Sleeping disorders infants

Common Sleep Disorders in Children

KEVIN A. CARTER, DO, NATHANAEL E. HATHAWAY, MD, AND CHRISTINE F. LETTIERI, MD

Up to 50% of children will experience a sleep problem. Early identification of sleep problems may prevent negative consequences, such as daytime sleepiness, irritability, behavioral problems, learning difficulties, motor vehicle crashes in teenagers, and poor academic performance. Obstructive sleep apnea occurs in 1% to 5% of children. Polysomnography is needed to diagnose the condition because it may not be detected through history and physical examination alone. Adenotonsillectomy is the primary treatment for most children with obstructive sleep apnea. Parasomnias are common in childhood; sleepwalking, sleep talking, confusional arousals, and sleep terrors tend to occur in the first half of the night, whereas nightmares are more common in the second half of the night. Only 4% of parasomnias will persist past adolescence; thus, the best management is parental reassurance and proper safety measures. Behavioral insomnia of childhood is common and is characterized by a learned inability to fall and/or stay asleep. Management begins with consistent implementation of good sleep hygiene practices, and, in some cases, use of extinction techniques may be appropriate. Delayed sleep phase disorder is most common in adolescence, presenting as difficulty falling asleep and awakening at socially acceptable times. Treatment involves good sleep hygiene and a consistent sleep-wake schedule, with nighttime melatonin and/or morning bright light therapy as needed. Diagnosing restless legs syndrome in children can be difficult; management focuses on trigger avoidance and treatment of iron deficiency, if present.

Sleep is one of the most commonly discussed topics during well-child visits.¹ It is important for primary care physicians to be familiar with normal childhood sleep patterns and common sleep disorders. Epidemiologic studies indicate that up to 50% of children experience a sleep problem,^2–4 and about 4% have a formal sleep disorder diagnosis.⁵

Clinical recommendation	Evidence rating	References
Sleep disorders should be considered in children presenting with irritability, behavioral problems, learning difficulties, and poor academic performance.	C	6–8, 52, 53
Adenotonsillectomy is the primary treatment for children with obstructive sleep apnea.	B	13, 56–58
Sleep or sedating medications have no role in the treatment of behavioral insomnia of childhood.	C	29, 30
If restless legs syndrome is suspected in a child, management should include a workup for iron deficiency and avoidance of triggers.	C	47–50

Normal Sleep in Infants and Children

Sleep is an opportunity for the body to conserve energy, restore its normal processes, promote physical growth, and support mental development. The most recognized consequence of inadequate sleep is daytime sleepiness. However, sleepiness in children commonly manifests as irritability, behavioral problems, learning difficulties, motor vehicle crashes in teenagers, and poor academic performance.^6–8 Distinguishing significant sleep disruptions from normal age-related changes can be challenging and can ultimately delay treatment.

Sleep changes considerably during the first few years of life and parallels physical maturation and development. Newborns require the greatest total sleep time and have a fragmented sleep-wake pattern. Starting at five months of age, infants have the ability to sleep for longer periods. At six months of age, children are able to go without nighttime feedings, but significant variation exists. Additionally, breastfeeding infants have more frequent awakenings, shorter sleep periods, and slightly shorter total sleep times.⁹ As children age, sleep periods gradually lengthen and total sleep time decreases (Figure 1).

The large variation in sleep behavior among children may be secondary to cultural or genetic differences; however, there are some general trends (Table 1).^10,11 Ultimately, knowing the normal developmental stages of sleep will help differentiate between normal sleep and common sleep disorders, such as obstructive sleep apnea (OSA), parasomnias, behavioral insomnia of childhood, delayed sleep phase disorder, and restless legs syndrome. These disorders are summarized in Table 2.^7,12–50

Obstructive Sleep Apnea

OSA is characterized by upper airway obstruction, despite respiratory effort, that disrupts normal sleep patterns and ventilation. ¹² OSA can be associated with obesity, excessive soft tissue in the upper airway, decreased upper airway lumen size, or failure of pharyngeal dilator muscles. However, in children, the obstruction is primarily due to enlarged tonsils and adenoids.^12,13 Onset usually occurs between two and eight years of age, coinciding with peak tonsil growth, but the condition can manifest at any age.⁵¹ The overall prevalence in children is 1% to 5%.¹³ It occurs equally among males and females, but is more common in ethnic minorities.¹³

