Sleep Disorders
Common Sleep Disorders in Children and Adolescents
Insomnia
Insomnia may take the from of difficulties getting to sleep, multiple awakenings during the night, or generally poor quality sleep that leaves one feeling unrefreshed despite adequate sleep duration. Multiple factors may contribute to insomnia including physiologic, cognitive, behavioural and mood based factors. Treatment options may include pharmacologic interventions or non-pharmacologic interventions such as attendance to proper sleep hygiene or cognitive-behavioural therapy.
Delayed Sleep Phase Disorder (DSPD)
Delayed Sleep Phase Disorder (DSPD) is a chronic disorder of sleep timing. People with DSPD tend to fall asleep at very late times, with difficulties getting up in the morning on school or work days, and sleeping in late on weekends. However, unlike a typical insomnia, patients actually have normal sleep if allowed to follow their own their own schedule (eg. 4am to noon). The issue is really one of time, and the tendency toward a delayed sleep pattern only becomes problamatic when it comes into conflict with school and work related pressures to awaken early.
Treatment options for Delayed Sleep Phase Disorder include chronotherapy, bright light therapy, and appropriately timed melatonin.
Obstructive Sleep Apean/Hypopnea Syndrome
Sleep apnea is a sleep disorder characterised by multiple episodes of breathing cessation (apneas) or otherwise disrupted breathing (hypopneas). Each of these events may be accompanied oxygen desaturations, elevations in blood pressure and disrupted sleep.
The short term consequences of this condition are daytime fatigue, sleepiness, mood changes and difficulties with concentration. Such symptoms in children may be confused with Attetnion Deficit Hyperactivity Disorder (ADHD). The long term consequences include an increased risk of high blood pressure, stroke, heart attacks and arrhythmias.
Symptoms of sleep apnea include snoring, witnessed pauses in breathing during sleep, bizarre sleeping positions, bedwetting, stunted growth, hyperactivity, daytime sleepiness and behavioural difficulties. Sleep apnea in children is associated with enlarged tonsils, obesity and craniofacial abnormalities.
Treatment options for sleep apnea include surgery, a Continuous Positive Air Pressure (CPAP) device, an oral appliance or conservative measures such as weight loss.
Restless Leg Syndrome (RLS)
Restless Leg Syndrome is characterized by a marked discomfort in one's legs ("the creepy crawlies", "heebie-jebies" etc.), accompanied by an urge to move one's legs which temporarily relieves the sensation. RLS usually occurs at night or during periods of prolonged inactivity (such as on an airplane). A number of pharmacologic treatments exist for the condition.
Periodic Limb Movement Disorder (PLMD)
Periodic Limb Movement Disorder is characterized by frequent leg jerks or kicks during the night which can disturb one's sleep and lead to daytime sleepiness. The disorder often accompanies Restless Leg Syndrome and is treated in a similar manner.
Sleepwalking
Sleepwalking, which is common in children is the results of incomplete arousals from deep sleep. Treatment options include behavioural and pharmacologic interventions.
Narcolepsy
Narcolepsy is neurologic condition characterized by severe and persistent sleepiness throughout the day as well as associated symptoms such as sleep paralysis (awakening with complete body paralysis lasting several minutes), hallucinatory activity shortly after waking up, and cataplexy (body weakness precipitated by emotional triggers such as laughing).
Attention-Deficit Hyperactivity Disorder (ADHD)
As many as 70-80% of all patients with Attention-Deficit Hyperactivity Disorder (ADHD) have difficulty sleeping. ADHD is associated with a number of common sleep disorders including insomnia, sleep apnea, and restless leg syndrome. In an individual child the quetion arises as to whether the interrupted sleep is the cause or the result of ADHD. However even when the diagnosis of ADHD is the correct, addressing co-existing sleep issues may dramatically improve ADHD symptoms.
Nocturnal Enuresis (bedwetting)
Nocturnal enuresis may be due to a number of maturational, medical and psychological factors. In particular it may be due to a disturbance in sleep due to a sleep disorder such as Obstructive Sleep Apnea. A sleep assessment and study is thus useful in the overall assessment of a child suffering from this condition.
For further information regarding paediatric sleep related issues may be found in a series of brochures published by our clinic. Sleep disorders have also received a fair deal of media attention.
