Chronic insomnia disorder can have a powerful impact on the quality of life for children and adolescents. People who suffer from chronic insomnia may have an increased risk of accidents and injury, impaired cognition, behavior, and overall health. But for children and adolescents, it can also affect childhood growth and development.
Signs of insomnia in infants and young children
It may be challenging to know if your child suffers from chronic insomnia. The most common signs of insomnia in young children are difficulty falling asleep and frequent night awakenings. Most children with these conditions will respond to behavioral treatments. But if those don’t work, other options are available and should be explored.
Targeting insomnia in children
When it comes to chronic insomnia disorder in children, one size does not fit all. Many factors can contribute to a child’s insomnia. Genetics, current developmental stages, behavior, and their environment can all play a part. By looking closely at distinct symptoms and family histories, we have built a framework to diagnose childhood insomnia. Recognizing that family history is the second most influential predictor of insomnia. Diagnosis should start with a thorough evaluation of sleep history and family history.
Based on family history and sleep symptoms we identified three specific types of insomnia:
1) Hypermotor Insomnia with movement during sleep is characterized by:
- Restlessness at bedtime and during the night
- Nighttime awakenings
- Growing pains
- This may represent an early type of restless legs syndrome (RLS)
A family history or symptoms include:
- RLS
- Iron-deficient anemia
For this type of insomnia, physicians may suggest additional iron.
2) Insomnia with early awakening or waking for the day during pre-dawn hours is characterized by:
- Early awakening
- Sleep terrors
A family history or symptoms include:
- Parasomnia
- Headache/migraine
- Depression
- Mood Disorders
Research suggests a connection between childhood insomnia with early awakening and the onset of depression in adolescence.
For this type of insomnia, the treatment may be a prescription for tryptophan or 5-hydroxy-tryptophan.
3) Insomnia with difficulties falling asleep and multiple awakenings is characterized by:
- Numerous awakenings and bedtime struggles
- Intolerance to certain foods or milk allergy
- Atopic dermatitis
A family history or symptoms include:
- Allergies within the family
- Asthma
- Allergic rhinitis
For this type of insomnia, a physician may suggest treatment with antihistamines.
Several cases diagnosed as behavioral insomnia may fall into one of these three categories. Keep in mind that early identification could help determine the most effective treatment strategies. Each type of insomnia has a different treatment approach. By taking a close look into symptoms and family history, a physician can determine the best treatment for childhood insomnia disorder in your child.
Oliviero Bruni M.D. is a full Professor in Child Neurology and Psychiatry in the Dept. of Developmental and Social Psychology, Sapienza University, Rome. He is the founder and past president of the International Pediatric Sleep Association and Field Editor (Pediatrics) of the journal Sleep Medicine.