Snoring and witnessed apneas are the classic symptoms of OSA, but not all snorers have the condition. The prevalence of habitual snoring in children is as high as 27%, which can complicate the recognition of OSA.^13,16,52 Other common symptoms include unusual sleeping positions (e.g., hyperextended neck, seated with open mouth), sleep-related paradoxical breathing, nighttime diaphoresis or enuresis, morning headaches, and excessive daytime sleepiness. However, children are less likely than adults to present with daytime sleepiness. Sleepiness in children is more likely to manifest as depressed mood, poor concentration, decreased attention, or behavioral issues.^6,52,53

Weight and body mass index are usually normal in children with OSA; however, the incidence of obesity-related sleep apnea is steadily increasing.^5,54 Physical examination findings can include enlarged tonsils, micrognathia, and pectus excavatum. However, subjective grading of tonsil size in children does not always correlate with objective findings.⁵⁵

Results of the history and physical examination alone correlate poorly with objective findings of OSA, and questionnaires have shown a sensitivity of only 78%.¹³ Therefore, children with suspected OSA should be referred for polysomnography.^17–19 In addition, referral to a sleep medicine specialist should be considered for those with high-risk features (e.g. , attention-deficit/hyperactivity disorder, cardiorespiratory failure, craniofacial abnormalities, congenital defects, Down syndrome).

Untreated OSA is associated with neurobehavioral problems, decreased attention, disturbed emotional regulation, decreased academic performance, nighttime enuresis, impaired growth, and, rarely, systemic hypertension, pulmonary hypertension, and cor pulmonale.^{6,17–20,52,53} Adenotonsillectomy is the primary treatment for OSA in children (Table 3).^13,18 Following adenotonsillectomy, postoperative polysomnography demonstrates resolution of OSA in more than 70% of normal-weight children, but in less than one-half of obese children.^13,56–58 Postoperative improvements in quality of life and behavior may also occur.^56–59 Children being considered for adenotonsillectomy who are at high risk of postoperative complications (risk factors include age younger than three years, severe OSA, obesity, current respiratory infection, craniofacial abnormalities, failure to thrive, cardiac complications of OSA, and neuromuscular disorders) should undergo the procedure as an inpatient. Once treated, all children should have a clinical assessment six to eight weeks postoperatively, and polysomnography should be repeated to assess for residual OSA in those with obesity, moderate to severe OSA on initial testing, or persistent symptoms.^13,17,18 If ordered, polysomnography should be performed after the pharynx has fully healed, usually no earlier than six weeks postoperatively.

Diagnosis

All children should be screened for snoring at well-child visits.13

Clinical and polysomnographic findings should be integrated to diagnose OSA; clinical indicators alone are not consistently reliable for predicting OSA.13,18

Adenotonsillectomy is a low-risk procedure, but should be performed only in those with proven OSA.13

Preoperative polysomnography is indicated before adenotonsillectomy in children with OSA. 13,18

Identifying the severity of OSA helps determine the risk of postoperative respiratory complications.13,18

Treatment

Adenotonsillectomy is the primary treatment for those with adenotonsillar hypertrophy; it is highly effective and leads to improved quality of life and behavior.13

Follow-up

Patients with mild OSA should receive postoperative and periodic clinical assessments for residual symptoms; if symptoms are present, postoperative polysomnography is indicated.13,18

Patients with moderate to severe OSA and obesity should receive postoperative polysomnography to assess for residual symptoms, as well as periodic clinical assessments13,18

Weight loss interventions have demonstrated benefits of reducing the severity of OSA and should be initiated in all children who are overweight or obese. ¹³ Continuous positive airway pressure should be offered to those with residual OSA symptoms or if adenotonsillectomy was not performed. There is limited evidence to support the use of intranasal corticosteroids for children with mild OSA or with residual mild OSA following adenotonsil-lectomy.⁶⁰ Although rapid maxillary expansion (i.e., use of an orthodontic device that widens the upper jaw) and montelukast (Singulair) are sometimes recommended, no clinical trial evidence supports the use of these treatments for OSA in children.

