Child and Adolescent Insomnia
How Many Hours of Sleep Should Children and Adolescents Get?
Newborns need the most sleep and typically get about 17 hours of sleep a day. Sleep duration and needs diminish with age, with 4-year-olds needing 12 hours of sleep, 10-year-olds needing about 10 hours of sleep, and adolescents needing at least 9 hours of sleep per night.
What is Insomnia? Can Children and Adolescents Experience Insomnia?
Insomnia refers to a common sleep disorder in which the person has trouble falling asleep, staying asleep, or achieving restful sleep. Early insomnia refers to difficulty initiating sleep. Middle insomnia refers to waking in the middle of the night; you may wake multiple times or just once and struggle to get back to sleep thereafter. Late insomnia refers to waking early in the morning – a few hours before you normally would – and struggling to return to sleep thereafter. Insomnia can happen to anyone at any life stage; it can and does occur in child and adolescent populations.
What is a Parasomnia?
Parasomnias are disorders characterized by abnormal or unusual behavior of the nervous system during sleep. Rhythmic Movement Disorders like head banging may occur in young children but almost always resolves by at 3 or 4. Partial Arousal Disorders like sleep walking, night terrors, and confusional arousals (when a sleeping person appears awake but their behavior is unusual) can all be understandably disturbing for parents if the behaviors become extreme (in which case, consultation with a sleep specialist is advised). A very common parasomnia called nocturnal enuresis, or bedwetting, affects about 5% of 7-year-olds at least once a week. Bedwetting can have psychological as well as physical causes, but behavioral treatment and temporary use of pull-ups can often be quite effective.
My 5-year-old Sleepwalks. Is That Normal?
Sleepwalking is not considered to be abnormal for children of certain ages. Due to increased amounts of slow wave sleep (SWS) that occur in early childhood (between the ages of 2 and 5 years old), children may be more prone to parasomnias like sleepwalking during that stage of development. Many childhood parasomnias like sleepwalking resolve spontaneously with time.
What Causes Insomnia in Children and Adolescents?
As with many mental health issues, insomnia is usually influenced by multiple factors. In early childhood, sleeplessness is commonly linked to child-rearing practices. Parental attitudes and behaviors around sleep/bedtime influence how children feel and learn about bedtime. Lack of behavioral limit-setting, inconsistent habits, and anxious parental response to sleep difficulties affect how children feel about themselves, sleep, and their ability to sleep without a primary care figure present.
Medical etiologies can also lead to sleep disturbance for some. Some sleep disorders previously thought to occur exclusively in adults are now being recognized in children. Obstructive-Sleep Apnea (OSA) is thought to occur in about 2% of children. Children diagnosed with Failure to Thrive may be more prone to developing OSA as a result of reduced slow-wave sleep during which the production of growth hormone is thought to occur. Gastroesophageal reflux can also keep children awake with complaints of pain, burning, or excessive coughing.
Delayed Sleep Phase Syndrome (DSPS) is especially common in adolescents and pre-teens. DSPS occurs when the time at which a young person falls asleep is delayed significantly changed either due to a period of protracted illness, ongoing disputes between caregiver and child about bedtime, bedtime refusal in order to play video games or engage with electronics, or habitually going to bed late on weekends or holidays. After some time (which varies between individuals), sleep becomes physiologically delayed and it becomes impossible to go to sleep earlier by choice. This abnormal sleep pattern is exacerbated by sleeping late into the next day, making it difficult for the child to attend school and maintain social or extracurricular functioning.
There are also several psychiatric diagnoses linked with disturbed sleep in children. Sleep disturbance (either sleeping too much, too little, at inappropriate times, or inconsistently) is common among those who suffer mood and anxiety disorders. Children with ADD may have sleep difficulty due to hyperactivity, difficulty remaining in bed, and impulses to play and do other things at bedtime. Circadian sleep-wake rhythm disorders are reported to be common among children and adolescents on the autism spectrum. Trauma and Posttraumatic Stress Disorder can also cause disruption to how the central nervous system functions; sleep can be difficult to initiate and young people and adults alike can experience trauma-related nightmares which cause them to be fearful or avoidant of sleep.
This is not a comprehensive guide to all the reasons why young people may experience disturbed sleep. Consultation with your child’s Pediatrician can help to clarify why your child is having sleep issues and whether a psychiatric consultation may be helpful.