The commonly encountered disorders of sleeping in children are nightmares, night terrors, and sleep-walking.
The physiology of sleep is very different in children and adults, and is complicated by the fact that it changes throughout development. Some of the differences include the following.
INSOMNIA
About 30 per cent of school-age children either have trouble getting to sleep or wake up repeatedly during the night. Common causes of sleeplessness in children include night-time fears (e.g. monsters), separation anxiety, daytime napping, worries, anxiety, depression, and in teenagers, caffeine, nicotine, and alcohol in the evenings. If a psychiatric or physical disorder is the cause, the best approach is to treat it. For many children, discussing their worries or fears can lessen them, and reassurance to the parents that the problem is likely to resolve by itself.
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NIGHTMARES
Nightmares are frightening dreams that cause the child to wake up, usually feeling slightly confused. The child may be distressed, and can take time to get back to sleep. They occur during REM sleep, and show a distinctive increase in activity on the EEG. Nightmares are common in childhood, especially around the ages of 5 or 6 years. Frequent nightmares may be accompanied by daytime anxiety. There is no specific treatment, so parents should be reassured that it is likely to improve with time and helped to reduce any stressful circumstances at home.
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NIGHT TERRORS
Night terrors are less common than nightmares. They are characterized by a sudden awakening in which the child sits upright, screams loudly, and has marked autonomic activation. Occasionally, there may be frantic motor activity which can lead to falling out of bed and injury. The episode occurs a few hours after going to bed, and usually lasts about 5 minutes. Afterwards the child goes back to sleep, and is unable to remember the events in the morning. There is no specific treatment, but it is important to reassure the family, make sure the child is safe at night, and ensure good sleep hygiene. Night terrors seldom persist into adult life.
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SLEEPWALKING
Sleepwalking is characterized by complex, automatic behaviours occurring during sleep. In children this usually involves wandering around the house. The child’s eyes are open and they avoid familiar objects. The child may appear agitated, does not respond to questions, and is often difficult to wake, although they can usually be led back to bed.
Episodes usually last for a few minutes, although rarely they may continue for as long as an hour. It is most common between the ages of 5 and 12 years, occurring at least once in 15 per cent of children in this age group. Occasionally, the disorder persists into adult life. There is no specific treatment, but as sleepwalkers occasionally harm themselves, parents should protect the child from injury by fastening doors and windows securely, barring stairs, and removing dangerous objects.
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