Interventions For Behavioral Insomnia Of Childhood
Medication is the most common treatment for behavioral insomnia in both children and adults. Stojanovski et al performed a chart review in outpatient health centers and found that approximately 80% of children who presented with a sleep disorder were prescribed medications. This is particularly worrisome as there are no FDA approved medications for treatment of insomnia in children, and there are concerns about the safety and side effects of these medications. Moreover, the evidence indicates that although pharmacological treatments may have rapid short-term effects on sleep problems, medications typically do not have long-term positive effects on sleep. Consequently, pharmacological interventions should generally not be the first line of treatment. If health care practitioners feel very strongly that medication is most appropriate for a particular case, it is best to use medications in combination with behavioral interventions.
In this paper, we focus on behavioral interventions that have been found to be well-established and strongly supported including extinction, graduated extinction, and early intervention/parent education and those that are considered probably efficacious or supported including scheduled awakenings and bedtime fading/positive routines.,, These interventions are described in detail below. In addition, readers may wish to consider the resources suggested in .
Definition And Subtypes Of Childhood Insomnia
Considering its characteristic features, the International Classification of Sleep Disorders 2nd edition classified pediatric insomnia independently as behavioral insomnia of childhood . In the ICSD 3rd edition, pediatric insomnia was integrated into chronic insomnia. Considering the distinctive characteristics of pediatric insomnia, the text mentions three subtypes of pediatric insomnia: sleep-onset association type, a childs dependency on specific stimulation, objects, or setting for initiating sleep or returning sleep following an awakening in the absence of these conditions, sleep-onset is significantly delayed limit-setting type, bedtime stalling or bedtime refusal that is met with and reinforced by inadequate limit-setting by a caregiver and mixed type, sleep-onset association difficulties and bedtime resistance.
Sleep associations are certain behaviors or environments that customarily appear at the time of sleep-onset that the child learns to need to fall asleep . In the presence of a negative or inappropriate sleep-onset association, parental interventions are required for the child to initiate sleep or return to sleep after a night awakening . Therefore, frequent night awakenings are the presenting symptom of the sleep-onset association type .
Children With Insomnia Symptoms Likely To Continue To Suffer As Adults Study
Researchers suggest parents and doctors should not assume sleep issues will go away with age.
Children who have trouble sleeping are likely to develop insomnia as adults, a study suggests.
The findings indicate parents and doctors should not assume the issues will go away with age, and that early interventions should be a priority given that sleep disorders are linked with poorer heart and mental health.
Researchers found that 43% of children aged five to 12 with insomnia symptoms, such as difficulty getting to sleep or staying asleep, continued to suffer through adolescence into adulthood.
Although around 27% of youngsters with the sleep issues saw their symptoms fade by adolescence, almost 19% experienced them coming and going into adulthood.
Sleep disorders especially sleep apnoea and insomnia are linked with poorer cardiovascular and mental health.
According to the study, about 15% of children without symptoms developed them during the transition to adolescence and then they continued.
More than one in five newly developed them in young adulthood.
In addition, about 16% of these children without insomnia symptoms experienced the issues coming and going.
Dr Fernandez-Mendoza added: We know that poor sleep is related to adverse health outcomes.
We suspect that many children who experience insomnia symptoms that persist into adulthood will also suffer from some negative health consequences.
Thats not what our study shows for a significant proportion of youth.
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What Is Pediatric Insomnia
Insomnia is a sleep disorder that causes problems falling asleep, staying asleep and waking up too early in the morning. Sleep is crucial to childhood development, and insomnia can lead to health problems or behavioral issues.
Insomnia can be short-term, lasting a few days or weeks, and may be related to medication, anxiety from a stressful event or illness. However, it can also be a long-term condition that will impact the child for their entire life.
Insomnia can be chronic , cyclical or transient .
While it is more common in adults, children can develop chronic insomnia, including 10% of adolescents .
How To Diagnose Child Insomnia
If you discuss this problem with a doctor, bring a completed sleep diary. Keep track of the times that the child goes to bed and wakes up for two weeks. You should also chart the times when the child wakes up during the night. List any ways the child tries to stay awake at past bedtime. Include how the adult reacts to these actions. For example, the doctor needs to know if the adult lets the child get up 10 times for a glass of water every night. This will help the doctor to recognize and treat child insomnia.
No tests should be needed to diagnose child insomnia. The childs history of going to sleep and waking is normally enough to pinpoint this disorder. Actigraphy could be used in extreme cases.
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Treatment Barriers Future Directions And Conclusions
Compared to medication, behavioral methods of intervention for insomnia are often more effective, more acceptable to parents and practitioners, and have fewer harmful side effects. There is strong evidence to support behavioral interventions, particularly in young children and infants, yet these interventions are rarely the first line of treatment. Two particularly significant challenges that help to explain why these interventions are so rarely the first line of treatment are: parents limited knowledge of, and access to, sleep interventions and a lack of training in sleep interventions among health care providers.
