Overview
Insomnia, or difficulty in sleeping, is a common issue among young children, with approximately 30% experiencing periods of sleep disturbances before the age of five. This often manifests as difficulty falling asleep or staying asleep. Typically, parents staying with the child until they fall asleep can manage this physiological event.
Age-related Factors
Young Children
- Prevalence: Approximately 30% before age five.
- Management: Parental presence until sleep onset.
School-age Children
- Prevalence: Less common than in younger children.
- Causes: Often linked to anxiety, school-related problems, or emotional difficulties.
Influencing Factors
- Screen Time: Quality and quantity of sleep are negatively impacted by the number of hours spent watching TV, using computers, internet, and mobile phones.
- ADHD and Learning Difficulties: Children with attention-deficit–hyperactivity disorder (ADHD) and learning difficulties often experience sleep problems.
- Medications: Drugs such as phenobarbitone and lamotrigine, commonly used in treating epilepsy, can cause sleep disturbances. In some cases, a depressive state may be responsible.
- Idiopathic Cases: A significant proportion of patients have no identifiable cause, with variable prognosis into adolescence and adulthood.
Neurodevelopmental Disabilities
Children with neurodevelopmental disabilities often experience significant disturbances in circadian rhythms, leading to severe disruption of family life. Conditions associated with these disturbances include:
- Autism Spectrum Disorders
- Angelman Syndrome
- Smith-Magenis Syndrome
- Severe Cerebral Palsy
- Blindness
Treatment
- Melatonin: Found to be a potent treatment for circadian rhythm disturbances in children with neurodevelopmental disabilities.
- Hypnotics: Drugs such as nitrazepam or chloral hydrate are rarely used and only considered when severe daily fatigue results from insomnia.
- Reassurance: For nocturnal awakenings in young children, followed by resumption of sleep in the early morning hours, reassurance is often sufficient.
Seizures and Insomnia
Seizures are a rare cause of insomnia and excessive daytime somnolence. In some patients, seizures are limited to awakening periods, often associated with paroxysmal EEG bursts.
