According to the American Family Physician organization, up to 50% of kids will endure a sleep problem. There are signs and symptoms indicating that your child has a sleep disorder. Identifying and addressing the concern in a timely manner can benefit a child developmentally, emotionally, and physically. Looking for root causes and an integrative approach can ensure that all angles are covered for your child's best interest.
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What are Sleep Disorders?
Sleep disorders are conditions where a child has trouble falling or staying asleep. There are specific reasons why this happens, some of them being anatomical, like obstructive sleep apnea, and others being behavioral, like sleepwalking or restless leg syndrome. Sleep disorders can have a trickling effect on a child's overall health and well-being. Addressing the issue through appropriate testing and therapeutic interventions is the best way to restore your child's sleep.
What are the Most Common Sleep Disorders in Kids?
There are several pediatric sleep disorders. Here are a few examples:
Obstructive Sleep Apnea (OSA)
This sleep condition is caused by an upper airway obstruction that disrupts breathing patterns and sleep. The primary cause in children is enlarged adenoids and tonsils, which is most prevalent when there is heightened tonsillar growth between ages two and eight. Associated signs of OSA are snoring, along with a hyperextended neck with a mouth open sleep position, sweating while sleeping, bedwetting, morning headaches, having a child that's very tired during the day, and sleep-related paradoxical breathing. Polysomnography (sleep study) is the diagnostic tool for determining if your child has OSA.
Parasomnias
This category encompasses abnormal behaviors, movements, and emotions that can occur during sleep. The most common occurrences are sleepwalking, sleep talking, confusional arousal, night terror, and nightmares. Most of these happen during the early stages of their sleep cycles, except for nightmares which occur later during rapid eye movement. An evaluation for OSA is relevant as it is the cause of parasomnias in about fifty percent of children experiencing this.
Restless Legs Syndrome (RLS)
Discomfort in a child's legs, with an urge to continuously move them, can keep kids up at night. This occurs in about 2% of children with sleep disturbance. This begins in the evenings while resting, and relief is only felt when they move their legs around. It can commonly be seen in kids with ADHD or growing pains. There is a significant familial link, as well as an iron deficiency state, that can be a predisposing factor to children developing restless legs syndrome.
Behavioral Insomnia of Childhood
This condition is a learned behavior where a child has a tough time falling asleep or staying asleep. There are two categories that a child could call into with behavior insomnia characteristics. One is where the child is unable to fall asleep without specific parameters. This is called the sleep on-set association type. The child has a routine or criteria that they use to regulate their sleep. This could be things like being rocked by mom, being sung to, or having a nightlight. The second type is limit-setting, where the parents or caregivers do not set parameters around sleep. Examples are a child sleeping in the parent's bed when they have difficulty sleeping or allowing your child to determine their bedtime and routine.
Delayed Sleep Phase Disorder
A dysfunctional circadian rhythm with disturbed sleep cycles is the main culprit of delayed sleep phase disorder. Our activities of daily living, sunlight exposure, meals, body temperature, melatonin release, and sleep cues help regulate a pattern that should be aligned with the 24-hour light cycle. Kids that have this disorder often are in their teenage years. They are beginning to be more social. They go to bed later with more nighttime artificial light exposure and wake up later. This throws off their body's natural circadian rhythm, causing a disturbance in their sleep.
Symptoms of Sleep Disorders in Kids
Due to the variation in types of sleep disturbances, there is a wide range of symptoms. Any combination of these characteristics could describe a child's sleep disorder:
- Waking frequently
- Noisy, choppy breathing
- Difficulty falling asleep
- Tossing and turning all night
- Pauses in breathing while sleeping
- Gasping for breath or snoring during sleep
- Waking up screaming
- Nightmares
- Sleepwalking
- Restless legs
- Irritability
- Bedwetting
- Overweight
- Attention Deficit/Hyperactivity Disorder
- Falling asleep in school
What Causes Sleep Disorders in Kids?
In many instances, sleep disorders can be caused by life changes. When a child is out of routine, their sleep cycles may be disturbed. Each specific sleep disorder may also be correlated to its own particular causes. In Obstructive Sleep Apnea, the primary concern is airway blockage. Enlarged adenoids and tonsils are determined to be the main culprit in taking up airway space. About 80% of all tonsillectomies currently done on kids are procedures to treat OSA. Other causes of OSA include childhood obesity, anatomical divergences, weakened tongue and throat muscles due to Cerebral Palsy or Down Syndrome, allergies, family history, use of sedatives, or cigarette smoke exposure.