Health care professionals are also partly responsible for sleep problems in children and adolescents being under-diagnosed. Sleep-related issues are often not discussed with health care providers because health care providers often do not ask about sleep. Health care providers may avoid questions related to sleep due to a lack of training in dealing with assessment of sleep problems and they may not have confidence in their abilities to work with individuals with sleep problems. Furthermore, like parents, health care providers may be unaware of the negative effects of insufficient sleep. In addition, when treatments are recommended, health care providers only recommend behavioral interventions in a minority of cases.
How Is It Treated
If your child is suffering from long-term insomnia, the best course of action is to consult a doctor immediately. However, if it is just short-term insomnia, it is possible for parents to provide the correct treatment at home, especially since medication is not always the best option for young children and adolescents. Here are a few tips to help your child overcome their struggle:
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Fears Of The Dark Or Monsters
Play games during the daytime that will make your child more comfortable when the lights are out, suggests Dr. Honaker. For example, give her a flashlight and let her hunt for a few stuffed animals in her room. You can go with her the first couple of times, but then coax her to go it alone as she becomes more comfortable. If she asks to sleep with the light on, try to resist. It’s okay to use a night-light, but bright lights can interfere with the release of the sleep-regulating natural hormone melatonin.
Should I Give My Child Melatonin
Melatonin is produced in the brain when it gets dark – to help us sleep. High levels of this hormone are produced in the night and low levels during the day. Melatonin deficiency can disrupt the body clock, so supplements are often used to alleviate problems such as insomnia.
“Melatonin can be used to treat difficulties with going to sleep or staying asleep,” explains D’Cruz. “It is known to benefit children with ADHD, autism and other developmental disabilities, or visual impairment, as these children may not produce enough melatonin or produce it too late.”
My son was eventually prescribed melatonin. But Dr D’Cruz points out that, for most children with sleep problems, behavioural strategies should be the first recourse before resorting to medication.
“Melatonin is a prescription-only medicine and there are no data on safety in long-term use,” she says. “It is said to be safe for short- and medium-term use – ie up to 18 months or so. While melatonin seems to be safe, there is a lack of evidence regarding its routine use among healthy children.”
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How Can I Help My Child Relax
Teaching your child ways to relax can help them fall asleep. The following relaxation idea is an example of one you can teach your child.
Your child lies down with their eyes closed and then tightens and relaxes all the muscles in their body, one after the other. Some children find it helps to do these muscle exercises while thinking about their favourite place such as the beach, or a park in grannys backyard.
What Is A Sleep Study
An overnight sleep study, or polysomnography, may be recommended for your child, especially if they have excessive daytime sleepiness, problems staying asleep, or OSA. The sleep study will help determine if your child has a diagnosable problem such as pure snoring, obstructive sleep apnea, restless legs syndrome, or another sleep problem. These disorders may require specific therapy that your child’s doctor will prescribe or your child might be sent to a specialist who may be able to help.
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About Insomnia In Children And Teenagers
Insomnia is a sleep problem. If your child has insomnia, it means she has trouble getting to sleep or staying asleep at night, or she might wake up too early.
Short-term insomnia lasts only a few days or weeks. This is also called acute insomnia.
Long-term insomnia is when your child has trouble sleeping at least three times a week, and this problem lasts for a month or longer. This is also called persistent or chronic insomnia.
The amount of sleep your child needs to be at his best for play, learning and concentration during the day depends on his age.
Sleep Problems In Young Children
Lots of young children find it difficult to settle down to sleep and will wake up during the night.
For some people, this might not be a problem. But if you or your child are suffering from a lack of sleep, there are some simple techniques you can try.
Every child is different, so only do what you feel comfortable with and what you think will suit your child.
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Signs That Your Child Isnt Getting Enough Sleep
Children, just like adults, have trouble controlling their moods when theyre sleep deprived. Sleep, or lack thereof, affects much of a childs behavior and state of mind. In some cases, the symptoms of insufficient sleep can even mimic those of ADHD.
If your child isnt getting enough sleep, they may:
- Often seem cranky, irritable, or over-emotional.
- Have trouble concentrating at school or at home? Has a teacher informed you of this problem.
- Fall asleep while riding in the car.
- Appear to struggle following conversations or seem to space out a lot.
- Have trouble waking up or fall back asleep after youve gotten them up for the day.
- Often become drowsy or crash much earlier than their regular bedtime.
If your child wakes up often in the night, or has trouble settling down, it could mean theyre struggling with insomnia, one of the biggest sleep issues among kids.
What Is Obstructive Sleep Apnea
Obstructive sleep apnea is a common problem in children today. According to the American Academy of Pediatrics, symptoms of sleep apnea in children include:
- Nighttime snoring with occasional pauses
- Gasping or choking
- Sleep disruption
Children with snoring and OSA often have large tonsils and/or adenoids. Many are obese and/or have an allergic disease. Sleep apnea is associated with the following consequences:
- Abnormal growth and development
- Removal of the adenoids and tonsils — as a last resort
Sometimes, nasal continuous positive airway pressure is used for children with obstructive sleep apnea. CPAP involves using a machine that delivers a stream of compressed air through a nasal mask to the child’s airway to keep it open during sleep.