Parasomnias

Parasomnias such as sleepwalking (somnambulism), sleep talking (somniloquy), confusional arousals, sleep terrors, and nightmares affect up to 50% of children.¹² They are defined as undesirable events that accompany sleep and typically occur during sleep-wake transitions.¹² They are additionally characterized by complex, awake-like activity by the child that appears purposeful but lacks meaningful interaction with his or her environment. Associated features include confusion, automatic behaviors, difficulty awakening, amnesia, and rapid return to full sleep after the event.

Most parasomnias, such as sleepwalking, sleep talking, confusional arousals, and sleep terrors, occur in the first half of the sleep period during slow wave sleep; children typically have no memory of the event. In contrast, nightmares typically occur in the last half of the sleep period during rapid eye movement sleep, with children able to remember the event. It is important to note that the symptoms and timing of nocturnal seizures can overlap with parasomnias. Physicians should inquire about repetitive stereotypic behaviors and odd posturing that could represent nocturnal seizures.¹²

Genetically predisposed individuals are susceptible to precipitating factors, contributing to the development of parasomnias. Precipitating factors include insufficient sleep and disorders causing partial awakenings from sleep. OSA is a common trigger for parasomnias, and a review of studies showed that more than one-half of children referred for sleep terrors or sleepwalking also had OSA. ²¹ Other triggers may include periodic limb movement disorder, gastroesophageal reflux disease, forced awakenings, and certain medications.^12,21

Parasomnias often resolve spontaneously by adolescence; however, 4% of persons will have recurring events.^12,22 Treatment centers on reassurance, reducing precipitating factors, and increasing total sleep times.^21,23,61 When it is appropriate, parents should be counseled about safety measures (e.g., locking doors and windows, using motion alarms, clearing the floor of toys, placing the mattress on the floor). Children who exhibit atypical, harmful, or violent behaviors or who are unresponsive to conservative treatments should be referred for further evaluation.

Behavioral Insomnia of Childhood

Behavioral insomnia of childhood is characterized by a learned inability to fall and/or stay asleep; the estimated prevalence is 10% to 30%.^12,24 The condition is divided into the sleep-onset association type and the limit-setting type. The sleep-onset association type is characterized by the child's inability or unwillingness to fall asleep or return to sleep in the absence of specific conditions, such as a parent rocking the child to sleep.¹² The limit-setting type occurs when parents fail to set appropriate limits, such as when the parents allow the child to sleep in their bed when the child refuses to sleep.¹² Most children with behavioral insomnia of childhood have features of both types.

Prevention is the best treatment for behavioral insomnia of childhood. Physicians should educate parents on normal sleep patterns, good sleep hygiene, realistic expectations, setting boundaries, and sleep plans. These plans should focus on regular and consistent feedings, nap times, bedtime routines, and sleep-wake times. Infants are more likely to become self-soothers (fall asleep on their own) when consistently placed in the crib awake vs. already asleep.^62,63 Creating a regular routine will establish expectations, and the child will eventually learn how to fall asleep on his or her own. Extinction techniques (placing the child in bed and ignoring him or her until the morning, or for a set period) are effective in the treatment of this disorder.^25–28 There are various extinction techniques, and no single method is superior. Techniques for managing behavioral insomnia of childhood are summarized in Table 4.²⁷ Sleep or sedating medications are ineffective for the treatment of this disorder.^29,30

Treatment technique	Description
Parental education	Parents are taught about good sleep practices, such as consistent feedings, nap times, bedtime routines, regular sleep-wake times, and placing the child in bed drowsy but awake.
Unmodified extinction	The child is placed in bed at a predetermined bedtime.
	The child's crying, calls for the parents, and tantrums are ignored until the following morning, although significant cries for suspected injuries or illnesses are not ignored.
	Cries are ignored to prevent reinforcing negative learned behavior (e.g., crying is rewarded with parental response/presence).
	This technique can be difficult and distressing for parents.
	Modified version for decreased parental distress:
		A parent stays in the child's room, but follows the same technique.
Graduated extinction	This is fundamentally the same as unmodified extinction, but with scheduled “check-ins.”
	A parent checks on the child on a fixed schedule (e. g., every 10 minutes) or in gradually increased intervals (e.g., first check-in after five minutes, second check-in after 10 minutes).
	Parental interactions with the child are calming and positive, but last no more than one minute at a time.
Positive bedtime routines/faded bedtime with response cost	Positive bedtime routines: Relaxing/calming activities are implemented before bedtime (e.g., bedtime stories).
	Faded bedtime: Bedtime is delayed until the predicted time of sleep onset to decrease the time the child spends in bed awake.
	Response cost: The child is removed from bed for a specific amount of time if sleep onset does not occur within the desired period.
Scheduled awakenings	Parents must document the pattern of nighttime awakenings.
	The child is awakened before the normally predicted nighttime awakening, and the number of scheduled awakenings is slowly decreased over time.

