Sleep problems in children and adolescents

Sleep disorders are common but often transient in Children and Adolescents. Some however can become chronic and require specialist attention.

Types of Sleep Disorders

  • Parasomnia: These are sleep disruptions where a person is aroused after they have fallen asleep and include sleep walking / talking, nightmare, sleep terrors, bruxism or grinding of teeth, bed-wetting (enuresis).    
  • Dyssomnia: These are disorders related to sleep initiation and includes Narcoplepsy (sudden onset day time sleeping / naps) and obstructive sleep apnea where upper airway gets blocked causing sleep disruption. These two conditions have a physiological basis. By far the commonest sleep problem is insomnia due to poor sleep routine which at times may be associated with underlying mental health disorders.     

Sleep Hygiene 

This article focuses primarily on re-establishing a good sleep routine by re-introducing a sleep routine / habit which aids sleep initiation. The principles are outlined below - 

  • To sleep at a designated time (e.g. 10 pm).
  • To wake up at a designated time irrespective of the time one falls asleep. Often people sleep late and wake up late, this way the sleep cycle gets pushed forwards rather than regularise. 
  • Use the bed only for sleeping. Using it for watching TV or playing games, having long telephonic chats or arguments create an association of the bed with these events. Memories of these events are oft triggered when one approaches the given bed.
  • The sleeping bedroom should ideally be clutter and noise free. There should not be any opportunity to stimulate the mind in anyway (TV, video games, music, distraction via smart phones – BBM / social networks). 
  • Making one self as comfortable as possible is important as well. Attempting to sleep hungry or after overeating is likely to interfere with sleep initiation. 
  • Avoid stimulant foods beyond 3pm – this includes coffee, tea, fizzy drinks (especially coca-cola and Pepsi) and chocolates / hot chocolate. These products contain a high level of caffeine. Simple substitution for decaf options alone may not work as the associated taste / texture / smells cue a conditioned response of arousal that these products trigger. 
  • Avoid oversleeping on weekends and taking afternoon naps. Catch-up sleep at other times may make it easier for the mind to remain aroused at night. 
  • Exercise at least 10-15 minutes a day (a brisk walk will do). The more activities you do during day time the better. 
  • Make sure you avoid taking unresolved matters to the bed. Set out 15 minutes after dinner to reflect over the day. If it’s been a hard day, ensure you resolve / problem solve by thinking through the difficulties (either alone or with someone). At times the problematic thoughts are about matters which can’t be resolved for weeks or months, in such an event, it helps to agree to "park" the problem and revisit it another time as simply brooding endlessly is unlikely to help. This would free up mental space needed to relax and sleep. 
  • When in bed, if it is difficult to fall asleep for any reason, its best to get out of the room. You may consider a light snack, milk; reading a dull book and go back to your room once you feel you are likely to fall asleep. Remember, no matter what time you sleep wake up at a designated time.  

Treat the underlying mental health disorder: 

Sleep initiation can be hard leading to insomnia when one is experiencing anxiety disorders, depression or the mind is aroused due to mania/hypomania associated with bipolar disorder or fearful paranoid thoughts linked to psychosis. Some children and adolescents with ADHD are very energetic even at fag end of the day and struggle to sleep. Some sleep problems are secondary to post traumatic stress, drug abuse. Occasionally depressed people may sleep excessively (hypersomnia).  

If the sleep problems are in the context of any of the above mental health disorders, sleep hygiene is important however it should be alongside treatment of these underlying conditions.