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Insomnia affects roughly 25% of children. Whether it is transient (short term-lasting only 2-3 days) or chronic (long term-lasting multiple days per week over the course of a month or more) insomnia, as in adults, can have significant effects on social interactions, cognitive function and behavior.
Diagnosis of insomnia in children can be challenging based on the fact that diagnosis is largely based on subjective symptoms and exclusion of other disorders. Many children have difficulty describing what they are feeling, or how many times the sleeping disturbance occurs. Still, if childhood insomnia is suspected, it is important for caregivers to explore treatment options.
Insomnia in children can appear at any age at any time and can vary from child to child. For some, sleep onset can be difficult due to other sleep disturbances or medical conditions such as obstructive sleep apnea, Attention-deficit/hyperactivity disorder, or autism. Stress, anxiety or depression can also play a role in delaying sleep for children as can the use of certain medications or caffeine.
In addition, there are behavioral insomnias whereby children have specific behavioral associations with sleep onset leaving them dependent on particular behaviors in order to achieve sleep or return to sleep. This kind of insomnia is known as behavioral insomnia of childhood or BIC. There are 3 definite types of behavioral insomnia of childhood.
The first has to do with sleep onset association. For children experiencing sleep onset behavioral insomnia, he or she needs to be with a specific person or item in order to fall asleep or to return to sleep after waking. It may also include needing to be rocked, nursed or held in order for sleep onset to occur.
The second type of behavioral insomnia is referred to as limiting-setting. Children with limit setting issues are known to stall or delay going to bed. Extra hugs, kisses, getting additional drinks of water or requesting more caregiver interaction are all prime examples of limit setting issues. Often when limit-setting issues are prevalent it can be discovered that there is a loose bedtime routine, inconsistent bedtime or sleep behaviors and overall lack of reinforcement to a definite bedtime.
Finally, the last type of behavioral insomnia is a combination of the first and second types; a child experiences both sleep onset association and limit setting symptoms. For those with combination of behavioral insomnias, sleep deprivation can be excessive leading to a wide variety of additional symptoms and other behavioral issues.
Children suffering from insomnia have a variety of negative consequences including but not limited to:
If left untreated, children with insomnia can develop lifelong issues with sleep and sleep maintenance leading to additional health issues as teens and adults. It is important to identify and work with a healthcare provider to overcome sleeping issues.
Treatments for insomnia are variable and dependent on the needs of the children and family. For children experiencing behavioral insomnia, behavioral treatments are most commonly utilized. Behavioral treatments include the use of extinction, bedtime fading, positive routines and adapting proper, consistent sleep hygiene.
Extinction is an approach to sleep onset whereby the child is in bed at a regular time and left alone until they fall asleep; there is no caregiver interaction at any point.
Bedtime fading on the other hand, involves postponing a child’s bedtime in order to sync the bedtime to his or her natural sleep onset time. Over time, bedtime will be manipulated as to allow for appropriate sleep times for the age of the child.
Positive routines create rewarding interactions and cues for bedtime leading to a quicker sleep onset.
Sleep hygiene, as with adults, involves creating a consistent routine around bedtime including limitations to stimulants, limited screen time, and creating a soothing, cool and comforting sleeping environment. Consistency and routine are keystones to developing proper sleep hygiene for sleep onset.
Other treatments may include medications or supplements, however many providers are cautious to utilize medications commonly prescribed in adult patients. There are no prescription drugs approved to treat childhood insomnia. However, some providers and physicians may suggest sleep aids in severe cases including zolpidem (Ambien) or antihistamines like diphenhydramine (Benadryl, Nytol).
Others suggest the use of melatonin, either short acting or long acting also known as timed released. Thought to be a safer alternative to prescribed medications, melatonin has been found to be beneficial to children at low doses. However, similar to prescribed medications, there is limited research proving the efficacy of the supplement use in children and is not approved by the FDA.
When considering treatments for insomnia in childhood, it is important to identify the kind of insomnia and the root cause. Work with the provider or physician to determine the correct avenue for treatment based on the needs of the family and child. It is also important to explore all of the options available while knowing the risks and benefits of each. A child’s sleep changes throughout the years and often sleep disturbances are transient and do not require long term treatments. Being able to acknowledge and diagnose insomnia properly will allow for success and adaptability as the child ages to overcome early sleep issues.