Childhood Insomnia Causes and Treatment

Most parents picture a crying baby when they think about kids and sleep problems. Many older kids and teens have problems sleeping too, including trouble going to sleep and waking up frequently in the middle of the night.

Unfortunately, not getting a good night's sleep can affect your child's mood and behavior during the day, leading to school and discipline problems.

Childhood Insomnia

Like adults, children with insomnia either have trouble going to sleep, staying asleep, or are simply not well rested after what should be a normal amount of time sleeping. In addition to being sleepy during the day, symptoms of childhood insomnia can include:

• Aggressiveness
• Decreased attention span
• Depressed mood
• Hyperactivity
• Irritability
• Memory problems
• Mood swings

Causes

One common reason that many children don't get enough sleep is that they go to bed too late. This is often because parents have unrealistic expectations for how much sleep their kids need or because their kids are over-scheduled, with too many activities and too much homework. Or your child may simply be up late texting, talking on the phone, playing video games, or watching TV.

Remember that children between the ages of 6 and 13 need about 9 to 11 hours of sleep each night, and teens need about 8 to 10 hours. If you set a realistic bedtime and your child is still not getting a good night's sleep, the common causes of insomnia can include:

• Anxiety
• Asthma (coughing)
• Caffeine
• Depression
• Eczema (itching)
• Neurodevelopmental disorders such as autism, Asperger's Syndrome (which the DSM-5 now classifies as Autism Spectrum Disorder), and intellectual disability
• Obstructive sleep apnea (snoring)
• Poor sleep habits
• Restless legs syndrome
• Side effects of medications, including stimulants used to treat ADHD, antidepressants, corticosteroids, and anticonvulsants
• Stress

Treatments

Although parents often want to turn to a prescription to treat their child's insomnia, it is much more important to look for any underlying medical or psychological problems that may need to be treated first. For example, if your child has obstructive sleep apnea and snores loudly at night and frequently stops breathing, then they might need to have their tonsils and adenoids removed.

Or if your child has a frequent nighttime cough because their asthma is poorly controlled, they may need stronger preventive asthma medication. If your child has sleep apnea, asthma, or is depressed, a sleeping pill is not the answer—especially since no sleeping pills have been approved for use by children.

Medications

Medications which are sometimes used when necessary and appropriate include:

• Antihistamines, although these commonly cause daytime drowsiness and would be used for only a short period
• Clonidine, such as if your child also has attention-deficit/hyperactivity disorder (ADHD) or behavior problems
• Melatonin
• Risperdal (risperidone), for children who have autism or behavior issues
• Sedating antidepressants, including Elavil (amitriptyline) and Remeron (mirtazapine)

Unless another diagnosis is the cause of your child's insomnia, a prescription is usually not the answer.

Non-Drug Treatments

Non-drug treatments for primary insomnia, or childhood insomnia that is not caused by another medical condition, can include:

• Avoiding caffeine
• Exercising regularly
• Getting out of bed and doing something quiet, such as reading, if your child doesn't fall asleep within 10 to 20 minutes
• Having a very consistent schedule of when your child goes to bed and wakes up, including weekends and holidays
• Restricting time spent in bed to only sleeping, which means no reading, doing homework, or watching TV in bed
• Stopping stimulating activities 30 to 60 minutes before bedtime, such as playing video games, watching TV, texting, or talking on the phone
• Teaching your child about relaxation techniques, including diaphragmatic breathing, progressive muscle relaxation, and visual imagery, which they can use when going to sleep

Seeing a counselor or child psychologist, in addition to your pediatrician, can also be helpful for most children with insomnia.

ADHD and Insomnia

It can be especially confusing to treat children with ADHD and insomnia since many of the symptoms of insomnia are the same as the symptoms of ADHD, and the treatments for ADHD can often cause insomnia. If your child's insomnia worsened when they started an ADHD medicine or had an increase in dosage, then the medicine may be to blame.

However, for some children with ADHD, it is their actual ADHD symptoms that cause them to have trouble sleeping. Surprisingly, a small dose of a short-acting stimulant in the afternoon or evening actually helps them sleep. Your pediatrician and/or a child psychiatrist can help sort out what is causing your child with ADHD to have sleep problems, which is important since not getting a good night's sleep can worsen all of the symptoms of ADHD.

And keep in mind that in some kids who seem to have symptoms of ADHD but who actually have a sleep disorder or simply aren't getting enough sleep, the ADHD symptoms can go away when their sleep problem is fixed.