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 (2 a.m. or later), sleeping in, difficulty awakening, and school tardiness. However, frequent nighttime awakenings are unusual, and sleep architecture is usually normal (Figure 2).

Treatment focuses on aligning the circadian rhythm with desired sleep-wake times. As in all sleep disorders, maintaining a regular sleep-wake cycle and practicing good sleep hygiene are the foundation of treatment. It is important to avoid bright lights before bedtime. Removing all light-emitting devices (e.g., electronics, portable media, tablet computers, cell phones) from the bedroom may be beneficial. Bright light therapy used for the first one to two hours after awakening may also be beneficial and will advance the circadian rhythm. ³¹ There is strong evidence that melatonin supplementation (0.3 to 5 mg given 1.5 to 6.5 hours before desired bedtime) is an effective treatment for delayed sleep phase disorder, although the exact dose or timing has not been well established.^36–38

Restless Legs Syndrome

The rate of restless legs syndrome in children is unclear, but limited studies suggest a prevalence of 2%.^12,39 The condition is characterized by an unpleasant sensation in the legs, with the urge to move the legs starting in the evening.¹² Rest worsens symptoms, and movement provides some relief. Other symptoms include difficulty falling asleep, bedtime resistance, “growing pains,” and symptoms similar to those of attention-deficit/hyperactivity disorder.^12,40,42,43 The condition in children is associated with negative behavior and mood, and decreased cognition and attention, and it is more common in children with attention-deficit/hyperactivity disorder. ^12,39,42

Dopamine dysfunction, genetics, and iron deficiency are thought to play a role in the pathogenesis of restless legs syndrome.^45–48 Additionally, symptoms may be exacerbated by excessive or inadequate physical activity or the use of caffeine, nicotine, antihistamines, selective serotonin reuptake inhibitors, or tricyclic antidepressants.⁴⁷

Diagnosing restless legs syndrome in children can be challenging because they may be unable to describe the core symptoms. A diagnosis can be made if the history is consistent with the condition and at least two of the following are present: a sleep disturbance, a first-degree relative has the condition, or five or more periodic limb movements per hour of sleep during polysomnography.¹² Once restless legs syndrome is diagnosed, conservative treatment includes avoiding exacerbating factors.⁴⁷ Because iron deficiency is common in children, measuring the ferritin level is reasonable. ^49,50 Iron replacement should be initiated if ferritin levels are less than 50 mcg per L, and they should be rechecked in three months.^46,48 There are no medications approved for treating restless legs syndrome in children. Patients with symptoms that do not respond to conservative treatments should be referred for further evaluation.

Data Sources: We searched PubMed using standard search and MESH search terms. The American Academy of Sleep Medicine, American Academy of Pediatrics, American Heart Association, and American Thoracic Society were searched for guidelines and recommendations. In addition, a set of references from Essential Evidence Plus were reviewed and cited as applicable. Search dates: March 2011 through November 2013.

Sleep in Infants (2-12 Months)

What to expect

Infants sleep between 9 and 12 hours during the night and nap between 2 and 5 hours during the day. At 2 months, infants take between two and four naps each day, and at 12 months, they take either one or two naps. Expect factors such as illness or a change in routine to disrupt your baby’s sleep. Developmental milestones, including pulling to a standing and crawling, may also temporarily disrupt sleep.

By 6 months of age, most babies are physiologically capable of sleeping through the night and no longer require nighttime feedings. However, 25%-50% continue to awaken during the night. When it comes to waking during the night, the most important point to understand is that all babies wake briefly between four and six times. Babies who are able to soothe themselves back to sleep (“self-soothers”) awaken briefly and go right back to sleep. In contrast, “signalers” are those babies who awaken their parents and need help getting back to sleep. Many of these signalers have developed inappropriate sleep onset associations and thus have difficulty self-soothing. This is often the result of parents developing the habit of helping their baby to fall asleep by rocking, holding, or bringing the child into their own bed. Over time, babies may learn to rely on this kind of help from their parents in order to fall asleep. Although this may not be a problem at bedtime, it may lead to difficulties with your baby falling back to sleep on her own during the night.

