Sleep! Throughout our lifetimes this restorative activity is fought, manipulated, embraced, and finally accepted as a necessary part of our lives. The parents of infants have firsthand experience in dealing with interrupted sleep, and many go on to learn about night wakings, bedtime struggles, early risings of energetic toddlers, and the rather bizarre nocturnal occurrences (sleepwalking, sleeptalking, teeth grinding, head banging and rocking, sleep terrors, and nightmares) that are common among children. As children get older, their repertoire of nighttime behaviors expands, and parental responses evolve and become more varied. The types of sleep disturbances seen in children change with age, although sleep disturbances such as bedtime struggles, night wakings, and sleepwalking have been shown to persist over a number of years (Anders & Eiben, 1997). Thus, although sleep problems in children may be common, they do not always go away on their own.
When parents request help with sleep problems, the situation has usually reached a crisis point. It is important for the child clinician to be able to help these parents and their children, as well as to be aware of the role sleep problems can play in other disorders of childhood. This chapter first reviews age differences in normal sleep states and patterns, and the types of sleep disturbances seen in children. Assessment and treatment of the most common sleep problems are then discussed.
To understand sleep disturbances, one must first have a rudimentary understanding of the physiology and development of sleep. A mature nervous system is necessary to regulate the sleep cycle over many hours, and thus children's sleep cycles follow a developmental course.
The sleeping person may appear inert, but his or her sleeping state is a complex, highly organized neurophysiological process. Sleep is divided into two distinctly different states: rapideye-movement (REM) sleep and non-rapid-eye-movement (NREM) sleep (Kales, 1969). REM sleep is also called “paradoxical sleep,” because it has features of both deep sleep and light sleep. It is characterized by an irregular pulse and respiratory rate, as well as rapid eye move-