Treating Children with Insomnia

Primary reasons why children suffer from insomnia 

Stress

Believe it or not, children do experience stress (similar to adults). Always show interest in your child’s life. It allows to build trust and share their worries. Ask them about school - you may find out whether they are being bullied. You may also need to think about:

What is the atmosphere like in the household? Do you and your spouse always fight? Did you recently suffer a family loss? Are there financial issues concerning the family? Did someone recently change a job? Did you move?

Yes, children do worry just like adults – and many of them worry much more than parents realize. And this excessive stress can cause them to experience insomnia.

Using stimulants or caffeine

Sleep can be affected by caffeine (found in coffee, sodas, and energy drinks) and stimulants. If your child drinks alcohol or smokes, their sleep quality will suffer. 

Side effects medications

Many drugs – over the counter and on prescription – have side effects that can lead to insomnia. For example, antidepressants, anticonvulsants, corticosteroids, and ADHD medicines can all cause insomnia. 

Other health problems 

Children with psychiatric, medical, or other sleep disorders may also suffer from insomnia. For example, a child who has uncontrolled nighttime asthma, eczema, or allergies won’t get the sleep they need. Without attention the conditions can become chronic, which will lead to even less sleep in future.

Other problems that can interfere with a child’s sleep include:

• growing pains
• muscle cramps
• heartburn
• fibromyalgia
• thyroid disease.

Take your child to a doctor to find out if it’s a physical ailment causing them to suffer from insomnia. If your child has a sleep disorder such as the restless leg syndrome or obstructive sleep apnea, they won’t be getting the sleep their body needs. 

Neurodevelopmental disorders – mental retardation, Asperger’s syndrome, and autism – as well as psychiatric problems – bipolar disorder or depression – will all interfere with sleep quality and can lead to insomnia. 

Environment

If your child’s room is too hot, too cold, too noisy, or too light, it can keep them from getting a good sleep. Give your child a comfortable mattress and organize the bedroom to reduce environmental interferences. Limit electronic devices in their room. 

Behavioral insomnia in children

Behavioral insomnia is one of the most prominent sleep disorders in children. It’s believed that 25% of children will experience it at some point in childhood. 

What are the symptoms of this disorder?

• Inability to fall sleep
• inability to stay asleep.

Both of these symptoms can cause children to have poor duration and quality of sleep. 

Children with behavioral insomnia don’t have good sleep hygiene – similarly to adults with sleep problems. They may be able to fall asleep, but poor sleeping practices interfere with a good night’s rest. The two kinds of behavioral insomnia are:

• sleep-onset association insomnia
• limit setting insomnia.

What are these conditions and what are the reasons a child may suffer from them?

Sleep-onset association insomnia

This condition is typically seen in infants and toddlers, which is suspected to happen due to negative associations with sleep. For example, a child may need a parent, activity, or comfort object to help them relax and fall asleep. A younger child may feel that they must be rocked, nursed, or cuddled to get to sleep. And if they wake up in the middle of the night, they may be unable to return to sleep without comfort from the parent. 

Environmental factors often keep a child from getting to sleep – room temperature, noise, and light. Young children are susceptible to their environment. When a child doesn’t have a pleasant sleeping environment, they can become reliant on the parent’s comfort to help them get to sleep. 

Older children may suffer from sleep-onset insomnia because of distracting items in their rooms such as phones, video gaming consoles, tablets, computers, TVs, etc. Why are these devices so bad for keeping a child from getting their beauty sleep?

• The content is often stimulating for their brains - the mind won’t slow down enough to fall asleep when it should.
• The light from these devices is terrible for the circadian rhythm, as it causes the brain to think it’s daylight, which delays the release of melatonin (the sleep promoting hormone). 

Treating sleep-onset insomnia in children means changes of habits that are affecting sleep quality. Instead of nursing, cuddling, or rocking a child back to sleep, use other relaxing methods. Change any activity you implement into the routine a little each night to avoid the child’s attachment to the activity. 

What are some other techniques that you can use to alleviate sleep-onset insomnia?

Extinction

This is the practice of letting a child know that they can soothe themselves (no parental involvement). For this practice to work effectively parents must not engage with the child when s/he wakes up and needs the external soothing s/he has grown accustomed to. Over time the child may learn to soothe themselves and fall asleep without help.

Graduated extinction 

This involves ignoring the awakenings of the child for a while. However, if the child still cries after this set time, then the parent is encouraged to help them go back to sleep. However, the amount of interaction between the parent and the child at this time needs to be minimal – no physical contact. 

Note: Some parents may be uncomfortable with the extinction method because of their inability to ignore a crying child. However, always attending to it sets up a bad precedent of inconsistencies, which can reinforce the crying. Children learn that crying will have their parents come running. This leads to adverse effects on the child-parent relationship. 