Safe Sleep Practices for Infants

• Practice the ABC’s of safe sleep: Babies should always sleep Alone, on their Backs, in a Crib. Place your baby on his or her back for every sleep, night time and nap time.

• Do not put your baby to sleep on his side or tummy.

• Once your baby can roll from his back to tummy and tummy to back, your baby can stay in the sleep position that he assumes. But always place your baby to sleep on his back.

• Place your baby on a firm mattress in a safety-approved crib with slats no greater than 2-3/8  inches apart.

• Make sure your baby’s face and head stay uncovered and clear of blankets and other coverings during sleep. If a blanket is used make sure your baby is placed “feet-to-foot” (feet at the bottom of the crib, blanket no higher than chest-level, blanket tucked in around mattress) in the crib. Remove all pillows from the crib.

• Create a “smoke-free-zone” around your baby.

• Avoid overheating during sleep and maintain your baby’s bedroom at a temperature comfortable for an average adult.

• Remove all mobiles and hanging crib toys by about the age of 5 months, when your baby begins to pull up in the crib.

• Remove crib bumpers by about 12 months, when your baby can begin to climb

For additional safe sleep practices for infants including information and video on choking, making a safe home environment, resources, swaddling and tummy time, click here. 

How to Help Your Infant Sleep Well

• Learn your baby’s signs of being sleepy. Some babies fuss or cry when they are tired, whereas others rub their eyes, stare off into space, or pull on their ears. Your baby will fall asleep more easily and more quickly if you put her down the minute she lets you know that she is sleepy.

• Decide on where your baby is going to sleep. Try to decide where your baby is going to sleep for the long run by 3 months of age as changes in sleeping arrangements will be harder on your baby as he gets older. For example, if your baby is sleeping in a bassinet, move him to a crib by 3 months.  Always practice the ABC’s of safe sleep: Babies should always sleep Alone, on their Backs, in a Crib.

• Develop a daily sleep schedule. Babies sleep best when they have consistent sleep times and wake times. Note that cutting back on naps to encourage nighttime sleep results in overtiredness and a worse night’s sleep.

• Encourage use of a security object. Once your baby is old enough (by 12 months), introduce a transitional/love object, such as a stuffed animal, a blanket, or a t-shirt that was worn by you (tie in a knot). Include it as part of your bedtime routine and whenever you are cuddling or comforting your baby. Don’t force your baby to accept the object, and realize that some babies never develop an attachment to a single item.

• Develop a bedtime routine. Establish a consistent bedtime routine that includes calm and enjoyable activities that you can stick with as your baby gets older. Examples include a bath and bedtime stories. The activities occurring closest to “lights out” should occur in the room where your baby sleeps. Also, avoid making bedtime feedings part of the bedtime routine after 6 months.

• Set up a consistent bedroom environment. Make sure your child’s bedroom environment is the same at bedtime as it is throughout the night (e.g. lighting). Also, babies sleep best in a room that is dark, cool, and quiet.

• Put your baby to bed drowsy but awake. After your bedtime routine, put your baby to bed drowsy but awake, which will encourage her to fall asleep independently. This will teach your baby to soothe herself to sleep, so that she will be able to fall back to sleep on her own when she naturally awakens during the night.

• Sleep when your baby sleeps. Parents need sleep also. Try to nap when your baby naps, and be sure to ask others for help so you can get some rest.

• Contact your doctor if you are concerned. Babies who are extremely fussy or frequently difficult to console may have a medical problem, such as colic or reflux. Also, be sure to contact your doctor if your baby ever seems to have problems breathing.

Adapted from: Mindell JA & Owens JA (2003). A Clinical Guide to Pediatric Sleep: Diagnosis and Management of Sleep Problems. Philadelphia:  Lippincott Williams & Wilkins.

Treatment of sleep disorders in children in Moscow

Sleep disorders (dyssomnia) in children - a group of disorders associated with the quantity or quality of sleep.

