Daytime Sleepiness
Some children are excessively sleepy during the daytime hours. The most frequent cause of this daytime sleepiness is insufficient sleep at night. Some medications also interfere with children's normal alertness.
Narcolepsy
Children with narcolepsy are overpowered by strong, uncontrollable urges to sleep. They may fall asleep immediately for several minutes to an hour at a time, often in inappropriate places like a classroom. As this occurs, the body may relax and they may fall to the floor. They awaken refreshed but may become sleepy again in another hour or two, whereupon the process repeats itself.
Narcolepsy usually first occurs during adolescence and tends to run in families. Although it is a lifelong condition, it can usually be successfully treated with medication.
Sleep Apnea
Children with sleep apnea briefly stop breathing many times during the night due to an obstruction in the respiratory tract, perhaps related to enlarged tonsils and adenoids or to obesity. As the child instinctively gasps for breath, she awakens for a few moments, her normal breathing pattern returns, and she immediately goes back to sleep, probably with no recollection that this episode has occurred. Because these brief awakenings can occur dozens and even hundreds of times a night, the youngster is sleep deprived, creating sleepiness the following day. Occasionally, these children will snore in their sleep as a symptom of the obstruction of the respiratory tract.
The underlying cause of this airway obstruction must be determined and treated to cure the apnea. Once it is relieved, the child can enjoy normal sleep again.
Nightmares
Nightmares are common in middle childhood. In a typical episode a child will have a scary dream, filled with monsters or other frightening beings. She may awaken, become anxious, breathe heavily and begin crying. Sometimes the experience is so terrifying that the child may resist going back to sleep, needing close and constant reassurance. Hug your child and speak calmly, reassuring her that it was only a bad dream. Often she will vividly describe the details of the scary dream in an effort to calm herself, helped along by her parents' reassurance. She may also remember the dream the next day and want to discuss it further.
In most children nightmares occur only occasionally, usually in the early morning hours. If they happen often - or if the same frightening dream recurs - talk to your physician about them. Nightmares seem to occur with increasing frequency during times of stress, so if these dreams are recurrent, evaluate the stress in your youngster's life. On rare occasions your pediatrician may suggest that your child receive some professional counseling.
Sleep Talking
Sleep talking (or somniloquy) occurs more often than sleepwalking. During sleep, the child begins speaking, often unintelligibly and in a monotone voice, and usually for no more than thirty seconds. Most episodes take place during nondreaming sleep.
Treatment is rarely needed or prescribed. However, when sleep talking occurs in combination with sleepwalking, pediatricians sometimes recommend medication.
Sleepwalking
About 15 percent of all children between ages 5 and 12 have at least one sleepwalking episode. This disorder (also called somnambulism) tends to affect boys more often than girls, and in a small number of children, episodes take place several nights a week.
Sleepwalking usually occurs during the second or third hour of nighttime sleep. The child sits up and, without totally awakening, leaves his bed, usually walking awkwardly, with his eyes open and a blank look on his face.
For several minutes he may wander through the house, even opening doors along the way, but his actions are purposeless. If spoken to, he may seem to respond, but the words are usually unintelligible. He will probably return to his bed on his own and go back to normal sleeping, recalling nothing of this nighttime activity when he awakens in the morning.
If your child sleepwalks, you need to minimize his chances of hurting himself. Make sure he has a safe environment - that is, outside doors should be locked so that he cannot leave the house, stairways should be blocked so he cannot walk up or down them and hazardous objects should be moved to a less dangerous location. When you find him walking in his sleep, gently lead him back to bed.
Sleepwalking tends to run in families. In most children this unusual habit disappears on its own, generally by early adolescence. For the frequent or troublesome sleepwalker, your pediatrician may prescribe medications to reduce the number of episodes.
Night Terrors
Night terrors are a different phenomenon from nightmares and can be quite upsetting for a parent to watch. About 90 to 180 minutes after falling asleep, the youngster will abruptly sit up in bed, open his eyes, and scream loudly or cry out for help. For the next few minutes he may gasp, moan, mumble, thrash about, and seem to be in a confused, agitated state. His breathing and heart rate will accelerate significantly. He will be unresponsive to his parents' attempts at comforting him and may even push them away. These episodes can sometimes last for 30 to 60 minutes before the child rather quickly returns to a peaceful sleep, remembering nothing about it the next morning, and leaving parents baffled and terrorized-hence, the name "night terrors."
Night terrors (or pavor nocturnus) occur in a relatively small number of children (1 to 5 percent), taking place during a nondreaming, deep stage of sleep. As frightening as they may be for parents, they are not a reflection of a psychological disturbance. They are a normal, although infrequent, part of the body's transition between sleep states. Sometimes physical exhaustion can contribute to a child's having night terrors. Most children outgrow night terrors without treatment, and parents can do nothing to resolve their occurrence. Parental patience and understanding are important, although these night terrors tend to be much more stressful for mother and father than for their children.
Excerpted from Caring for Your School-Age Child: Ages 5 to 12, Bantam 1999
© Copyright 2000 American Academy of Pediatrics