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Maintaining A Consistent Routine
A consistent bedtime routine can help children fall asleep more easily. Try:
- checking that the childs bedtime is appropriate for their age
- sticking to the same sleep schedule, even on weekends
- doing the same, predictable tasks before bed every night, such as brushing the teeth, combing the hair, or reading a bedtime story
- avoiding activities that are too stimulating, such as watching TV or playing video games, in the hours leading up to sleep
Delayed Sleep Phase Disorder
The master circadian clock, located within the suprachiasmatic nucleus, controls the timing of sleep and cycles approximately every 24 hours in most individuals.31 The discrepancy between the internal clock and the external world requires continuous resetting by time cues, such as light, melatonin, physical activity, body temperature, and meals. Light is the most powerful of these entrainers. Inappropriate timing of light exposure can alter the circadian rhythm. For example, light exposure before bedtime can suppress melatonin and ultimately delay sleep onset.31,32
In children with delayed sleep phase disorder, habitual sleep-wake times are delayed by at least two hours compared with socially acceptable times.12 The disorder is more common during adolescence when the circadian rhythm is thought to lengthen and the child becomes more social.31,64 The prevalence in adolescents is 7% to 16%.12,31,34 The disorder is diagnosed using patient history and documentation of sleep and wake times on a sleep diary or log. Parental concerns usually focus on late bedtimes , sleeping in, difficulty awakening, and school tardiness. However, frequent nighttime awakenings are unusual, and sleep architecture is usually normal .
Time to day
Time to day
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Causes Of Insomnia In Children
What are some of the possible causes of sleep problems in children? Sometimes insomnia in children can be caused by a medical problem, which is why it is important to go a pediatrician or specialist to make a proper diagnosis. The behavioral and psychological causes most frequent are the following:
Aside from these behavioral problems, there are other causes derived from medical problems that prevent the child from sleeping. Allergies may fragment sleep, while ear infections, colic, and other pains may keep them from sleeping. This is why it is so important to see a doctor to find the underlying cause.
A New Reason To Take Childhood Sleep Problems Seriously
Childrens sleep can be notoriously rocky, but new research serves as a reminder to parents to not simply brush it off as a rite of passage if their child has a difficult time falling or staying asleep.
The findings, , show that 43% of children who had symptoms of insomnia continued to grapple with the sleep disorder in their 20s and 30s.
And its not necessarily rare. Estimates suggest up to a quarter of kids have insomnia symptoms of some kind.
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Causes Of Insomnia In Kids
For many children, their difficulties falling or staying asleep stem from their daytime habits or how they spend their time right before bed. Eating too much sugary food during the day, for example, or watching TV right before bed could be enough to disrupt your childs sleep. Of course, younger children especially will have difficulty making the connection between their habits and the quality of their sleep, so youll have to act as a sleep detective on their behalf.
Other common reasons why your child may be experiencing sleep difficulties include
Insomnia and too much time in bed
Sometimes, a childs insomnia may stem from having more time allotted for sleep than they need each night. In these cases, your child could fight their bedtime or wake up in the night or too early in the morning. To find an ideal bedtime, note when your child starts to become drowsy in the evening. Thats the time they should be going to bed, so start their bedtime routine about 45 minutes earlier. If theyre awake much longer, they may start to get a second wind, and then become more difficult to handle.
Establishing A Healthy Sleep Environment
Where possible, create an environment for sleep that is calm, cool, and quiet. Allow the child to help with this, as they can tell adults what makes them feel comfortable and safe. This may mean:
- moving objects around so that they do not cast scary shadows
- moving the bed to another place in the room
- letting the child choose their own bedding or pajamas
- removing things that they find distracting, such as ticking clocks or screens
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If Your Child Will Not Go To Sleep Without You
This technique can help toddlers or older children get used to going to sleep without you in the room.
It can also be used whenever your child wakes in the middle of the night.
Be prepared for your child to take a long time to settle when you first start.
You can use strokes or pats instead of kisses if your child sleeps in a cot and you cannot reach them to give them a kiss.
- Follow a regular calming bedtime routine.
- Put your child to bed when they’re drowsy but awake, then kiss them goodnight.
- Promise to go back in a few moments to give them another kiss.
- Return almost immediately to give a kiss.
- Take a few steps to the door, then return immediately to give a kiss.
- Promise to return in a few moments to give them another kiss.
- Put something away or do something in the room then give them a kiss.
- As long as the child stays in bed, keep returning to give more kisses.
- Do something outside their room and return to give kisses.
- If the child gets out of bed, say: “Back into bed and I’ll give you a kiss”.
- Keep going back often to give kisses until they’re asleep.
- Repeat every time your child wakes during the night.