Children are often subject to various sleep disorders from a very early age. Most often, these disorders include insomnia, sleepwalking, sleep-talking, nightmares, bruxism, and enuresis.

Causes of sleep disorders

Dyssomnias in children may be based on emotional upheavals, somatic or neurological problems. nine0003

The most common cause of sleep disorders is the child's emotional overexcitation just before going to bed: noisy outdoor games, computer games, watching TV. An important role is played by children's fears. Children are often very impressionable and may not cope with emotional experiences after watching scary movies, computer games with elements of aggression, as well as after stressful situations in the family and school. As a result, insomnia, nightmares, restless sleep occur. nine0003

Some types of dyssomnias are caused by the immaturity of the nervous system and disappear with age, however, those dyssomnias that significantly affect the quality of a child's life require correction by a specialist. So, for example, during sleepwalking (somnambulism, sleepwalking), a child can get injured. With insufficient sleep, frequent awakenings, the child is depressed during the day, distracted, which can affect the quality of education and academic performance.

Diagnosis

If the child has severe sleep disorders, parents should contact a pediatric neurologist. The doctor will conduct a detailed diagnosis of the child's nervous system, establish the cause of the development of dyssomnia. nine0003

First of all, it is necessary to exclude somatic pathology, as a result of which secondary sleep disturbance could occur (disorders of the respiratory, cardiovascular systems, gastrointestinal tract, dysfunction of the thyroid gland).

Otherwise, the neurologist will refer you to the appropriate specialist – paediatrician, gastroenterologist or endocrinologist. Also, such a phenomenon as nocturnal enuresis may be a manifestation of a disease of the genitourinary system and requires examination by a nephrologist or urologist. The main methods for diagnosing sleep disorders are polysomnography and EEG - these methods record various physiological parameters during sleep and allow you to evaluate each phase of sleep separately. nine0003

Treatment

Treatment of dyssomnia in children begins with parents adjusting their sleep-wake schedule and bedtime preparation. Due to the immaturity of the child's nervous system, the child's inhibition and relaxation processes may be disrupted, which leads to difficulty falling asleep. A neuropsychologist will help correct this violation. It is necessary to set the same time for falling asleep and waking up, stop active games and noisy events an hour before bedtime.

It is best to take small walks in the fresh air, to occupy the child with something calm, monotonous - drawing, embroidery, reading. A child can be shown therapeutic massage, osteopathy, reflexology, as well as a psychologist's consultation if the child has fears, phobias and problems with the emotional background. Also, a neurologist can prescribe drugs that strengthen the nervous system - vitamins and phytopreparations. nine0003

Sleep disorders in children: description of the disease, causes, symptoms, cost of treatment in Moscow

Sleep disturbances in children negatively affect not only their health, but also the condition of adults, who, due to the problem, also cannot fully relax. One-time sleep problems at any age are not dangerous. If the child has a violation becomes frequent, then it is necessary to seek medical help and be sure to carry out treatment. There are a lot of reasons for the appearance of a problem, and for the effectiveness of therapy it is necessary to establish exactly which of them takes place in a particular case. Sometimes disturbed sleep is associated with an attempt by the baby to manipulate parents, but most often this problem turns out to be a pathology that needs to be eliminated. nine0003

Children's sleep disorders are quite common and affect about 20% of preschool children. In schoolchildren and adolescents, the problem appears even more often, as they are already becoming more independent and often themselves, overpowering the body's signals of readiness for sleep, break the correct biorhythms. As a rule, severe disorders are not common, and in most cases, eliminating the disease with proper treatment is quite simple. It has been observed that most often children who have learning difficulties have sleep problems. nine0003

Doctors single out a separate special risk group, which includes children who are more likely to experience violations. It usually includes babies with developmental defects, mental pathologies and sensory impairments. Also, sometimes it includes hyperexcitable children who practically cannot sleep during the day and do not rest fully at night. Artificially, babies living without a regimen fall into the risk group, because of which their body receives too much stress during the day, which ultimately causes severe emotional overwork and further problems with sleep. Chaos in the daily routine of a child, when he lives not according to the regime, but according to his needs, causes serious harm. Because of this, doctors strongly advise parents not to experiment on their babies. nine0003

Types of sleep disorders

Quite a lot of types of sleep disorders are distinguished, which are manifested in the fact that children's sleep is not long enough or proceeds with certain disorders. Depending on which of them is diagnosed, the doctor will prescribe the necessary treatment.

