A review of the evidence
Sleep disorders in children and adolescents –
How big a problem is it?
Kotagal S, Pianosi P.
The Bottom Line:
- About 20% of children and teenagers have problems staying asleep at night or staying awake during the day.
- Their general health and their ability to learn and take part in family, school and social activities can be badly affected by lack of sleep.
- Sleep disorders can impair memory and the ability to concentrate, reduce memory span, and contribute to behaviour problems.
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What problem is being addressed?
Getting enough sleep is important to our ability to learn, listen, concentrate and solve problems.
Young children need between 9 and 12 hours of sleep a night. Adolescents still need 8 1/2 to more than 9 hours of sleep a night, but changes in their biological clock cause them to stay awake later at night and wake up later in the morning, which is why so many teens seem to be sleep deprived.
The authors looked at Cochrane reviews and key original articles on childhood sleep-wake disorders, andrelied on their own clinical experience, to produce this article on the causes and prevalence of sleep disorders in children and adolescents.
How common are sleep disorders?
A recent telephone survey of 1,125 adolescents aged 15-18 fromFrance, Great Britain, Germany, and Italy found that about 20%were sleepy in the daytime, 25% had trouble sleeping at night, and 4%met established criteria for sleep disorder.
What causes sleep disorders?
The most likely physical source of poor sleep is obstructive sleep apnea in which the throat is blocked by swollen or enlarged tissue, cutting off the flow of air to the lungs –loud snoring is a good first clue that this is the case.
Other disorders that could be responsible include:
- restless legs syndrome in which there is jerking or twitching of the legs that partially awaken the child or teenager,
- depression or anxiety disorders, and
- narcolepsy, a type of brain disorder that produces sudden sleep episodes could be responsible.
The most frequent cause of sleep disorders is poor “sleep hygiene” in which there is no set routine for sleep. Teenagers usually can’t go to sleep before 10:30 at night (the brain won’t let them!) and yet they need 9 or 10 hours per night.
Avoiding nicotine, caffeine, strenuous exercise at night, and worry can help teens who have trouble getting to sleep, and avoidance of other substances, including alcohol and nicotine from smoking, may help them stay asleep through the night.
Conclusions
Family doctors should consider referring a child or teenager to a specialist if he/she:
- rarely, if ever, feels refreshed and alert on awakening,
- has difficulty staying awake at school,
- falls asleep during short car rides,
- usually needs a nap when he/she gets home from school,
- has difficulty getting to sleep or staying asleep on a regular basis for over a month, or
- sleep walks or wakes in a confused or agitated state.
The underlying cause, whether poor sleep hygiene, depression, or sleep apnea, should be addressed to improve sleep in children and adolescents.
The preceding is a summary of:
Kotagal S, Pianosi P. Sleep disorders in children and adolescents. British Medical Journal 2006, 332: 828-832.
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