Sleep is a part of our lives. When we sleep, we rest both physically and mentally. When we are awake, the physiological balance in our body is completely disturbed, which is why sleeping is necessary in order for that balance to be restored.
Sleeping disorders are frequent and, in spite of the esteemed opinion, they also affect children. Some forms are more frequent in children, and some in adults. Every single child has had problems with sleeping at some point, but we refer to the disorder only when, due to a sleep disorder, the child starts having difficulties in performing everyday activities: the child is tired, sleepy, unable to concentrate on learning, or avoids going on school excursions, because the child is ashamed of his or hers unusual sleeping behaviors.
Sleeping disorders can be divided into four major sections:
- Primary sleeping disorders – it is assumed that these occur due to the abnormalities in the mechanisms that are responsible for the commencement or balancing the periods of sleeping and wakefulness, and are often complicated by the environmental factors. We divide these disorders into: dyssomnia – characterized by the abnormalities in the amount, quality, and periods of sleeping; parasomnia – characterized by the abnormal behavior or physiological events that are related to sleeping, specific stages of sleeping, or the transition between the sleep-wake stages.
- Sleeping disorder related to other mental disorders
- Sleeping disorders caused by the impairment of general health
- Sleeping disorders caused by the psychoactive substances.
When we talk about the sleeping disorders, we primarily refer to the primary disorders.
Dyssomnias
Primary insomnia – It is a disorder characterized by difficulties in falling or staying asleep, or the inadequate amounts of sleep. This disorder is more frequent in adults, even though it is not excluded in children. If it occurs in children, then it is mostly caused by the environmental factors: a child has problems in school or in dealing with his peers, so that the child thinks during the night or experiences difficulties when separated from the parents. It is important to stress the fact that the roots of the light and interrupted sleep stem from the family.
Primary hypersomnia – It is characterized by the excessive sleepiness and also occurs in some families. This disorder usually appears in adolescence, and it is the most intensive between the ages of 15 and 30.
Narcolepsy – It refers to the repetitive and uncontrollable attacks of the restful sleep. The sleepiness is reduced after these attacks, only to return a few hours later. Narcolepsy is usually preceded by a period of the daytime sleepiness. In clinical terms, this disorder mostly becomes apparent in adolescence. The family research points to the role of genetic factors in the development of this disorder.
Sleeping disorders related to breathing – These refer to the intermittent breathing that leads to the excessive sleepiness or insomnia. This disorder usually occurs in middle age, and it is related to the enlarged tonsils in children. The family tendency towards this disorder has been described.
Irregular sleep-wake syndrome – An important hallmark of this disorder is a permanent repeating model of the intermittent sleep, which is a consequence of an imbalance between the individual endogen sleep-wake systems on the one hand, and the environmental pressures on the other hand. It most frequently occurs in persons who work the night shifts and in adolescents: the sleep-wake rhythm in adolescents is different from the sleep-wake rhythm in adults, due to the environmental requirements.
If they follow their rhythm, adolescents go to sleep late and feel the need to sleep for long periods of time, while the environmental requirements of getting up early because of school cause the permanent feeling of fatigue in adolescents.
Parasomnias
Nightmares – An important hallmark of this disorder is the repetition of the terrifying dreams that lead to waking up. The content of these dreams is related to the intimidating physical dangers (persecution, attack, injury), or the danger can be less prominent, while a personal mistake or embarrassment becomes more prominent (dreams in which we get embarrassed, fail an exam, get a bad grade in school).
In most cases, nightmares are not a reflection of the real life events. Several nightmares can occur during the night, mostly with the same theme. They end in waking up and long-lasting feeling of fear, which leads to the difficulties in falling asleep again.
Nightmares usually begin between the ages of three and six. The majority of children have these dreams at least occasionally, but after several years of occasional recurrence, they spontaneously disappear. Between the ages of three and five, 10 – 50 percent of children have such strong nightmares that they cause the parents to have serious concerns. Nightmares can sometimes happen to adults. If their frequency is high (several nightmares per week), dreams can become a serious source of concern.
Night terrors – This disorder is characterized by the recurring, sudden awakenings. They usually occur during the first third of sleep, start with screaming or crying, and last up to ten minutes. The episodes of terror are followed by excitement and behavior that is characteristic for intensive fear.
During the night terror episode, it is difficult to wake up or console the child, and if the child does wake up, he or she does not remember the dream or remembers only some fragments of it. The next day, the child does not remember anything. Night terrors usually begin occurring in children between the ages of four and twelve, and they spontaneously disappear during adolescence. Some research talk about the family tendency towards the night terrors.
Sleepwalking – It refers to the recurring episodes of the motor behavior that start during the sleep state, and involve getting out of bed and walking. These episodes usually occur in the first third of the night. During sleepwalking, the wakefulness and the ability to respond to stimuli are reduced. Remembering the events from the previous night is limited during the following day.
The sleepwalking episodes include different behaviors: from mild ones, when the child sits in the bed, looks around, and plays with the bed sheet or the blanket, to the more complex ones, when the child gets up, exits the room or even the house, eats, talks. The simpler activities usually happen, but the more complex activities such as operating machinery are also described.
If the child wakes up after a sleepwalking episode, he or she is disoriented. Between 10 and 30 percent of children experience at least one sleepwalking episode, while the recurring ones are less frequent (5 percent of children experience them). Sleepwalking is frequent among the members of the same family.
Individual therapeutic approach
It is important to mention that all sleeping disorders can occur in both adults and children, but some are still more frequent in children. The sleeping disorders from the parasomnia group are more frequent in children, and most of them spontaneously disappear after adolescence.
Narcolepsy and hypersomnia are more frequent in adolescents, while the insomnia is more frequent in adults, even though it can occur in children. Occasional sleeping disorders can occur in healthy children, as well. However, if the disorder is of such high intensity that it prevents a child from the normal everyday functioning, whether the child is always tired or avoids other people because of the unusual sleeping behavior, we can then refer to it as a sleeping disorder.
The treatment of sleeping disorders is individual. We must always pay attention to whether the sleeping disorder is accompanied with some other disorders (mental or physical), or whether it is about the combustion of the psychoactive substances. Intensive night terrors and nightmares are often related to the separation anxiety issues in children and they can be treated with psychotherapy. The medications are prescribed only in extreme cases.