1. Violations of falling asleep and maintaining normal sleep. It can occur at any age and even in infants. The problem is characterized by the fact that often the period of falling asleep is significantly lengthened, and sleep becomes too sensitive, and it is interrupted by any, even minor, sounds or weak light. The patient can sometimes wake up only due to the fact that he himself moved during sleep. nine0003

2. Disturbances of sleep and wakefulness. This phenomenon is more common among teenagers. Sleep delay is more common when the body gives signals to go to sleep with a delay of one or more hours. In this case, usually the child is engaged in any business for too long, and as a result, his sleep is shifted to a later time. Because of this, the child begins to get up with a shift for several hours. The lack of sleep that occurs due to an early rise to school provokes a backlog in studies and a general deterioration in the condition. nine0003

3. Sleep apnea. The problem appears more often in children who suffer from obesity between the ages of 3 and 10 years. With such a violation during sleep, a short-term cessation of breathing occurs. Most often in a child, recovery of breathing is characterized by a loud snoring sound that makes the baby wake up. When waking, the child is usually very upset, and not rarely frightened. What happened to him, he cannot explain.

4. Nightmares. This phenomenon is usually observed in the first half of sleep. Due to emotional or physical overload, the brain fails, producing nightmares. Most children experience this problem between the ages of 6 and 12. Such a sleep disorder in a child of 2 years old can develop only against the background of a very strong emotional shock. If disturbed during sleep, the child may scream, make active movements, and even jump out of bed. Not infrequently, his eyes at this time are open, glassy. The pulse is always high. Profuse sweat. Sometimes the phenomenon is provoked by the general unfavorable situation for children in the family, which also includes the refusal to divorce only for the sake of the child, since children still feel and experience the constant tension between adults. nine0003

5. Confusion of consciousness. More often, children aged 9 months to 16 months suffer from this phenomenon at the time of awakening, when their body is developing very actively. At the same time, a few minutes before awakening, the child begins to move vigorously, and waking up, cries for no apparent reason. If no congenital pathologies or diseases are revealed, then the doctor usually prescribes for treatment simply a calmer daily routine and relaxing massages before bedtime.

6. Nocturnal enuresis. Sleep incontinence usually affects children between the ages of 4 and 12. This phenomenon is due to the fact that not everyone's nervous system at this age already works well enough for an overflow of the bladder to cause awakening. Also, the problem often develops due to stress, when, due to a strong emotional overstrain, the nervous system, which has already functioned in an adult, gives a pronounced failure, ceasing to send the correct wake-up signals when urinating. nine0003

7. Violations of rhythmic movements. This phenomenon is noted at the beginning of sleep or at the end. In the middle of sleep, it occurs much less frequently and, as a rule, if there has been an awakening. The duration of such an attack is up to 15 minutes. At this time, the child sways with his whole body, shakes or knocks his head. Usually, by the age of four or five, such phenomena disappear in a child on their own. We start the violation in most cases in 2 months.

8. Narcolepsy. Acute sleep attacks, which the patient cannot fight, occur spontaneously at any time of the day and can develop even at the time of eating or physical activity. Also, such a violation is characterized by the appearance of hallucinations in the patient when falling asleep and waking up and sleep paralysis, in which for several minutes after the child has woken up, he cannot move, speak or even open his eyes. nine0003

It is not always possible for parents to independently determine which type of violation occurs in a child. This is usually possible only if the problem has classic manifestations. However, even if we ourselves managed to correctly classify a sleep disorder, this does not mean that treatment can be carried out without a doctor. Only a specialist should deal with the problem.

What can provoke a violation

Sleep disturbances are provoked in childhood (in the absence of physical problems) by external negative factors.

Learn more

• 
  How young can a child learn guitar
• 
  What helps with nausea and vomiting while pregnant
• 
  How to surprise your child with a vacation
• 
  Pregnancy at the age of 38
• 
  Complications with pcos
• 
  Pregnancy at the age of 38
• 
  Complications with pcos
• 
  Bleeding during 8 months pregnant
• 
  36 week pregnant check up
• 
  One month baby constipated
• 
  Pregnancy at the age of 38