Sleep disorders in children

A range of sleep disorders can occur in children, but the most common ones among young patients are sleep apnoea, bed-wetting, sleep-walking and nightmares/night terrors.

Sleep apnoea: Children of all ages can be affected by sleep apnoea. A child with sleep apnoea may display the usual adult OSA symptoms of daytime sleepiness, waking unrefreshed and poor memory and concentration, however unlike adults with the disorder, may also exhibit hyperactive behaviour (and in some cases, displays of aggression). Common causes of sleep apnoea in children are obesity, and tonsils that are too large for the airways, resulting in airway occlusion during sleep.

Bed-wetting: Bed-wetting, or nocturnal enuresis, is another problem that many children face. Although this is all part of growing up for toddlers, when an older child is still having issues staying dry at night it can be a source of embarrassment and frustration. Most children grow out of bed-wetting by around the age of 4 or 5. However, for those that don't, this may be related to a hormonal imbalance resulting in the child’s bladder 'overflowing' at night. Excessive consumption of fluids prior to going to bed can also contribute to bed-wetting, as can a sleep-arousal disorder where a child does not respond to his or her body’s signals to wake up and go to the bathroom.

There are a number of things a parent can do to help treat and/or manage their child's bed wetting. Behaviour modifying methods such as restricting fluid intake at night and ensuring a child goes to the toilet prior to going to sleep. There are also devices that sound an alarm once a child begins to wet the bed. This acts to wake the child so they can finish urinating in the toilet in the hope that this will become a learned behaviour. Medication can also help.

Sleep-walking: Sleep-walking (or somnambulism) is sleep disorder that mainly occurs in children, involving the child’s engaging in behaviour normally associated with wakefulness. The behaviour usually ceases around puberty. In the majority of cases, a family history of sleep-walking exists. A child may respond to questions while sleep-walking, however their answers may be slow, simple or nonsensical, and it should be noted that if awakened during a sleep-walking episode, a child may appear confused and disorientated by their surroundings.

Preventative measures can be taken to protect a child suffering from sleep-walking. By ensuring the house is safe (i.e., no sharp objects lying around) and keeping all doors and windows locked, a parent can assist in keeping their child free from injury during these episodes. Medications can also be taken to prevent sleep-walking. These normally act by decreasing the number of arousals and the amount of slow-wave sleep achieved during the night (the stage of sleep where sleep-walking most commonly occurs).

Nightmares and night terrors are other common events that can hinder a child from achieving a good night's sleep.

If you are concerned about your child having a sleep-disorder, discuss the issue with your General Practitioner, who may recommend an overnight sleep study, or consultation with a Specialist Sleep Physician.

Dreaming, nightmares and night terrors

Dreams occur during a stage of sleep called Rapid Eye Movement sleep (REM sleep). During REM sleep our brains are as active as when we are awake. Dreams during REM sleep are often bizarre and strange and may even be frightening, as in the case of nightmares. There are a number of different theories as to why we dream such as memory consolidation and elimination of experiences and memories that are not needed.

A nightmare is a frightening or unpleasant dream which can make you feel anxious, scared or upset. Nightmares usually occur in the early hours of the morning (or during the second half of a sleep cycle) when our longest periods of REM sleep occur. Nightmares usually wake the sleeper, and as it is easier to remember dreams when awoken from REM sleep – the sleeper often remember what they were dreaming about and what was frightening.

Nightmares are more common in children than adults.

The causes of nightmares include: stressful events that occur during the day (schoolwork, problems at home or at work), illness or death of a close family member/friend, watching scary movies or reading scary books, sudden alcohol withdrawal and some medications (such as antidepressants and sleeping tablets).

A night terror is an episode of extreme terror in which a person is unable to wake fully. Episodes usually occur in children between 18 months and 6 years. A child wakes suddenly from slow wave sleep or deep sleep (during NREM sleep -Non Rapid Eye Movement sleep) and although appearing awake, is confused, disoriented and unaware of anyone around. Night terrors usually occur during the first couple of hours of sleep and may occur more than once during a night. A child may thrash around or scream loudly in bed and cannot be comforted or fully awakened. The terror can last between 5-10 minutes (sometimes longer), after which the child will settle back down to sleep. Typically a child does not remember the night terror in the morning.

Night terrors may become more frequent and worse with sleep deprivation (insufficient sleep) or overtiredness, illness, fever, anxiety, stressful events and some medications. There may also be a genetic factor, as night terrors can run in families.