Sleeping Disorders in Children

Introduction

Sleep is one of the greatest mysteries of life. It is often difficult to understand what is happening when we are asleep, thus when one does something while asleep, it can be very confusing. There are several disorders of sleep in children and adolescence. Some of them are more serious while the majority are benign.

SLEEPWALKING (SOMNAMBULISM)

It is a partial arousal disorder that occurs while the child is in early state 1V of sleep. It only occurs in deep sleep. It has a tendency of running in families. It is more common between 4 and 12 years. Boys are more affected than girls.
Sleepwalking usually occurs about one to four hours after falling asleep. They experiences partial waking at the end of the second sleep cycle i.e. as they come out of stage 1V non REM sleep. This arousal or walking is only partial, in that although their bodies can move, a person’s brain is not fully awake.

When the brainwaves of a sleepwalker are monitored, one find mixed patterns, including those found during deep sleep, those found during transition towards waking and as well as patterns found during drowsy and waking state. Because the brain is in such a state, it is possible for one to exhibit walking and sleeping behaviors.

The child is able to stand up, open the eyes, avoid obstacle and open the door or even turn on and off the lights. However, the individual is unable to form memories, which is associated with the state of wakefulness, because the child does not have any memory of the sleepwakening episode.

The episode usually lasts from one to forty minutes, ending usually with the child going back to bed on his/her own (Ferber, 1985).

Sleepwalking may start as soon as the child learns to crawl, but more common between the age four to twelve. Until age six, sleepwalking is regarded as a normal maturation process, with it being partly due to a child’s very deep stage 1V sleep, rather than been caused by physical or emotional problem.

If a child exhibits sleepwalking at adolescence and middle childhood, they are likely to act in more agitated manner. If agitation occurs, the child is less likely to respond to your questions, the parent will find it difficult to return the child back to bed. This increases the chances of injuring themselves e.g. when coming down the stairs.

According to Feber (1985) this is due to the child trying to work out the feelings that he/she feels unable to express while awake, or may be due to the child feeling stress.

It is also postulated that there may be biological factors or hormones and even medical problems that contribute to sleepwalking. And there is a genetic link is sleepwalking i.e. sleepwalking children usually have family members with histories of sleepwalking. Males are more common sleepwalkers that females.

THERAPEUTIC MEASURES

Although most children outgrow the disorder by puberty, any etiological factor should be addressed e.g. if a parent feels that fatigue may be a contributory factor, the child should avoid late night sleep and establish a good sleep-wake cycle. If the problem is too severe, medication such as tranquilizers and anti-depressives may be helpful.

To prevent injuries, remove all dangerous objects from the child’s way and keep windows and doors closed. If possible the child should sleep on the ground floor of a multiple storey house.

Finally never yell or make loud noise to awaken the child. Just guide him/her back to bed. Never make the child feel ashamed about sleepwalking.

SLEEPTALKING

This is a disorder which is found in both adults and children but more common in children. It usually occurs together with sleepwalking.

According to (Caldwell, 1995), it happens in a more lighter stage i.e. stage III of non REM sleep. It is usually associated with sleepmoving such as rolling and sleepwalking.

The speech is usually unclear and mumbled or disorganized in that it consists of word or two. Even if a child can converse, the speech has little emotions (Hale, 1991).

If sleeptalking happens during stage 1V REM phase of sleep. The speech is usually organized and with emotions such as laughing and crying. Like sleepwalkers, sleeptalkers never remember talking in their sleep.

Sleeptalking is not due to any psychological or physical disturbances. The words of a sleeptalkers do not reveal any hidden truth or secrets about the child but reflect what the child was doing that day.

Caffeine, sleep deprivation seems to increase the incidence of sleeptalking and should be avoided in sleeptalkers.

NIGHT TERRORS AND NIGHT MARES

These are dream anxiety disorders known as parasomnias. They are both frightening experiences to the observer. They are not one and the same thing and the two .words cannot be used synonymously.

They usually occur at 3 to 5 years. Two to three percent of children will experience an episode of night terror or nightmare in this age group.

NIGHT TERRORS

Night terrors occur in the REM deep sleep. It may last anywhere from few minutes to an hour but the child is still asleep. The eyes may open but the child is not awake. When she does wake up, she has no recollection of what happened rather than a sense of fear.

AETIOLOGY

It usually runs in families. If a child has a night terror, it likely that one of the parents had night terrors as a child. Fatigue and psychological stress may also play a role.

PREVENTIVE MEASURES

Make sure that your child get enough rest. Beware of things that upset your child increase psychological stress e.g. horror movies.

