Test Your Knowledge

According to the National Institutes of Health, more than 100 disorders of sleeping and waking have been identified. They may fall into one of several categories.

Dyssomnias are disturbances in the amount, timing or quality of sleep resulting in excessive daytime sleepiness. Some common dyssomnias that affect children include:

• Insomnia. Condition of inadequate or poor sleep that may include difficulty falling asleep, waking up frequently during the night with difficulty falling back asleep, waking up too early in the morning or nonrestful sleep.
  
  
• Sleep apnea. Sleep disorder that causes breathing to become shallow or stop while sleeping. Each pause in breath usually lasts 10 to 20 seconds. Pauses can occur 20 to 30 times in an hour. Sleep apnea in children is associated with daytime drowsiness, poor academic performance and hyperactivity. Obstructive sleep apnea syndrome (OSAS) involves snoring associated with gasping or pauses in breathing. Between 1 and 3 percent of children have this disorder, according to the National Sleep Foundation (NSF). Childhood obesity raises the risk of having sleep apnea.
  
  
• Restless legs syndrome (RLS). Sleep disorder characterized by unpleasant sensations in the legs that are described as creeping, crawling, tingling, pulling or painful. RLS can result from changes in bedtime routine, increased amounts of iron in the body and use of certain medications.
  
  
• Narcolepsy. Chronic sleep disorder characterized by excessive and overwhelming daytime sleepiness and short “sleep attacks,” even after adequate nighttime sleep. About 250,000 Americans have narcolepsy, according to the National Center on Sleep Disorders Research. Its cause is unknown. Narcolepsy may begin as early as age 10 and is most likely to be noticed in puberty.
  
  
• Periodic limb movement disorder (nocturnal myoclonus). Characterized by periodic episodes of repetitive jerking and kicking during sleep.

Parasomnias are disorders that involve abnormal behavioral or physiological events during sleep. They involve partial arousal or interference with sleep stage transition. Some common examples of parasomnias that affect children include:

• Arousal disorders. Disorders that involve partial arousal, such as sleepwalking and night terrors, which are characterized by sudden arousal from sleep and increased pulse and breathing rate. Night terrors occur when a child wakes up screaming at night and appears confused. Although children in the midst of a night terror appear to be awake, they typically cannot communicate. Night terrors often strike between the ages of 4 and 12 and tend to affect boys more often than girls. Sleepwalking is another arousal disorder. It involves walking around for between five and 20 minutes while in a state of sleep, usually within two hours of falling asleep. Although children in this state appear to be awake, they are actually sleeping and in danger of hurting themselves. Sleepwalking usually begins between the ages of 6 and 12 and affects more boys than girls. Up to 40 percent of children sleepwalk, according to the NSF.
  
  
• Sleep-wake transition disorders. Disorders that interfere with sleep stage transition. Sleeptalking – in which a child talks, laughs or cries during sleep – is one example. In most cases, the child does not remember the behavior the next day. Sleeptalking typically does not require treatment.
  
  
• Nightmares. These are frightening dreams that occur during rapid eye movement (REM) sleep and are associated with increased pulse and rate of breathing, profuse sweating and arousal. Many children have occasional nightmares. Although scary, they are relatively minor and infrequent disruptions in sleep. However, about 3 to 5 percent of preschool and school-aged children may experience chronic nightmares, according to the NSF. These dreams cause significant interference with a child’s ability to sleep and feel rested.
  
  
• Teeth-grinding (bruxism). This occurs in children who clench and grind their teeth during sleep. Over time, this can wear down the teeth or cause jaw pain. Mouthguards or splints are often used to treat this condition.
  
  
• Bedwetting. Bedwetting is a symptom that occurs when a person cannot control bladder function, usually during sleep. It is also known as enuresis, and affects 15 percent of children – especially boys – after the age of 3, according to the American Academy of Child and Adolescent Psychiatry. Occasional bedwetting is a normal part of childhood. However, other factors – including stress – can cause bedwetting. In such cases, it may require treatment.

Some sleep abnormalities may not rise to the level of a sleep disorder. For example, snoring is the result of a partial blockage of the airway that triggers a vibration in the back of the throat. Between 10 and 12 percent of children snore regularly, according to the NSF. This is often caused by nasal congestion or an enlarged adenoid or tonsils, but may be associated with a sleep disorder such as sleep apnea. In other cases, children may resist sleep or develop poor sleep habits. They may be reluctant to go to bed or may insist that a parent stay with them. This is often caused by normal developmental issues, such as separation anxiety. These types of disturbances are considered secondary, as opposed to primary (e.g., sleep apnea).