Scheduled awakenings

This involves waking a child up 10 to 15 minutes before their typical nocturnal awakenings. At this time parents should be involved in the comforting routines the child is used to – rocking, feeding, etc. As the treatment goes on, the time between these awakenings should increase until there are no more awakenings to be had. 

Limit-setting insomnia

This condition happens when children want to challenge their parents during bedtime and refuse to go to sleep. For example, they may delay bedtime by asking for a drink, go to the bathroom, or read another story, etc. Children who have no set bedtimes – they go to bed when they want – often challenge their parents before going to sleep. This lack of set bedtimes can hinder the circadian rhythm. 

What are some of the things that parents can do to treat limit-setting insomnia in children? Be strict on sleep hygiene and bedtime routine. Other things you can do are:

• Implement relaxing activities such as brushing teeth, a relaxing bath, a goodnight kiss, reading a book, etc. before bedtime.
• Create an environment that promotes sleep - a dark, cool, quiet room (no distractions or clutter). 
• Turn off electronics before going to bed.
• Ensure that the child gets plenty of exercise during the day (this will release their pent-up energy).
• Do not eat or drink caffeine before going to bed. Caffeine should be avoided after lunch.
• Read books instead of watching TV before going to bed.
• Do not give in to unreasonable demands at bedtime. If you read a story to your child before bed, ensure they understand that there is a time limit to it.
• Maintain their sleep schedule every day (weekends too).
• Older children may need positive reinforcement when they follow their bedtime schedules.
• Always be consistent with their bedtime routines. 

The best way to treat behavioral insomnia in children 

The best possible treatment for either one of these conditions is educating parents about the stages of a child’s sleep development. This knowledge will allow them to understand the timing, duration, and frequency of their children’s sleep requirements – preventing sleep problems from developing in the first place. 

The education should begin by teaching parents that following their own sleep hygiene practices will help the child follow what has been set up for them. It boils down to practicing what you preach and being a role model for your child to follow. 

Another critical thing is to be consistent with the routine, which helps children to understand what you expect of them, and know what to expect from you. Consistency is key to creating and maintaining bedtimes and bedtime routines.

Talk to your child’s doctor about their sleeping habits. Inform them about:

• how long your child sleeps
• what kind of bedtime resistance you are faced with
• if your child has daytime sleepiness, snoring, and other possible sleep problems.

Make the pediatrician aware of anything that keeps your child from waking up feeling refreshed, rejuvenated, and ready to face the day.

When should you take your child to a doctor?

When insomnia has gone on for some time or is having a strongly negative impact on the child. When children don’t get enough sleep, they are typically grumpy, irritable, and tired. This makes it hard for them to focus at school and study well. 

Once these effects are felt, the problem needs immediate addressing. If you cannot resolve it yourself, seek help from an expert. You’ll be given tips on how to implement a bedtime routine and create an environment conducive to sleep. The doctor will identify possible underlying problems that could keep your child awake when they should be sleeping. 

Possible treatments of childhood insomnia

It’s not uncommon for parents to want a quick fix treatment such as a prescription, but medication isn’t always the answer. After all, the issues that cause their child’s insomnia could be psychological or medical. 

For instance, if your child is suffering from obstructive sleep apnea and snoring all night with frequent pauses in breathing, they may need to have their adenoids and tonsils removed. Or if the child is continually coughing at night due to uncontrolled asthma, s/he may need an medication that prevents the asthma.

Children who have depression, asthma, or sleep apnea don’t need a sleeping pill, they need something else.

Sleeping pills are often advertised on TV – Lunesta or Ambien CR – but these drugs have not been approved for use by children. The medications approved for children (when needed) include:

• antihistamines – commonly cause daytime drowsiness, so should be used only for a short period of time
• Clonidine – especially useful in children with behavioral problems (ADHD)
• Melatonin
• Risperdal – great for children with behavioral problems such as autism 
• Sedating antidepressants – Remeron and amitriptyline.

Unless there is some underlying diagnosis that causes a child to suffer from insomnia, there is no reason for them to use a prescription. 

Nonprescription treatments for childhood insomnia

There are many childhood insomnia nonprescription treatments that can be helpful. Try to:

• restrict time spent in bed to sleeping only – no TV, no homework, no reading, etc. 
• maintain consistent bedtime and wake time – holidays and weekends included
• teach your child relaxation methods such as progressive muscle relaxation, diaphragmatic breathing, and visual imagery that can be used at bedtime. 
• avoid all stimulating activities 60 minutes before bed – no TV, no playing games, no talking or texting on the phone, etc. 
• if your child is unable to sleep within 20 minutes, get out of bed and read or do something relaxing. 
• exercise regularly.
• avoid consuming caffeine.

Talk to your child’s doctor and psychologist about other strategies to treat your child’s insomnia.