There’s something important about insomnia that I did not know before I studied it.
I confess I thought of insomniacs as people who stayed up all night because they did not get tired. I was wrong. People with insomnia are not merely tired. They are exhausted. They want to sleep desperately but cannot. The less they sleep the worse a person suffering with insomnia feels.
Worst of all, perhaps, children suffer from insomnia too. And it’s more common in children than I ever imagined. Some experts believe that as many as 30% of children suffer from insomnia or other significant sleep disturbance.
Insomnia in Children is Different from Adult Insomnia
…in some ways at any rate. It is often the parent, not the child, who first notices that there is a problem. And children have a type of insomnia that develops with the “help” of their parents. I’ll get to that a little later. But many of the causes are very similar to the things that keep adults awake. In fact, many adults report that they’ve had trouble sleeping since childhood.
The simple definition of insomnia is “habitual sleeplessness”. But embedded in that simple definition is the entire field of sleep problems in children. The problem is most often lack of sleep, or absence of enough sleep. The trick is to figure out what makes the absence of sleep “habitual”.
In children, we tend to define insomnia by its effects, not by its duration. If the sleeplessness has a negative effect on the child or her parents, it does not matter how recently it started or how long it lasts.
Long- and Short-term
Having said that, sometimes it’s useful to ask how long the child has had trouble sleeping. Short-term reasons for sleeplessness include illness, or a medication the child is taking. The sleep problem will often go away when the child recovers or stops the medication. But if the child is not sick or taking medication, and yet the sleep problem happens at least three times per week, and/or lasts more than a month, there might be another problem that deserves medical attention.
Need a SLEEP COACH?
I firmly believe that sleep is the natural condition. Children (and adults) sleep naturally unless there is something keeping them from sleeping. So it’s essential to figure out what is keeping the child awake.
In children, you are less likely to have her come up to you and say “Gee, mom, I’d really like to sleep but I can’t!” More likely, you’ll notice something is wrong before she does. Common symptoms in children include:
- Early Waking: Typically, we’re talking about a child who awakens at 3:45 AM and appears to be up for the day. This may appear first as an annoyance to parents. It’s important to realize the child is not doing this on purpose!
- Anxiety about going to bed and being able to fall asleep: The child knows they’ll have trouble falling asleep and they’re anxious about it. These anxieties can take the form of fear of the dark, or fear of monsters under the bed. The more anxious they become, the tougher it gets for them to fall asleep!
- Daytime Sleepiness: Even if you believe the child is sleeping at night, they might not be getting enough restful sleep. They’ll tire out during the day.
- School or behavior problems: Sometimes the first sign of a sleep problem will be notes coming home from school. Or you may notice the child misbehaving when she never did before. Or she’s misbehaving more often than before.
- Irritability/mood swings: Irritability simply means sensitivity to changing moods quickly. This is different from simple grumpiness. The parent reports that the child is “easily set off”, or that she “flies into a rage” over seemingly small things. Lack of sleep will do this to a child (or an adult, for that matter!)
- Depression: Sometimes the sleepless child will not be irritable or badly behaved. She’ll just have a flat, or depressed mood. It’s difficult sometimes to know which caused which, lack of sleep or the depression (more on this below)
- Hyperactivity: It’s not unusual for children to misdiagnosed with ADHD. To some extent, this is understandable. Lots of things are mistaken for ADHD. Narcolepsy and Restless Legs Syndrome, for example. But neither is this an excuse. Whenever teachers or any other authority suggests to you that your child may have ADHD, it’s necessary to rule out other causes for the behaviors.
- Decreased attention span: It’s difficult to concentrate when you haven’t slept. Most of the time the child herself will not realize she cannot stay on task. It will be pointed out to her by others.
- Aggression: This is a product of the irritability mentioned above. A previously docile child may lash out unexpectedly. This is a red flag that should always raise concerns about a sleep disturbance.
- Memory problems: There is a close association between sleeplessness and memory problems. It is suspected that a normal sleep pattern is necessary for solidifying memories. This is important to remember for students pulling “all-nighters”. Lack of sleep never helps memory.
- Making errors or having accidents: This is a particularly serious, potentially deadly sign in young drivers. Attentiveness, distractibility, and reaction time are all affected by sleeplessness.
What Causes Insomnia in Children?
- Stress: We like to think of childhood as carefree and blissful. Sadly this is a myth. It always has been a myth. Childhood is stressful, more or less for many, if not most children. Children have a limited number of ways to communicate that things are not okay in their world, and loss of sleep is one of them (the others are acting out and refusing to eat).
