When kids have problems sleeping

KidAwakeBy Laura Barnhardt Cech

Adriana Vieco couldn't really relate to the sleep exhaustion that mothers of infants often feel — that is, until her son was 4 and a half.

"He went from sleeping from 7:30 p.m. to 6:30 a.m. to getting up at 8, 11, 1 and 3. We didn't know what to do," says Vieco, a Kensington trial lawyer about her son's sudden problem sleeping.

Nico had become scared of the dark, but fearing that he wasn't getting quality sleep, Vieco had turned off the light and music in her son's room so they wouldn't become a crutch.

When Nico would wake in the night, he turned on all the lights in the house. It escalated to the point where Vieco and her husband turned off the electrical breaker. "It was crazy," she says.

Vieco is hardly the only parent left exhausted and concerned by a child's problems sleeping.


Growing number of sleep issuesSleep-Chart-How-Many-Hours

A growing number of children have sleep disorders, from narcolepsy (disturbed sleeping patterns with daytime loss of wakefulness) to sleep apnea (a breathing obstruction that interrupts sleep). Left untreated, these issues can cause behavior problems, increased risk for heart problems, diabetes and more.

While there are 80 defined sleep disorders, the most common issue for children is sleep deficiency — or lack of sleep, says Dr. Daniel S. Lewin, Associate Director of the Pediatric Sleep Medicine and Director of the Pulmonary Behavioral Medicine Program at the Children's National Medical Center in Washington, D.C.

Teens especially are prone to sleep deficits, caused, in part, because their biological clocks shift to a naturally later bedtime. They often stay up late (made later by continued use of electronics), and then have trouble waking up and staying awake during classes, or they compensate with an afternoon nap, which makes falling asleep that night harder.

"It becomes a vicious cycle," says Dr. Maria Cecilia Melendres, a Johns Hopkins University pediatric pulmonologist who specializes in pediatric sleep disorders and treats patients at the Sleep Center at Mt. Washington Pediatric Hospital in Baltimore.

The sleeping pattern of teenagers has prompted some parents and physicians to lobby schools to change the start times of high schools. Fairfax County and Montgomery County are among the school systems considering it.

But sleep deficiencies are a problem for children of all ages.

Sometimes it can be something simple such as caffeine, which often robs children of needed sleep without parents realizing it. Even an iced tea at dinner can interfere with sleep, says Lewin. Children also need a regular bedtime, with no electronic media ideally an hour before bed. (Parents of teenagers don't laugh — at least aim for 30 minutes, says Lewin.)

"We need a very regular routine to transition to sleep," says Lewin, who recommends reading and talking before bed. "It's absolutely critical."

Misdiagnosis

Because sleep disorders can cause attention issues, impulse control and emotional regulation problems, some children are misdiagnosed with other disorders when in reality they just need more sleep, according to Lewin and other physicians.

"A child with a sleep deficit, for example, can look severely depressed," says Lewin.

Many sleep specialists say they see children with unrecognized and untreated sleep disorders instead being treated for ADHD or another behavioral issue. When they treat the sleep issue, the ADHD is often resolved.

"Looking back, the parents realize they were snoring loudly," Melendres says. "...Kids who are treated for sleep [disorders] often see behavior improve."

(It's also true that some children on the Asperger-Autism spectrum have sleep issues. A sleep disorder isn't causing the Autism, Lewin says, but because of the developmental issues, the child may not learn the bedtime cues that a typically-developing child does.)

Kids' snoring

If the snoring is loud enough for a parent to hear, it's extremely loud in the child's head, Lewin says. "The sound in their head alone has some impact on their sleep," he says.

A child who snores will likely be referred to an ear, nose and throat specialist. The snoring may be caused by postnasal drip, swollen tonsils, or obesity.

Snoring may also be a symptom of sleep apnea or interrupted breathing. To determine if it is, a sleep study is done. The child spends the night in the lab, with electrodes measuring breathing, heart rate, eye and limb movement and more. Parents stay with their child, usually napping in a nearby recliner.

"It wasn't scary," assures Tonya Jones, an Owings Mills mother whose 12-year-old was snoring loudly at night 2 years ago. "It was actually the most peaceful night of sleep I'd had in a long time."

While CPAP breathing machines are often the answer for adults with sleep apnea, surgery to remove tonsils and adenoids and/or weight management programs are usually part of the treatment for children.

Jones' son was already being treated at Mt. Washington's Weigh Smart Program. But she also learned that turning off the TV and video games before bed would help.

"His sleeping habits were a big part of it," she says. "Weight issues were all part of it."

By addressing both, Jones has seen remarkable improvement. Her son no longer falls asleep in class. And she says, "He wakes up with his own alarm. Before I had to go in and get him up. Now, he's up with no problem."

Read on for treatments for sleep problems


Treatments for sleep issues

Besides changes in sleep habits and schedules, doctors may also recommend melatonin, which is a hormone that helps regulate sleep cycles. How it's used varies by child.

A school-age child taking medication for ADHD may be given the melatonin just before bedtime. But an adolescent might need to take it 5 to 6 hours before bed.

"It's not a blanket remedy for everyone," Lewin says.

Doctors avoid prescribing sleeping medications for children, and behavioral therapy is always the first-line treatment, Melendres says.

It may seem intuitive to catch up on sleep on the weekends, but that's not actually a good idea because doing so can confuse the body's clock, Lewin says. "It feels great, but it's a problem if the biological clock reset."

To help teens struggling with sleep deficits, it's actually better to wake up earlier on the weekends, Lewin says. "You'll gradually increase sleep hunger, and they'll fall asleep easier."

It's also important to resist the urge to take long naps. But daily cat naps or power naps of about 15 minutes are recommended, Lewin says.

Sometimes, a slight adjustment can make a huge difference.

After reviewing Vieco's problems with her son Nico, Lewin suggested the family keep a log of the wakings. And in the meantime, he suggested turning a small light in the boy's bedroom back on.

"He went back to sleeping through to 7 a.m.," says Vieco. "It was so simple."

And yet, she says, "It changed our lives... We're so thankful."


How much sleep does your child need?

  • Toddlers (Ages 1 to 3): 12 to 14 hours.
  • Preschoolers (Ages 3 to 5): 11 to 13 hours.
  • School-aged (Ages 5 to 12): 10 to 11 hours.
  • Ages 13 and up: 9 to 10 hours.

Source: National Sleep Foundation

Warning signs of a sleep disorder

Below are some warning signs from Dr. Maria Cecilia Melendres and Dr. Daniel S. Lewin.

  • Snoring
  • Interrupted and labored breathing
  • Difficulty waking in the morning
  • Feeling tired during the day, even after a full night's sleep (in school-age children who no longer take naps)
  • Taking more than 20-30 minutes to fall asleep
  • Inability to stay asleep

More information:

John's Hopkins Children's Center
Mt. Washington Pediatric Hospital
Children's National Health System
The National Sleep Foundation