Children usually have night terrors at the same time. Wake the child up for few minutes before night terror and let her sleep again.

NIGHTMARES

These are harmless dream state that occur during REM phase of sleep. The child also screams and shouts.
Because the REM phase is not a deep phase of sleep, the child may have recollection of the events and does not look confused as in night terror. It is a milder form of “horror movie in the mind”.

In night terror, the child wakes up sweating and full of fear. His pulse increases up to 115 to 120bpm while in nightmare the child just looks confused and pulse if ever it increased it rarely goes beyond 100 bpm.

MOVEMENT DISORDERS

The child usually tosses and turns around during the night. She even throws away blankets. She may go to the extent of falling off the bed. In some children only the legs moves but the rest of the body remains stationary. This is called restless legs.

Other children move all limbs unconsciously during deep non REM sleep. The limbs may alternate in movement or simultaneously gently move. These movements are usually gentle.

The etiology is still obscure but most children outgrow this disorder by school going age.

PREVENTIVE MEASURES

  • Let your child sleep in a closed cot bed or on the floor mattress to prevent the from falling.
  • If the temperature is extremely cold, just put back the blankets without disturbing the child.

INSOMNIA

This is excessive lack of sleep in children. It occurs in children who drink caffeine before sleep. The child finds it difficult to fall asleep. Excessive sleeping during the day also contributes.

PREVENTIVE MEASURES

  • Avoid caffeine before sleep.
  • Establish a normal sleep wake cycle for the child.
  • Do not sedate the child in an attempt to make him sleep.

EXCESSIVE SLEEPINESS

This will depend on what the parent regards as excessive. Where do we draw the line? Children have short sleep wake cycles than adults especially in the neonatal period.

Sleeping that is in excess, that it worries the parent requires medical attention. It may be the marker of an underlying disease. Paediatric consultation is necessary to rule out underlying illness.

Mothers who take sedatives during breastfeeding may affect their children’s alertness as they are mostly excreted through breast milk. Alcohol and hypnotics should be avoided in nursing mothers.

CHILDREN SLEEPING WITH PARENTS

This is an iatroenic, acquired behavior that a child learn from sleeping with parents They demand a lot of closeness to parents such that even when they are big, they still demand to sleep with parents. They refuse to go to sleep alone and this result in a child staying awake till late. When parents wake up early for work, the child also wakes-up.
This may be very frustrating to parents, social relation and romantic intimacy.

Children should learn to sleep alone from early years. Sleeping with parents can only be done as a fun on a weekend morning but not as routine.

BEDWETTING

The medical name for bedwetting is nocturnal enuresis. Enuresis means involuntary voiding of urine beyond the age of anticipated control.

It affects 15 to 20% of children of 5 to 6 old and about 1% of the adolescence. Most children with enuresis are emotionally normal.

Enuresis usually runs in families. If both parents were bedwetters, the child has 70% chance of bedwetting by age 10. If one parent was a bedwetter, the child has 30% chance of wetting the bed by 10 years. It affects boys more that girls.

TYPES OF ENURESIS

Primary Enuresis: This means the child wets his bed since toddlerhood.
Secondary Enuresis: The child who was dry at night starts wetting the bed. Children with secondary enuresis usually have underlying medical or social problem e.g. urinary tract infection, diabetes, divorce or school problem.

CAUSES AND TREATMENT

  • Deep sleeping: Most children seen at du Pont Enuresis Clinic are deep sleepers. They have difficulty in arousing even if their bladders are full.
  • Infantile bladder : These children’s bladders react to fullness in a manner that an infant bladder react i.e. by strong involuntary contraction.
  • The level of ADA at night: ADA is an anti-diuretic hormone that is secreted at high levels at night, thus avoiding loss of fluid through the kidney. In these children the hormone remains at low concentration throughout the night.

TREATMENT

Buzzer Alarm
This device, although it takes time to achieve the desired results, helps to arouse a deep sleeping child.

ADA Nasal Spray
This helps to retain fluid and this reduces the urinary volume.

Behavioral Modification
A loving parent should encourage the child to wake up. Do not make the child to feel ashamed of the act because the child’s dry days are just ahead.

Other methods like fluid restriction have been tried with little success. The most important thing is to have a positive attitude.

REFERENCES

  • Caldwell, T P. (1995) Sleep. Toronto
  • Farber, R (1995). Solve your child sleep problem
  • Hace, D (1981). Complete book of sleep. Toronto.
  • Borbely, A (1986). Secrets of sleep. New York.
  • Hadriecs, J (1954). Dreams and nightmares. Penguin books.
  • Kidshealth. org. website