Psychiatric Disorders Key in Childhood Insomnia: Ask about Depression, Anxiety, and Somatization. Family History of Mental Illness Could Also Play Role

Article excerpt

BALTIMORE -- Why anyone would want to "sleep like a baby" is beyond any parent who has ever faced a sleepless child night after night.

"Insomnia is actually a very common problem in children," Ann C. Halbower, M.D., co-director of the sleep and breathing disorders clinic at Johns Hopkins Children's Center, said at a meeting on pediatric trends sponsored by Johns Hopkins University.

About 25% of children between 1 and 5 years old have trouble with bedtime or sleeping through the night, and the number of adolescents experiencing insomnia ranges between 5% and 17%.

The reasons for insomnia in children are many and complex, and there are several common traits to look for, Dr. Halbower said. Ask about depression, anxiety, and somatization. Find out if sleep quality varies by night and is unpredictable. Here are a few other key items to ask about when getting a patient's history:

* Family history of psychiatric disorders or alcohol abuse.

* Incidents of restless legs or frequent kicking at night.

* Medication use and recent changes in medication use.

* Over-the-counter medications or home remedies (including use of parents' drugs).

* Medical issues.

* Recent or past stresses.

* Hallucinations or sleep paralysis (narcolepsy).

During assessment of children for insomnia, it's important to rule out a condition called delayed sleep phase syndrome. This condition is typical in teenagers, though it can occur in younger children as well. It involves a mismatch between the child's internal rhythm and external social clues, so that the child is sleeping or awake at inappropriate times; the syndrome can resemble insomnia. "Most of these patients sleep well--they're not insomniacs--but they do it at the wrong time," Dr. Halbower said. Light therapy--using exposure to light to modify circadian rhythms--can be helpful in treating patients with delayed sleep phase syndrome or depression.

Childhood sleeplessness can have a number of causes, each of which requires a different treatment approach, she explained. Behavioral sleep problems are common in infants, and parents are often unknowingly to blame. Infants with sleep-onset dissociation disorder learn to associate certain conditions--such as being rocked, fed, or simply having the parent nearby--with falling asleep. The infant is then unable to fall asleep when these conditions are not present. Treatment for behavioral sleep problems centers on graduated extinction--the process of slowly weaning a child from inappropriate associations. Parental education is crucial, Dr. Halbower said.

Inadequate sleep hygiene is another cause of trouble initiating sleep for children. …