to irregular heart beat and other health problems, the usual treatment is surgery to remove the tonsils, adenoids or other excessive tissue.

"It’s amazing how much they improve function-wise," Santos said.

Other sleep problems in children are sleepwalking, sleep-talking, nightmares, night terrors and teeth-grinding. Most occur during the toddler years and will soon be outgrown, so aren’t treated, says Santos.

"The treatment for some of these conditions are medications that prevent the deepest, most restful stages of sleep, so they normally aren’t prescribed."

Exceptions to the no-treatment rule are children who put themselves in danger by going outdoors during sleepwalking. Also, excessive teeth-grinding may be treated with a mouth guard if it affects dental health.

Santos says some parents worry that night terrors are actually seizures. This is because a child having a night terror may have a blank stare and doesn’t remember the episode afterwards. A child having a nightmare, on the other hand, can be awakened and usually remembers the dream. While night terrors may resemble seizures, Santos says they are usually nothing to worry about unless there are other symptoms, such as sudden bed-wetting, unusual movements at night, blood on the pillow, a sore tongue on awakening, or staring behavior during the day.

While many childhood sleep problems are temporary and will be outgrown, Santos urges parents to consult a physician if they are worried about the problem and if it affects daytime functioning.