Treating Children with Insomnia

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Children generally sleep deeper and longer than adults, but that doesn’t mean there aren’t kids with problems. Diagnosing sleep problems in children can be harder than in adults. Adults with sleep disorders are the ones who complain to doctors, but when kids have problem it is more typically their parents who mention it to physicians. Kids are usually less articulate and able to describe their subjective experiences than adults.This can make it more challenging to determine whether insomnia and other disorders are behavioral in origin or biological. Further, as children grow up their sleep needs change and different individuals can be at different points in development at the same age. A study at Northwestern University confirmed what parents have long known.  Preschoolers who sleep less than 10 hours a day are more likely to misbehave in social situations.

For health care professionals, treating children with insomnia is tricky. A high percentage of children go through a period when they have difficulty sleeping; this sleeplessness is sometimes due to sickness or rapid growth, either physical or emotional. There are few studies on the appropriate treatment for children with severe insomnia. As with adults, the physician first looks for treatable causes of the insomnia. Experts consider behavioral treatments the first-line therapies even though kids and their parents may resist them. You can consult your doctor but most will be reluctant to prescribe medication for children.

Adult insomnia medications are thought to be safe by some experts and have been used in certain cases at adjusted dosages, but none have been approved by the FDA for children. The caveats and warnings about using medicine for insomnia in adults apply more strongly for use in children. Such medications include the long-acting benzodiazepine flurazepam (Dalmane) and certain antihistamines, such as trimeprazine (Temaril). Short-acting benzodiazepines may have some use for brief treatment of children with insomnia related to mood disorders or medication.

A 2006 conference conducted by the National Sleep Foundation brought together experts in the field. The conference participants unanimously agreed there is a need for pharmacologic management of pediatric insomnia and the consensus was that the use of hypnotic and psychotropic medications when little formal study has been done on these drugs in children was troubling. They called for clinical trials to establish the safery and efficacy of medicines for childhood insomnia and a more established consensus among the medical profession.

Clinical trials show antihistamines have the same effect on sleep behavior in children that they do in adults: they reduce sleep latency and number of perceived nighttime awakenings, but it is less clear that they increase total sleep time. An article in the British Medical Journal concluded “diphenhydramine is a safe, effective bedtime sleep aid for paediatric patients.”

A retrospective study published in BMC Pediatrics concluded that hypnosis can aid insomnia treatment in children over age 7. However, most primary care doctors are unfamiliar with hypnosis. A Dutch study in 2001 looked at use of melatonin for sleep onset insomnia in kids. The results were not very good. A Canadian study, however, found success with a combination of sleep hygiene and melatonin.

The paucity of medicines approved from children (not just sleep medicines) has attracted attention of lawmakers, and in 2012 the US Congress gave the FDA authority to make the pharmaceutical companies test their products for use in pediatric applications.

The British Association for Psychopharmacology organized a conference in 2009 about treatment of insomnia, circadian disorders, and other sleep problems in children. There was no great news at the conference, but the wide participation shows the interest among scholars and clinicians in this field.

Like adults, children are more likely to snore when they are overweight.  It has also been shown that kids with ADHD are much more likely to snore.  Treating the snoring reduces incidence of ADHD. A correlation between frequent snoring and poor academic performance has also been found, leading to the idea that sleep-disordered breathing can negatively affect the cognitive capacity of the growing child.  All the more reason to treat sleep problems.

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