03.Common sleep disorders
such as sleepwalking, ‘night terrors’ and nightmares. If your child is a sleepwalker, the most important thing to do is minimise their ability to hurt themselves. Make sure knives, medicines and chemicals are locked up, doors and windows are closed and so on. If you find your child sleepwalking, don’t try to wake them, but gently guide them back to bed.
A child who wakes up in the middle of the night screaming may be experiencing night terrors. They usually happen during deep sleep, very often at exactly the same time each night. The child may appear to be awake, but they don’t respond to you talking to them. They may sweat, breathe quickly and have enlarged pupils. If your child is having regular night terrors at the same time, try to partially wake them before the episode happens and pat them gently on the back for a few minutes. Then allow the child to settle themselves back to sleep.
After a nightmare, a child needs some time to tell you what their dream was about, as well as getting some reassurance from you. It’s best then to put them back in their own bed if you’ve moved them.
affects children as well as adults. The sufferer literally blocks off their airway and stops breathing over and over again throughout their sleep. According to Dr Jim Papadopoulos, thoracic (sleep) paediatrician at St George Private Hospital, Sydney, about 3% of children aged two to six suffer from obstructive sleep apnoea, but it can occur at any age, including infants.
Symptoms can include snoring or loud breathing, pauses in breathing accompanied by choking or gasping noises, restless sleep, sweating in sleep, and daytime tiredness, moodiness and hyperactivity.
The good news is that having their tonsils and adenoids removed (adenotonsillectomy) is an effective treatment for most (but not all) of these children. Another contributing factor to sleep apnoea is obesity, which can also cause sleepiness on its own.
If you suspect your child has a sleeping disorder, it’s important to get them diagnosed correctly. A physical examination and consultation with a doctor or a paediatrician specialising in sleep disorders is the first step. They may also ask you to keep a sleep diary, or want to monitor sleep with special sensors by having your child stay overnight in a children’s sleep unit. The parent also stays the night in the same room and the sleep sensors don’t as a rule distress the child, as they don’t hurt or stress them.
Children with delays and disabilities
Children who are neurologically impaired (those with conditions such as Angelman’s syndrome or autism) or who have psychological illnesses (such as ADHD) commonly have trouble getting to sleep or staying asleep. Sleep hygiene is vital to help these children.
Other behavioural strategies, such as using reward systems or changing sleep onset associations (see below), have shown some success. It’s also important to have the child diagnosed for possible sleep disorders such as sleep apnoea, which could be connected with their condition.
Some preliminary testing using valerian had positive results with neurologically disabled children, but because the test group was so small further studies are needed. Some children have also responded to melatonin replacement therapy. While it’s not recommended that supplements be used on children without careful monitoring by a paediatric sleep specialist, it’s worth noting these are possibilities that warrant further investigation.
Sleep onset association disorder
Sometimes a child has no trouble getting off to sleep, but will wake regularly crying and needs a parent to put them back to sleep. This constant disruption to everyone’s sleep can create a very sleep-deprived household. The pattern can be set up from what the child associates with sleep. This is because, during the sleep cycle, we all partially wake up approximately every 60 to 90 minutes and check our environment (though we usually don’t remember doing so).
However, if we awaken and our environment has changed we might then completely wake up. For example, if a child goes to sleep with the light on but wakes to find it’s been switched off, they may react to the change in the environment and become fully awake. They may become frightened and cry until the parent comes and turns the light on, after which they’ll go to sleep again.
To overcome this pattern, a more useful sleep association needs to be set up. For instance, if your child won’t sleep without being rocked in your arms, continue to do this for three or four nights, but also introduce a couple of other sleep associations like a teddy bear or soft blanket for the child to hold. After a few nights, instead of rocking your child, sit next to them and pat them while they go to sleep, as well as using the teddy and blanket. Then, after a few more nights, sit next to them without patting them. After a few more, stand by the door while they go to sleep. Finally, let them fall asleep with just the teddy and blanket to comfort them.