Sleep difficulties in children

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When I had to do night shifts during my medical training, I came to understand how sleep deprivation could sometimes be used as a form of torture. After being awake for sometimes 30 plus hours, life just did not seem right. My body felt as if it lost the ability to regulate itself, especially emotionally. Sleep deprivation can wreak havoc in families and it is thus not surprising that it is a common problem that we discuss in consultations.  

Sleep difficulties are very common in children with cross sectional surveys finding that between 20-30% of children having some sleep related difficulty at any given time. Addressing these difficulties are very important, as lack of sleep could impact on a child’s physical, emotional, cognitive and social wellbeing…. Not to talk about the parents’ emotional wellbeing.   

The most common cause of sleep problems is behavioural, such as bed time refusal, delayed sleep onset and prolonged night time awakenings requiring parental intervention. Some medical conditions can also cause sleep difficulties such as obstructive sleep apnoea, movement disorders or other sleep conditions called parasomnias. A child could also struggle sleeping secondary to an underlying medical condition, such as breathing difficulties, pain, medication or due to psychological stressors, anxiety or depression. In our practice, one of the most common co-existing conditions we see associated with sleep difficulties are in children with ADHD or autistic spectrum disorder with between 50-70% of children with ADHD having an associated sleep disturbance. 

It is important to try and identify the reason for the sleep difficulties and to treat this if possible. Some children might require further investigations to assess ongoing difficulties, especially children with associated breathing or movement disorders in sleep. For children who have behavioural insomnia, behavioural interventions can improve sleep for most children. Bedtime routines, systematic ignoring or extinction, bedtime fading and positive reinforcement are a few strategies that have been proven effective, if used consistently. In some children, medication might be needed to help a child back into a sleep routine if other strategies have not been successful. 

For further reading, the Sleep Health Foundation of Australia have several useful factsheets. https://www.sleephealthfoundation.org.au/public-information/fact-sheets-a-z.html  

Sweet dreams!

Dr. Adele Heyer

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