pediatric insomnia

this review describes a few pertinent conditions of sleep disorders in children and adolescents as well as provides clinically useful approaches to sleep complaints and both pharmacologic and nonpharmacological treatments of some common pediatric sleep disorders. developmental history with focus on sleep and wake patterns as well as potential medical illnesses that affect sleep during infancy and childhood can provide clues to the duration and degree of sleep disturbances in the child. diagnostic tests such as multiple sleep latency test (mslt) can be useful to quantify sleepiness and explore presence of sleep disorders (e.g., narcolepsy) that can predispose children and adolescents to daytime sleepiness. this is thought to be due to concept of “negative associations” where children associate sleep with distressing sensations in their limbs thereby perpetuating fear and anxiety surrounding bedtime. if a child requires certain circumstances to initiate sleep and there are difficulties with parental limit-setting, the diagnosis is combined type.

behavioral interventions should be the mainstay of treatment of pediatric insomnia and should be offered as initial treatment (or in conjunction with medications) to parents and children. available psychopharmacological treatments (e.g., prazosin, a selective alpha-2 antagonist)66 of nightmares and other sleep disturbances in pediatric ptsd are very limited when compared to adults, and behavioral treatments, such as imagery rehearsal (rehearsal of less fearful explanations and images of nightmares during the day resulting in positive dream imagery during the night), can be useful in adolescents and children without developmental disorders. for example, in children with anxiety and mood disorders, treatment of underlying anxiety and/or mood symptoms with antidepressants can often be helpful in alleviating sleep difficulties. it is also important to note that certain conditions (e.g., tourette’s syndrome and migraines) appear to be associated with increased prevalence of sleep walking and are speculated to be due to abnormal serotonin systems in the brain.72 parasomnias have been shown to be precipitated by undiagnosed srbd, such as osa, due to the propensity of apneic events to produce sleep fragmentation, arousals, and chronic sleep deprivation;73 therefore, presence of srbd should be screened for in children who present with recurrent parasomnias. delayed sleep phase syndrome (dsps) is the most common sleep disturbance seen in adolescents and is characterized by a physiological shift in sleep onset to later times of the night. however, there appears to be a rather slow development in awareness regarding childhood sleep difficulties among the general public and healthcare professionals.

the effectiveness of cbt for childhood sleep disorders has been well demonstrated in controlled studies and clinical case reports. if medical causes of enuresis are ruled out, children younger than 6 years should be managed with child and family reassurance that the enuresis is developmentally normal. sleep onset should be delayed in 3-hour increments each night until the desired sleep time is established. [20]  ramelteon, a melatonin receptor agonist, is a us food and drug administration (fda)–approved medication for the treatment of insomnia in adults. in one recent survey, one third of pediatricians reported using clonidine for sleep onset, nighttime awakening, early morning awakening problems, and parasomnias. [qxmd medline link]. [qxmd medline link].

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childhood insomnia. insomnia in children is defined as repeated difficulty with sleep initiation, duration, consolidation, or quality that occurs despite age- no information is available for this page. pharmacotherapy for insomnia in youth is generally not a permanent intervention. for transient episodes of insomnia, melatonin or antihistamines, .

what is pediatric insomnia? insomnia is a sleep disorder that causes problems falling asleep, staying asleep and waking up too early in the morning. sleep is crucial to childhood development, and insomnia can lead to health problems or behavioral issues. sleep disorders in children and adolescents are common and may result in a host of other problems. learn about pediatric sleep disorders and how to manage them. in infants and young children, bedtime problems and night waking are common and the main presentations of insomnia. a variety of behavioral and medical problems can present with childhood insomnia, typically manifested as bedtime resistance,, .

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