OSA, restless leg syndrome, and other medical conditions can cause parasomnias. When the body cannot fully engage in a sleep pattern, these sleep disturbances can occur. Other primary causes of parasomnias include lack of sleep, medications, and an immature sleep-wake cycle pattern. There are no exact causes of restless leg syndrome, but it is speculated to be caused by vitamin, nutrient, or neurotransmitter deficiencies in kids. Both Iron and dopamine depletions should be considered when RLS is present.
Insomnia related to behavioral issues is typically caused by intrinsic or extrinsic factors. Intrinsic factors include inborn considerations, such as concomitant medical diagnosis, neurodevelopmental conditions, anxiety, or the child's temperament. Hyperarousal, which is often genetically linked, can also contribute to intrinsic factors for insomnia. Extrinsic factors are more of a parent or provider issue. It's commonly seen when the caregiver does not set boundaries and rules around bedtime. Many family dynamic factors can contribute to this, such as the mental and emotional well-being of the parents, living situations, or mental health implications.
In the last common sleep disorder- delayed sleep phase disorder, science has not yet come to a clear-cut cause. There is some indication that it is related to puberty which sparks an exaggerated physiological reaction to shifts in adolescents' internal circadian rhythm.
Most Common Test for Sleep Disorders
The majority of sleep disorder conditions are diagnosed based on clinical assessment and parent reporting. Depending on clinical assessment, your child may be referred for one or more of these tests to evaluate or verify their sleep disorder.
Sleep Study
A sleep study, clinically known as a Polysomnogram, is used to evaluate for Obstructive Sleep Apnea. During this overnight test, your child's brain activity, breathing patterns, episodes of snoring, heart rate, accessory neck muscles, and oxygen levels will be recorded throughout the night using diagnostic sensors. This process can be cumbersome, but most children can sleep well while wearing this. The goal is to measure all these parameters to determine if sleep apnea is causing disordered sleep patterns. Video polysomnography is an additional sleep study to assess restless leg syndrome. This is similar to the previously mentioned test but uses video recording to see where movements align with brain activity.
Electroencephalogram (EEG)
Assessing brain activity with EEG will show if a complex condition is present. In clinical presentations of parasomnia or RLS, a physician might refer you to a neurologist for Electroencephalography testing. Sometimes complex movement patterns seen in parasomnia can mimic seizure activity. Depending on the severity of a child's sleepwalking, sleep talking, or confusional arousal, their doctor may want to rule out seizure activity.
Actigraphy
This is a test that is sometimes utilized in the diagnosis process of childhood insomnia and sleep apnea. Actigraphy is a wrist-sensory device that measures body movement. It can assess when movement occurs, the intensity of the person's movement, and the duration of movement in all directions. This analysis method is especially beneficial in children on the autism spectrum to determine what is impacting their sleep.
Blood Analysis
Determining that there is no medical cause for a child's sleep dysfunction is essential. Since low iron, low dopamine, and conditions leading to this can cause restless leg syndrome, it's important to rule out medically induced contributors.
Functional Medicine Labs to Test for Root Cause of Sleep Disorders
Combining conventional testing methodologies with functional medicine investigation should give a comprehensive picture of a child's sleeping disorder.
Iron Panel
Running a full iron panel, including Iron with TIBC, Transferrin Saturation, and Ferritin, will provide a complete picture. These markers indicate iron status, how well iron is being utilized, and iron storage. This panel will rule out any iron-related deficiencies as a cause of sleep disorders. Since these tests require a blood draw, it's highly recommended to go to a facility specializing in pediatric blood draws.
Neurotransmitters
If your child has restless leg syndrome or a concomitant condition like Attention Deficit/Hyperactive Disorder (ADHD), a deficiency in dopamine could give insight into the root cause. Neurotransmitter levels can be tested with a Neurotransmitters Test.
Micronutrient Testing
While no specific vitamin or mineral has been determined to cause sleep disorders, theoretical evidence suggests deficiencies can lead to RLS. Utilizing a Whole Blood Nutrient Profile test is an excellent way to identify and treat with nutraceutical therapy to support better sleep.
Stool Analysis
The gut microbiome can influence many areas of health and well-being. Gut dysbiosis has been heavily investigated in its relation to brain health. The connection between dysbiosis and sleep has also been drawn. The GI-MAP + Zonulin test by Diagnostic Solutions and the GI Effects® Comprehensive Profile from Genova Diagnostics both offer comprehensive stool analysis.
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Conventional Treatment for Pediatric Sleep Disorders
Mainstream treatments for sleep conditions in kids involve behavioral therapy, talk therapy, surgical procedures, and the use of prescription medications depending on the cause. Behavior therapy is an intervention used in all three types of sleep disorders, other than Obstructive Sleep Apnea cases. Cognitive Behavioral Therapy (CBT) is geared toward helping kids transition their irrational and fear-based thoughts into more relaxing thought patterns. Prescription medications are typically recommended short term and in conjunction with behavioral therapy. Guanfacine (blood pressure and ADHD medication), Diphenhydramine (an Antihistamine), and Lorazepam (Benzodiazepines) are three types of prescription drugs that may be recommended for a child's sleep disturbances. Talk therapy is also important and is primarily done by the parents or caregivers who engage in positive conversation with their child.
