The Many Faces of Pediatric Insomnia

By: Dr. Irina Trosman

The Many Faces of Pediatric InsomniaAs unusual as it sounds to adults, children suffer from insomnia too. There are a variety of reasons why kids may have difficulties falling or staying asleep. As a sleep physician, it’s my job to collect a full history from the child and parents, examine the child, and try to identify the reason for insomnia.

Over the last few months I have seen children of all ages with complaints of insomnia. Here are some of their stories.

Ella

10-year old girl Ella* was brought to the sleep medicine clinic by her father. She has always been a bit of an anxious child. She previously shared a bedroom with her twin sister, but once the girls got their own rooms, Ella found herself having difficulty falling asleep. Ella began co-sleeping with her mom shortly thereafter. Since her mom frequently wasn’t in bed until 11 pm, Ella stayed up in the mom’s bedroom and watched TV. When her mom was out of town, Ella would stay up for hours and was unable to fall asleep independently. She was then tired and sleepy the following day. Upon further questioning, I found that the family had been under a lot of stress due to maternal grandparents’ health issues. Ella’s mom had been traveling a lot and caring for her ailing parents. When she was back in town, she worked long hours and did not spend much time with the children. It turns out the only time Ella and her mother had together was their bedtime.

We spent a fair amount of time talking about Ella’s worries and potential need for a protected time with her mom besides bedtime. We worked on anxiety reducing techniques and the ways to make Ella comfortable in her own bedroom. While Ella’s mom remains very busy, the child’s father needed to take a more active role.  He began spending additional time with his daughters, reading and talking about their day.

During a subsequent visit one month later, Ella and her father were happy and relaxed.  After a few weeks, Ella started sleeping in her own bedroom and now has no difficulty falling asleep independently. It was, in fact, Ella’s mom who started looking for Ella’s company late in the evening. However, Ella made a surprisingly mature decision and declined mom’s offer to sleep in her bedroom. Instead, she decided to sleep with mom’s robe in her bed to keep her “comfy.”

Marianne

8-year-old Marianne* came to a visit with her parents due to difficulty falling asleep for several years. The family tried Benadryl and Melatonin to no avail. The child was tired and frequently complained of leg pain. Upon further questioning, it was discovered that Marianne’s leg pains made her so uncomfortable, she had to massage her legs for relief. She was frequently waking up at night with an uncomfortable feeling in her legs and had a difficult time falling back to sleep. She was restless during sleep and tired in the morning. After careful evaluation and some additional tests, Marianne was diagnosed with restless leg syndrome. It was interesting to find that her father suffered from the same disorder even though he developed symptoms in his 20’s. Treatment of restless leg syndrome made a dramatic difference in Marianne’s quality of sleep and improved her daytime energy level.  Now she has only minimal symptoms and no further difficulty falling or staying asleep.

Kathy

14-year-old Kathy* had no problems sleeping until a year ago when she became a victim of cyberbullying. As a result, she was moody, tired, sleeping only a few hours per night, and having frequent bad dreams. Upon further interview without her parents in the room, she admitted to being depressed and cutting herself. With her permission to discuss the case with the parents, we sat down for a lengthy conversation.  Kathy and her family were referred to family counseling and a psychologist specializing in treatment of depression in adolescents. Kathy is doing remarkably better, though there is still a long road to recovery. Her insomnia has significantly improved with cognitive behavioral therapy.

Martin

6-year-old Martin* is an adorable boy with asthma and allergies who was having difficulty staying asleep at night. He used to frequently wake up, sleep walk, grind his teeth, and talk in his sleep. He had frequent accidents and slept in pull ups. He was embarrassed and wanted to sleep in “real underwear” like his old brother. Martin was found to have enlarged tonsils and adenoids and had a sleep study consistent with a significant case of sleep apnea (problems with breathing during sleep). His adenoids and tonsils were blocking his airways so that the child couldn’t breathe or sleep well at night.  Martin underwent a surgery for the removal of adenoids and tonsils. During his three month follow up, Martin’s mother happily reported resolution of all his symptoms including nocturnal awakenings and bedwetting.

These stories illustrate various causes of pediatric insomnia, however, every case is different. Careful evaluation is required to make an accurate diagnosis. Though sleep medicine visits may be lengthy, the results of evaluation are usually very rewarding. A good night’s sleep for the whole family is the outcome we always thrive for!

*The name has been changed to ensure the privacy of the patient.