Sleep & Insomnia in Children

Sleep is a normally recurring state characterized by lessened consciousness, awareness of the surroundings and movement.  In humans, the main sleep episode usually occurs as one consolidated period of approximately 8 hours every night, and accounts for about one third of human life. 

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Why is sleep important?

Adequate sleep – in terms of both quantity and quality – is essential at all stages of life, particularly so during childhood where neuronal development occurs. Insufficient sleep in children affects cognitive performance and aggravates adaptive behavioral problems. Longer sleep duration at preschool age may be important for a child’s later behavior.

The optimal amount of sleep one should have each night varies with age and between individuals. The National Sleep Foundation (NSF) provides guidelines to determine how much sleep is needed per age group. preschoolers between 10 and 13 hours, and school-aged children between 9 and 11 hours. For teenagers, 8 to 10 hours was considered appropriate.  However, research shows that teenagers tend to sleep less as they go to bed later, which results in an increased level of sleepiness and inattention during the day. 

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Sleep has also been linked to the correct functioning of various vital organs and metabolic processes such as:

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• Vital brain functions such as cognitive functioning, learning, memory, decision making and behavior

• Regulation of fat in the liver; dysregulation can lead to severe issues like diabetes and obesity

• Cardiovascular disease risk reduction

• Growth hormone secretion

• Immune system function

 

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What is the mechanism behind sleep?

Sleep is a vital process. The homeostatic urge to sleep increases with time following awakening. Our sleeping patterns follow circadian patterns (the cyclical changes in the body over a 24-hour period). Our circadian rhythm is set to overlap the day-night period by the brain’s ‘clock’ - the suprachiasmatic nucleus (SCN). ​

 

​This ‘clock’ regulates when we sleep and when we are awake and is very sensitive to the hormone melatonin (produced in the pineal gland) that serves as a signal of darkness in the body. Melatonin production follows the circadian rhythm:  low levels during periods of bright light and increasing levels as night falls. Throughout the night, Melatonin continues to deliver this ‘darkness signal’ to the body to ensure proper control of homeostatic systems such as sleep and blood pressure rhythms.

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What is insomnia?

Insomnia disorder is a complaint on one or more of the following symptoms for at least 3 nights per week and being present for at least 3 months:  ​

• Difficulty falling asleep

• Difficulty staying asleep

• Early morning awakening 

According to DSM-5, people who suffer from insomnia experience daytime distress the next day: they feel tired, unrefreshed and often find it difficult to function. This causes impairment in social, occupational, educational, behavioral and other important areas of daytime functioning. 

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​The prevalence of insomnia in children that goes beyond bedtime refusal and night awakenings ranges from 1-6% in the general pediatric population but is as high as 50-80% in children with neurodevelopmental or psychiatric comorbidities including ADHD. 

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New studies demonstrate the negative consequences of sleeplessness in children and adolescents. These include hyperactivity, irritability, restlessness, poor concentration, impulsiveness, suicide risk, and poor memory. Families of children with sleep disturbances also suffer from sleep deprivation, exhibiting negative effects on daytime function and well-being, as well as elevated levels of family stress, mood swings, and relationship instability.

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