Insomnia is a sleep disorder in which a child struggles to fall asleep or has trouble staying asleep. While insomnia is common in adults, it is less so in children. Sleep is crucial for proper childhood development, so it's important to make sure your child is getting enough.
Most insomnia in children is related to behavior. The three main kinds of insomnia that affect kids are:
- Sleep-onset association insomnia - Young children may associate bedtime with certain actions, objects or settings. If your child is used to being rocked to sleep or if she drinks from a particular bottle at bedtime, she may have trouble falling asleep under different circumstances.
- Limit-setting insomnia - Older children may refuse to go to sleep or delay sleep in the absence of strictly enforced bedtimes. Between 10 and 30 percent of children have the limit-setting form.
- Inadequate sleep hygiene - Habits that keep adolescents from going to sleep or disrupt the sleep schedule are known as inadequate sleep hygiene. Between 1 and 2% of teens and young adults have this type of insomnia.
A fourth type of insomnia in kids is one that doesn't have a recognizable cause and may run in families. Idiopathic insomnia is extremely rare, affecting fewer than 1% of children.
Aside from behavioral or genetic reasons, other things that may cause insomnia in children include:
- Anxiety, stress or depression
- Breathing problems, such as sleep apnea or asthma
- Certain drugs, including some asthma, allergy and cold medicines
- Sleep disorders, including restless legs syndrome
- Difficulty falling back asleep once awake
- Easily distracted (may resemble ADHD)
- Excessive drowsiness or grogginess during the day
- Trouble falling asleep
- Waking up during the night
- Waking up early (while it's still dark out)
Tests and Diagnosis
The National Institutes of Health recommend that newborns get between 16 and 18 hours of sleep each day. Preschool-aged children should get between 11 and12 hours, while older children should get at least 10 hours of sleep at night. If your child isn't getting enough sleep, see your pediatrician.
A pediatrician will want to know your child’s sleep history and may ask if sleep disorders run in your family. The doctor will perform a physical exam to rule out medical conditions that may be behind your child’s insomnia. He may also recommend a sleep study (polysomnogram).
During the sleep study, your child will spend the night in a sleep lab. Polysomnography records eye movements, brain activity, heart rate and blood pressure. It also can tell how much oxygen is in your child’s blood and how much air is moving through his nose while he breathes. A sleep study can rule out other sleep disorders that may be behind the insomnia.
Not only can insomnia affect childhood development, it can cause sleeplessness for the whole family. Kids with insomnia may keep parents up at night or begin a power struggle when it's time to wake up. Insomnia may impact your child's grades and social life as well.
Changing your child's sleep habits (sleep hygiene) is usually the first step to tackling insomnia. Steps you can take at home:
- Make sure your child has a regular bedtime and nighttime routine.
- Make sure your child gets some kind of physical activity, preferably outside, every day.
- Make sure your child's bedroom is quiet, cool and dark (a small night light is fine).
- Maintain a similar sleep schedule on weeknights and weekends (staying up late and sleeping in can disrupt the body's sleep-wake cycle).
- Don't use your child's bedroom for timeouts or other punishments.
- Reserve the hour before bed as "quiet time" (no bright lights, television or computer screens).
- Avoid heavy meals within two hours of bedtime (light snacks are okay).
- Avoid caffeinated beverages in the hours before bedtime.
- Use relaxation techniques, including baths right before bed.
- Limit napping during the day (naps are normal for infants and pre-school aged kids).
If you've done all the above and your child still can't sleep, see a doctor. A sleep specialist may recommend the following treatments depending on your child's symptoms:
- Cognitive behavioral therapy (CBT): CBT combines cognitive therapy, relaxation training and sleep hygiene training. CBT can help change bad habits that disrupt your child's sleep.
- Over-the-counter medications: Antihistamines can help your child sleep at night but may cause severe daytime sleepiness.
- Prescription sleeping pills: Doctors rarely prescribe medications for insomnia in children. Side effects for those and other medications can be dangerous for kids.
- Melatonin: Melatonin is a sleep hormone that may help kids with both insomnia and ADHD.
How can I tell if my child has insomnia?
Children with insomnia may have trouble falling asleep or getting back to sleep after waking during the night. Kids with insomnia are often groggy or distracted during the day. They may also be anxious, irritable or experience mood swings. Aggressiveness, hyperactivity and poor impulse control can be symptoms of insomnia as well.
What is the prognosis for children with insomnia?
By regulating children’s bedtimes, most insomnia eventually goes away. There aren’t usually any long-term effects from childhood insomnia.