What is insomnia?
Insomnia is a sleep disturbance in which children have trouble falling asleep or staying asleep at night. Sometimes the complaint is one of waking up too early. While older children may complain of this on their own, often it is the parent of the youngster who brings this to attention. Insomnia complaints are generally associated with a feeling of non-restorative sleep and impairment in daytime functioning.
Insomnia can be classified based on duration (short- or long-term), severity, and frequency of the problem. Short-term insomnia may occur for just a few days to weeks and is caused by factors that will usually easily pass (eg, sickness, a short-term medication your child is taking). Long-term insomnia occurs three times a week for a month or longer and may be caused by factors for which you would seek medical advice for your child (eg, depression, anxiety, pain, medical problems). Sometimes, there may be no obvious reason at all. In children, bedtime resistance and dependency on a parent to initiate sleep is also considered as a form of insomnia with behavioral causes at the root of the problem.
What are the symptoms of insomnia?
Symptoms of insomnia include:
- Sleep problems – difficulty falling asleep or staying asleep or waking up too early in the morning
- Tension/worry about going to bed and being able to fall asleep
- Being sleepy during the day
- School or disciplinary problems
- Irritability/mood swings
- Decreased attention span
- Memory problems
- Making errors or having accidents
What causes childhood insomnia?
There are a number of possible causes of insomnia, including:
- Stress. Yes, kids, just like adults can suffer from stress. So don't hesitate to show interest in your child's life and build trust so they feel comfortable sharing their worries with you. Ask how things are going at school. Is your child being bullied by someone? Is everything under your own roof running smoothly (ie, is there arguing, fighting between siblings, marital or financial problems; has there been a death in the family, a recent job change; has the family recently moved)? Children worry more than you might think and excess worry and stress can lead to insomnia.
- Use of caffeine or other stimulants. Remember even some clear sodas and most energy drinks have caffeine. Nicotine and alcohol interfere with sleep as well.
- Side effects of certain medications. For example, drugs used to treat attention deficit hyperactivity disorder, antidepressants, corticosteroids, and anticonvulsants can cause insomnia.
- Medical, psychiatric and other sleep disorders. Uncontrolled nighttime asthma, a stuffy nose from allergies or itchy skin from eczema can get in the way of good sleep. If these conditions are chronic, they may be easily ignored until they flare up. Other medical disorders, including fibromyalgia, muscle cramps, growing pains, heartburn, and thyroid disease can all cause insomnia. Be sure to have your child's physical health examined as a possible cause of insomnia. Sleep disorders such as obstructive sleep apnea (associated with snoring) and restless legs syndrome may interfere with your child’s sleep. Neurodevelopmental disorders, such as autism, mental retardation, and Asperger's syndrome, can also be a cause of insomnia. Finally, psychiatric conditions like depression or bipolar disorder can be associated with poor sleep.
- Environmental factors. Noise, heat, cold, and light conditions in the bedroom can interfere with sleep. Make sure the bed and mattress are comfortable and the bedroom is organized to reduce environmental interference. This includes restrictions on the use of electronics in the bedroom.
How is insomnia diagnosed?
There is no specific test for insomnia. The diagnosis is based on symptoms and the exclusion of other medical problems, psychiatric problems and other sleep disorders.
How is insomnia in children treated?
Treatment methods for insomnia in children can involve any of the following:
- Institute good sleep hygiene habits. Good sleep hygiene habits include: restricting time spent in bed to simply sleeping (no reading, doing homework or watching TV in bed); maintaining a regular sleep schedule (going to bed and waking up at the same time each day including weekends and holidays); avoiding caffeinated products 4-6 hours before bedtime (caffeinated products include coffee, tea, colas, some non-cola pops, energy drinks, and chocolates); avoiding tobacco and other drugs; and establishing a bedtime routine that does not include stimulating activities within an hour of bedtime (such as TV watching, electronic gaming, heavy homework, or computer gaming).
- Comfortable sleep environment. Maintaining a bedroom that is quiet, calm, comfortable (< 75 degrees F), and dark (a nightlight is acceptable for children afraid of a dark bedroom). This also includes attention that the night time ambience of the house is relaxed, calm, quiet, dark etc. Avoid arguments or discussion of anxiety-provoking issues just before bed time.
- Teach children how to relax. Deep breathing, positive mental imagery while lying in bed (such as visualizing the sun's caressing rays beachside or breathing in fresh, cool mountain air), and other relaxation techniques (eg, quiet abdominal breathing) can be helpful aids to falling asleep.
- Remove clocks from the bedroom. It may be best to remove all clocks from the bedroom – or at least turn their face away from the bed so that your child does not see it while trying to sleep. Watching the clock while trying to sleep can cause anxiety and make it harder to fall asleep. Remember there on clocks on phones too.
- Set bedtime to obtain the usual amount of sleep. Set bedtime so that your child gets his or her usual amount of sleep – the typical 9 to 11 hours per night depending on your child's age. (Children between the ages of 6 and 12 need about 10 to 11 hours of sleep each night; teens need about 9 hours of sleep each night.)
- Get up out of bed instead of tossing and turning. It is better for your child to get up and engage in a very calm activity in relatively low light for 15-20 minutes (eg reading), rather than stay in bed and toss and turn if he or she can't sleep. After staying out of bed for 20-30 minutes or so, they may return and attempt to sleep. If after a 15-20 minute attempt there is no success, they should get up again and try the relaxing activity again. Repeat the cycle as necessary.
- Consider behavioral therapy. Specialists in behavioral and cognitive therapy are sometimes needed to work with the child and family to help using psychological methods without drugs. These methods are very helpful and generally better for the child in the long term. Your sleep specialist is a good source for more information in this regard.
A word on medications: Medications are usually not recommended for children and adolescents with insomnia and are used only in very special circumstances. It is much more important to look for any underlying medical or psychological problems that may need to be treated first. Another issue with insomnia medications and sleeping pills and aids is that many have not been approved by the FDA for use in children. It is important to work closely with your doctor regarding medication issues, and this includes over-the-counter drugs, supplements (eg, melatonin), and herbal products you might be considering giving your child.
Additional Sleep Information and Suggested Readings
- Mindell, JA and Owens, JA. A Clinical Guide to Pediatric Sleep: Diagnosis and Management of Sleep Problems. Philadelphia, PA: Lippincott Williams and Wilkins, 2003.
- www.sleepeducation.com and other educational links on the American Academy of Sleep Medicine website www.aasmnet.org.
- The National Sleep Foundation at www.sleepfoundation.org.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 5/30/2013…#14301