It's tough for any parent to discover that their child may have a sleep disorder. After all, no mother wants to see her son or daughter tired all of the time; and no father wants to watch his child struggle with falling asleep or staying asleep during the night. However, recent studies estimate that nearly 30% of children may have a sleep disorder at some point in their lives.
While sleep disorders can come with varying degrees of severity, the majority of them can be treated. What's important is that parents recognize the signs of sleep disorders so that they can get their child treated for the underlying causes, rather than treating the symptoms alone.
One of the most important keys in understanding how to identify sleep troubles in children is to have a good idea of how much sleep they should be getting for their age.
How Much Sleep Do Children Need?
1-4 weeks old- Newborns sleep approximately 16-17 hours a day with periods of wakefulness lasting 1-3 hours. However, most newborns have not developed a night/day sleep cycle, so their periods of sleep and wakefulness can vary to all hours of the day. Most parents will have to adjust their own sleep schedules to accommodate newborns.
1-4 months old- Babies of this age still tend to sleep about the same amount of hours, but their night/day sleep cycles begin to kick in, with them sleeping longer at night, although they still wake for feedings and changes.
4 months-1 year- Babies of this age still require between 14-15 hours of sleep every day. However, many of them are able to sleep through most of the night and take up to 3 naps during the day and evening. During this period it is important to really begin to establish healthy sleep habits for your child.
1-3 years- Most toddlers need about 12-14 hours of sleep, but often get less due to the schedules of parents and older children in the house. They will more than likely lose their early morning nap and early evening nap and tend to only take one nap a day.
3-6 years- Approximately 11-12 hours of sleep. Younger children of this group may still require a short nap during the day, but their need to nap usually diminishes by the time they enter the first grade.
7-12 years- Children of these age groups tend to need about 10-12 hours of nightly sleep but often only get about 9-10 hours.
13-18 years- Teens of this age require about 8-10 hours of sleep, but rarely get the full amount they need. The demands of schoolwork, after-school programs, and activities often cut into their nightly sleep. Most teens report getting about 6-8 hours of sleep.
Signs of Sleep Disorders In Children
EDS is one of the most common symptoms of sleep disorders in both children and adults as more than a few sleep disorders lead to daytime drowsiness. It's not uncommon for children to feel overly tired on occasion. However, if their daytime drowsiness is fairly regular, it could very well be linked to a sleep disorder even if it appears that they are getting enough sleep at night.
If your child is sleepy throughout the day, takes naps at ages where most kids don't nap, has trouble waking in the morning, or just has a general lack of energy during the day, they may have EDS. Common sleep disorders that have symptoms of EDS are obstructive sleep apnea, narcolepsy, and restless leg syndrome.
2. Trouble sleeping
If your child often complains about not being able to go to sleep or has trouble staying asleep, or often wakes much earlier than normal, it could be a sign of insomnia. Insomnia in children can be caused by a variety of factors including stress, pain, or mental disorders. Stress can come from a variety of sources itself including difficulty with school or schoolwork, social issues, family issues, or changes to their regular life patterns like moving to a new town.
Snoring in itself isn't harmful as it's merely a sound caused by vibrations in the upper airway. However, the vibrations can be caused by a blockage in which the air isn't reaching the lungs efficiently, which can lead to a sleep disorder. Snoring in children isn't as often a precursor to a sleep disorder as it is in adults. Some common causes of snoring in children are respiratory infections, nasal congestion, a deviated septum, or enlarged tonsils and/or adenoids.
However, a few children who snore may have obstructive sleep apnea (OSA), which can be caused by some of the above sources of snoring. As many as 3% of children have obstructive sleep apnea.
Nightmares are frightening dreams that occur during REM sleep and can wake a child up feeling terrified, threatened, and afraid, making falling back asleep difficult. Occasional nightmares are pretty common in children beginning around the age of 3 and can occur more frequently between the ages of 6-10. Usually, the frequency of nightmares begins to taper off after the age of 10.
Nightmares can lead to a sleep disorder if they are very frequent and wake the child up often during the night. Frequent wakings can disturb children's sleep and lead to EDS, anxiety, and behavioral problems. Nightmares can also be caused by PTSD.
5. Night Terrors
Night terrors are distinguished from nightmares in that the child never fully awakens from sleep. Because the child rarely awakens during a night terror event, it's not as frightening to them as nightmares, but may be very scary to witness for the parents. Often during a night terror episode, the child will sit up in bed and scream or cry. Other physical signs can be present as well including sweating, rapid breathing, increased heart rate, eyes may be wide open (although the child is asleep), and muscle tension.
Episodes of night terrors often last less than 5 minutes with the child rarely waking up. It is best for the parent to not try to rouse the child awake either as it may be extremely frightening for them.
Causes of night terrors have been linked to an immature central nervous system and will often be outgrown by adolescence. A recent article published in Pediatrics shows a link indicating bullying as a potential cause of certain parasomnia sleep disorders including nightmares and night terrors.
6. Sleep Walking
Sleepwalking is very common in children with as many as 30% of children between 3-7 having walked in their sleep. Sleepwalking occurs when a child leaves the bed in the middle of the night while still asleep. Their eyes may be open and they may mumble unintelligible utterances as they walk about. Sleepwalking occurrences can last between 5-15 minutes but occasionally longer. Most children who sleepwalk outgrow it by the time they're teenagers. Sleepwalking can be dangerous especially if the child is walking downstairs during episodes, turning on appliances, or leaving the house. Try to make your child's environment as safe as possible to avoid injuries. It is also not recommended to wake a sleepwalker during an episode as it may cause fear and confusion in the child.
Bedwetting (enuresis) in most children is not all that uncommon, and by itself isn't cause for concern. Bedwetting isn't considered a sleep disorder unless the child is older than five years old and has episodes at least 2 times a week regularly.
Bed-wetting can be caused if there is family history of bed-wetting, developmental lag, low bladder control, and emotional distress. However, if your child frequently wets the bed and is also experiencing daytime drowsiness, it could be a sign of obstructive sleep apnea.
What You Can Do
Sleep disorders in children can lead not only to tired and cranky children, but to all kinds of behavioral problems at home, in school, and in their social lives as well. If you think your child may have a sleep disorder, the first step is to alert your child's pediatrician to any sleep-related issues that they've been having.
From there, you may find that either the problems may go away on their own, surgery to remove tonsils and/or adenoids may be necessary, or a sleep study may need to be performed.
At the Alaska Sleep Clinic, we specialize in not only treating adult patients with their sleeping disorders, but ASC is the leader in treating pediatric studies in Alaska as well. Our Pediatric Medical Director, Dr. Harry Yuan, specializes in sleep and pulmonology. To learn more about Dr. Yuan, click the link below.