One in three children and adolescents experience sleep problems. Common complaints include bedtime refusal, frequent awakenings, daytime sleepiness, nightmares and sleepwalking. These children may be irritable, less successful in school and more prone to injury. Parents often become frustrated and lose sleep themselves trying to help.
How can you deal with this problem? To start, set realistic sleep expectations. If your child is getting too much sleep during the day – such as naps in the car – he may wake frequently or have sleep refusal. Discuss appropriate sleep requirements and schedule with your pediatrician.
Partial awakenings, or times when a child enters a light sleep from a deeper sleep, are normal. Your child may open his eyes but resume a deeper sleep once he recognizes a familiar environment. This is especially common among babies 6 to 12 months of age. To prevent problems from developing, let children fall asleep by themselves in the familiar surroundings of their crib or bed. Parents should not disturb them during partial awakenings.
For a child who has developed an association between sleep onset and activities like being held, rocked, being fed or watching television, it’s not uncommon for frequent awakenings. The actual problem, though, is not spontaneous awakenings during the night, but the child’s inability to resume sleep on his own in the absence of the transitional activity. Children must be conditioned to a new sleep association habit that requires putting them to bed while still awake.
Many toddlers are reluctant to go to bed feeling they will miss exciting events, or they simply prefer not to be left alone. However, inconsistent bedtime rules confuse toddlers and may result not only in bedtime refusal but also nighttime awakenings. A predictable, non-stimulating, non-negotiable bedtime routine should be implemented. Make bedtime pleasant and never make going to bed a punishment. If your child gets out of bed, calmly and immediately lead them back.
Sleepwalking or night terrors affect 25 percent of children, and can come with dramatic symptoms such as elevated heartbeat, rapid breathing and sweating. Children may be unresponsive to the environment, and not remember the episode upon awakening. A sleeping child who suddenly screams and is found thrashing about and sweaty with dilated pupils is likely having a night terror. After 10 minutes or so they should be able to return to a calm sleep state. Episodes are worsened by inadequate or disruptive sleep. Stress reduction or a brief afternoon nap may be helpful.
What’s the difference between night terrors and nightmares? A child having a nightmare may awaken spontaneously and will usually remember the dream. There is little movement during the episode and once the child is awake, he is consolable. Anxiety or disturbing daytime events may trigger nightmares. Television shows, movies, video games and books should be screened for material that may be too frightening.
In most children with a behavioral sleep problem, a detailed history and physical examination are sufficient to provide an accurate diagnosis. In cases where further study is warranted, the studies should be tailored to each child’s needs. An overnight sleep study is useful if a disorder such as nocturnal seizures, obstructive sleep apnea or narcolepsy is suspected. Consultation with your pediatrician or a sleep specialist is the first step towards a restful night.
Dr. Lee Choo-Kang is a Mercy Clinic pediatric respiratory and sleep medicine specialist at Mercy Children’s Hospital St. Louis.