Complementary and Integrative Medicine Treatment for Pediatric Sleep Disorders
Integrative medicine, the combination of conventional medicine with complementary therapies, can offer a holistic approach to treating sleep disorders in children. Here are a few examples of integrative medicine treatments for sleep disorders:
Nutrition for Sleep Disorders
Healthy eating with a broad spectrum of macronutrients, vitamins, and minerals is vital for optimal sleep. One study examined the effects of a Mediterranean diet on sleep-related problems in pediatric patients. Results concluded that those that remained diligent with the dietary guidelines had a better sleep and fewer sleep disturbances. A Mediterranean diet is a whole-food nutrition plan emphasizing seasonally available vegetables and fruits, minimally processed items, healthy fats like olive oil, high-quality lean protein, and moderate consumption of dairy foods.
Supplements and Herbs That Help With Sleep Disorders
Implementing complementary supplements and supportive care for a child suffering from a sleep disorder can provide immediate relief and help address underlying deficiencies. Here are some of the evidence-based integrative sleep supplements:
Melatonin
This hormone plays a critical role in regulating sleep. In optimal circadian rhythms, melatonin is released from the pineal gland when our brain responds to darkness. Melatonin helps induce a state of sleepiness by influencing many areas of the brain. It also has a role in developing our body's sleep-wake patterns. For reasons previously mentioned, children who have a disturbance in this pattern may benefit from melatonin support. Supplementation of melatonin is safe and effective in treating sleep disorders at a dosage between 1 to 5 mg, which should be calculated using this formula: .05-.15 mg per kg of body weight. It's best to start low and work with an integrative healthcare practitioner on the correct dosing for your child.
Vitamin D
A correlation has been found between sleep disorders and vitamin D deficiency. In this study, 20 of the 39 children were vitamin D deficient. Compared with the others with sufficient vitamin D status, the deficient vitamin D group engaged in less sleep which was also less restorative. Measuring the vitamin status, supplementing, and monitoring could be an opportunity to improve your child's sleep while also learning the intricate dynamics of how micronutrients can impact health. Vitamin D supplementation ranges from 600-1000 IU daily for therapeutic dosing in children older than one-year-old.
Iron Supplementation
As mentioned, Iron deficiency can play a vital role in sleep rhythms. Those with a deficiency may have a triggered sleep disorder response. By completing a complete iron panel, you should be able to detect the bigger picture of what is going on with the child. Multiple parameters of sleep were included in this review, with a correlation between restless legs syndrome being the most connected sleep disorder to low iron status. Incorporating iron-rich foods, including liver, red meat, oysters, chicken, and green leafy vegetables, is one avenue to address a deficiency. Recommended doses for iron supplementation are based on age and range from .27mg to 15mg per day.
Chamomile
This plant is also called German Chamomile. Traditionally, Chamomile has been used as a calming herb to promote relaxation and reduce swelling. A meta-analysis and systematic review found significant improvement in sleep quality in those that took Chamomile. When starting Chamomile with kids, it's best taken as a tea, which can also aid as a bedtime ritual.
Cognitive Behavioral Therapy (CBT) for Sleep Disorders in Pediatrics
CBT has been used conventionally as a treatment for sleep disorders in children. Over the last decade or so, more research has been investigating the benefits of CBT on sleep disorders. The KiSS-program showed long-term success in implementing cognitive behavioral therapy for insomnia over a 1-year study. Utilizing this form of therapy with other integrative and holistic interventions can target sleep disorders from multiple angles.
Acupuncture for Sleep Disorders in Pediatrics
Acupuncture is a TCM (Traditional Chinese Medicine) treatment that has shown promising results in treating insomnia sleep disorders. In one randomized control trial, the treatment group received acupuncture treatments three times per week for four weeks. They also wore an at-home sleep monitor and completed relevant questionnaires during this time. Starting at the two, and then four-week mark, the treatment group saw significant improvements in their sleep quality. Incorporating acupuncture as an intervention for children with sleep disorders may be an effective avenue to healing.
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Summary
Supporting a kid through their childhood can look a variety of ways. It can be physically, mentally, and socially exhausting for children suffering during these times due to unmanaged sleep disorders. Getting to the root cause of their disturbances would be the initial step in helping them re-establish their health and feel rested. If you suspect a possibility that your child or loved one is experiencing a specific sleep disorder, it may be time to visit with a holistic practitioner who will run appropriate functional medicine tests and provide integrative options for care.
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