Sleep disorder

Most children and adolescents experience sleep problems at some stage. Sleep problems may not necessarily meet diagnostic criteria but are nevertheless a source of considerable distress for both children and their families due to a reduction in the child’s overall functioning and wellbeing.

Most therapies for nightmares tend to involve techniques to reduce anxiety such as relaxation and parental counselling. Sedatives and/or melatonin supplementation are only considered helpful as a last resort (depending on the severity and duration of the problem).

In many cases, therapy is not needed because the nightmares disappear on their own. If therapeutic intervention is required, nightmares and night terrors are addressed through a combination of medication, education regarding the nature of the problem, dietary changes, relaxation techniques, and parental counselling – all of which have proven to be effective. Unfortunately, these interventions do not treat potential underlying causes such as daytime stress and anxiety. A combined approach can produce the best outcomes.

SLEEP WALKING

In the late 1960s, Professor Barry Sterman at UCLA discovered that there are alpha rhythms in the brain, termed ‘sleep spindles’, which do not appear in restless sleepers, people with restless legs, and sleepwalkers. 

Sleepwalking can be benign – a habit that is broken by making changes to a child’s sleeping environment (e.g., changing their bedroom for a few days). It is not recommended to try and wake a sleepwalking child as they may become distressed. We recommend guiding or carrying them back to bed.

DIFFICULTY GOING TO SLEEP

Behavioural techniques are more successful than sleeping tablets, but before behavioural interventions commence, causes such as colic, milk intolerance, sleep phobias, and/or nightmares need to be ruled out and treated appropriately. If the child feels safe during waking hours, the most effective behavioural technique involves tucking the child in at bedtime, leaving the bedroom, and not returning until the child is asleep. Failing this, the parent can briefly re-enter the bedroom to ensure the child has no physical complaints. The first night is often difficult for all involved, but if this routine is applied consistently and correctly, rapid progress is made. Controlled crying is not useful in the long term since it may teach learned helplessness. Halfway measures, such as allowing the child to cry for 20 minutes before intervening is also counter-productive because the child’s crying may be positively reinforced.

SLEEP-WAKE RHYTHM DISORDERS

Children with free-running 25-hour sleep-wake rhythms can benefit from bright light therapy which blocks drift and resynchronises the sleep-wake rhythm. This therapy involves waking the child early, around 7.00am, and exposing the child to sunlight or bright ‘daylight lamps’. In the evening, the child should avoid bright white lights, in favour of warm lights, and avoid artificial light from TV, phones, or computer screens.