- Caffeine or other stimulants: Many parents do not realize just how much stimulant their children are consuming in the form of soda and so-called “power drinks”. Leave aside the issue of sugar, and the damage it wreaks! You should always examine the diet of a child who cannot sleep.
- Medications: The treatment for ADHD is notorious for causing insomnia. The medications are amphetamine-based stimulants. One thing for certain is that no inattentive child is made more attentive by losing sleep! These medications should be very closely monitored to say the least, if not eliminated entirely.
- Medical causes: Difficulty breathing is a common, often unrecognized cause of sleeplessness. Sometimes sleep disturbance is the first sign of asthma in children. Children with obstructive sleep apnea often have a great deal of difficulty staying asleep. If a child is too itchy from her eczema, or too uncomfortable with her heartburn (reflux), she may have trouble falling asleep and staying asleep. Finally, thyroid problems may cause sleeplessness. All these potential causes should be addressed with a physician.
- Psychiatric causes: Depressed children often do not sleep well. Their anxiety and irritability may be worse at night when they are not distracted by daytime activities. And then there is the cause no one wants to talk about, physical or sexual abuse. Nevertheless, abuse is a cause of sleeplessness and we should take it seriously.
- Environment: Places that are too loud, too hot, too cold, or too light are difficult to sleep in. So are places where electronic devices are too close by!
The Special Cause of Childhood Insomnia
There is one cause of sleeplessness in which the parents are very much part of the cause. Many children cannot sleep because their parents did not allow them to learn to fall asleep on their own. These are the parents who, with the best of intentions, allow their children to develop bad sleep associations. The problem may be that the child needs contact with parents to fall asleep. Or perhaps the child needs to have a bottle or pacifier. These dependencies often lead to sleep problems that the parents end up wishing they never got into.
Another cause is parental lack of limits-setting at bedtime. Again, I’m sure this is done with the best of intentions, but the results can be devastating for sleep. For example, the child who asks for glasses of water repeatedly, or who is allowed to wander the house at bedtime.
Treating Insomnia in Children
The treatment is based on fixing the cause or causes. That’s why it is so important to understand all the possible ways that a child can lose sleep. Regardless of cause, there are some basic sleep techniques that are always helpful:
- Set a consistent bedtime and routine: Everybody, child and adult, sleeps better when their day is regular and bedtime is is the same time every night. The bedtime routine should be the same as well. It should be as calm and as free of stimulation as possible. If the problem is truly that the child is not tired, try moving bedtime later, by 15 minutes at a time, until the child is good and ready for bed!
- Comfortable sleep environment: Not too hot, not too cold, quiet and dark! It’s a good idea to keep clocks out of the room of a person who has trouble sleeping. This is especially true of clocks that glow in the dark. It goes without saying that devices with screens must be eliminated. They are the enemies of sleep!
- Relaxation techniques: Most parents do not know how to teach relaxation. But there is an entire industry of relaxation products available that can help teach a child (or an adult for that matter) how to relax at bedtime. An easy way to start is to make the time between dinner and bedtime as boring and non-stimulating as possible.
- No tossing and turning! If a child will toss and turn instead of sleeping, have her get out of bed and do something relaxing but boring, like reading in low light. Try this for 20 minutes at a time. If this does not work, have the child repeat at least twice.
- Cognitive Behavioral Therapy: If medical causes have been ruled out, and you cannot help the child using these techniques, it may be useful to seek the help of a therapist. If nothing else, a therapist may help a child manage the anxiety that so often magnifies sleeplessness.
- The Bell on the Door: For the child who insists on sleeping with you, I recommend calmly but firmly leading the child back to bed. No arguments, no explanations. You can even tie a bell to the child’s door and respond immediately when you hear it ring. If you do this correctly and do not give in, the child will give up trying to sleep with you.
What About Medications?
I and most sleep experts caution strongly against the use of medications to treat insomnia in children. The first and most important job of the physician and the sleep coach is to find the cause and to treat it. Only in the rarest circumstances, and only as a last resort, should you medicate a child for sleeplessness. The downsides outweigh the upsides. As with teaching a child to sleep on her own when she’s a baby, so it is with curing insomnia. If it is a medical problem, it should be identified so you can treat it. If it is a problem of environment or diet, these should be adjusted.
And if the problem is simply that you’ve developed bad sleep associations or poor limits-setting, these should be reversed. In some ways, these are the toughest causes of insomnia to fix. But fix them you must. The entire family’s sleep depends upon it.