Sleep-Wake Disorders in Childhood

Term used in DSM-5 for disorders related to sleep quality, timing, and associated behaviors.
Older DSM versions divided disorders; DSM-5 groups them under a single diagnostic code.
Multiple types, each with specific criteria.

Insomnia Disorder: Chronic difficulty initiating or maintaining sleep.
Hypersomnolence Disorder: Excessive sleepiness or abnormally prolonged sleep.
Narcolepsy: Sudden sleep attacks.
Breathing-Related Sleep Disorders (Sleep Apnea): Upper airway blockage during sleep.
Parasomnias: Sleepwalking, night terrors, acting out dreams.
Most common in children and adolescents are insomnia, parasomnias, and sleep apnea.

Between 25% and 40% of children and adolescents experience some type of sleep problem.
Approximately 4% of these are diagnosed with a clinical sleep disorder.
A sleep-wake disorder is diagnosed when persistent sleep disturbances cause distress and interfere with daytime functioning (health, behavior, academic performance).

Children vs. Adults: Children often exhibit hyperactivity or irritability, not just sleepiness.
Discovery by Parents/Caregivers: Observations of bedtime resistance, frequent night awakenings, seeking parental comfort, snoring, unusual movements, or screaming during sleep.
Older Kids/Teens: May complain of insomnia or excessive daytime sleepiness, or anxiety about sleep.
Other Discovery Methods: Incidental medical findings (e.g., small for age), school issues (poor grades, difficulty focusing), or rare emergencies (e.g., sleepwalking dangers).

Sleep difficulties occur at least 3 times a week for at least 3 months.
Must cause significant distress or impairment.
Insomnia Example: Persistent difficulty falling/staying asleep or poor sleep quality, despite adequate opportunity, accompanied by daytime impairment.

Sleep Logs/Diaries: Parental or adolescent tracking of sleep patterns for several weeks.
Actigraphs: Wearable sleep trackers to estimate sleep patterns.
Sleep Studies (Polysomnography): Primary method for diagnosing conditions like sleep apnea.
Questionnaires.
Medical Evaluation: Rule out underlying medical conditions (e.g., hormonal issues, allergies, asthma, reflux, medication side effects).
Psychiatric Conditions: Assess for comorbid anxiety or mood disorders.
Developmental Stage: Crucial for differentiating normal sleep patterns from disorders (e.g., infant waking, occasional nightmares).
Screen Exposure: Blue light from screens interferes with natural melatonin release, impacting sleep readiness.

Inconsistent bedtime routines/lack of schedule.
Poor parental modeling of sleep hygiene.
Co-sleeping.
Genetic predisposition (e.g., sleepwalking).
Medical conditions (e.g., allergies, asthma, recurrent ear infections, eczema, obesity, acid reflux).

Consistent Bedtime Routine: Establish a predictable sequence of activities (e.g., bath, pajamas, teeth) that serves as sleep cues, performed at the same time nightly.
Good Sleep Hygiene Education: Promote practices like sleeping in a dark, quiet, cool environment; limiting caffeine and sugar intake; avoiding screen time at least 1 hour before bed.
Teaching Self-Soothe: Put children to bed drowsy but still awake to help them learn to fall asleep independently in their own bed.
Limit Setting Techniques: Parents set firm but calm boundaries for children who stall or refuse bedtime, e.g., a "bedtime pass" or consistent rules for electronics and lights out.
Positive Reinforcement: Use reward systems (e.g., sticker charts, token economy) and praise for sleeping through the night or staying in their own bed to motivate positive sleep behaviors.