Colin Snow
Sleep is crucial for a child's health and development, but nearly half of children experience sleep issues at some point in their childhood. Sleep disorders in children can cause a variety of negative consequences, including health, behaviour, and development problems. While it is uncommon for a one-year-old to have a sleep disorder, it is not impossible. Common sleep disorders in children include sleep apnea, insomnia, and parasomnias, which are disruptive sleep-related behaviours such as sleepwalking, sleep talking, night terrors, and nightmares. Sleepwalking, for example, tends to be more common in children than in adults, with approximately 5% of children exhibiting signs of sleepwalking.
| Characteristics | Values |
|---|---|
| Percentage of children experiencing sleep problems | 40-50% |
| Percentage of children with a formal sleep disorder diagnosis | 4% |
| Percentage of children with insomnia | 20-30% |
| Percentage of children with obstructive sleep apnea | 1-5% |
| Percentage of children with habitual snoring | 27% |
| Percentage of children with sleepwalking | 5% |
| Percentage of children with confusional arousals | 17.3% (up to age 13), 2.9-4.2% (adolescents older than 15) |
| Common sleep disorders | Parasomnias, sleep apnea, insomnia, restless legs syndrome, narcolepsy, periodic limb movement disorder |
| Negative consequences of sleep disorders | Health, behavior, and development problems, disciplinary issues, anxiety, irritability, depression, apathy, overeating, poor attention span, memory deficiencies, increased risk of accidents and injuries, growth, blood sugar, and immune system issues |
| Treatment | Bedtime routine, treatment of underlying medical conditions, positive association with bedtime, reward system, safety precautions, parental reassurance, surgery, medication |
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What You'll Learn
Sleepwalking, night terrors, and nightmares
Sleep disorders can affect nearly half of all children at some point in their childhood. Sleepwalking, night terrors, and nightmares are all common sleep disorders in children. While sleepwalking and nightmares can be distressing for parents, they are usually outgrown as the child gets older.
Sleepwalking
Sleepwalking, or somnambulism, involves walking or performing other complex behaviours while asleep. It is more common in children than adults, with approximately 5% of children sleepwalking compared to 1.5% of adults. Sleepwalking tends to peak between the ages of 8 and 12, and it often resolves as the child grows older. If a child is frequently and persistently sleepwalking, it is important to speak with a pediatrician to rule out any serious underlying causes and develop an effective treatment plan. Safety precautions are also crucial to managing sleepwalking in children.
Night Terrors
Night terrors are sudden episodes of agitation that occur during a state of deep sleep. They are different from nightmares as children usually sleep through night terrors and do not remember them upon waking up. Night terrors typically occur during the first few hours of sleep, while nightmares tend to happen in the second half of the night when the child is sleeping lightly and dreaming. Night terrors can be scary for parents as the child might look awake, with open eyes or even crying, but they are actually still asleep and won't respond to comfort. It is recommended to avoid waking your child during a night terror as it will only cause confusion and disorientation. Instead, gently guide them back to bed if they get up, and they will usually settle back to sleep quickly. Night terrors are most common in children aged 2 to 4 years, but they can occur up to the age of 12. Most children outgrow night terrors by the time they reach puberty.
Nightmares
Nightmares are common in children, and they can be upsetting for both the child and their parents. After a nightmare, a child may wake up, remember the frightening dream, and feel distressed. It is important to comfort and reassure your child if they experience nightmares. While nightmares can be disruptive, they are usually not a cause for serious concern.
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Insomnia and behavioural insomnia
Sleep is an integral part of a child's health and development. A large longitudinal cohort study involving 13,988 children showed that at any point between the ages of 2 and 10, 72–87% experienced one or more sleep-quality disturbances. Overall, 50.0% of children regularly woke at least once in the night at the age of 2, which decreased to 13.5% by the age of 10. A large percentage of children also reported regularly waking early in the morning (36.3% at 2 years and 58.2% at 10 years), regularly having difficulty falling asleep (37.1% at 2 years and 63.0% at 10 years), and regularly experiencing nightmares (26.2% at 2 years and 49.5% at 10 years).
Behavioural insomnia in children (BIC) is a type of pediatric insomnia that encompasses three behavioural disorders: sleep-onset association, limit-setting, and combined BIC. Sleep-onset association is the most common among infants and toddlers, where the child has learned to fall asleep only under specific bedtime conditions (e.g., while being rocked, cuddled, or nursed). If the child wakes up during the night, they are often unable to fall back asleep unless those same conditions are met. Limit-setting BIC involves children explicitly refusing to go to bed or attempting to delay bedtime with persistent requests, such as asking for "one more story" or another trip to the bathroom. Combined BIC occurs when a child exhibits both a reliance on a sleep aid and defiance around bedtime.
Behavioural interventions are the first choice for the treatment of pediatric insomnia, and medication should be used in combination with non-pharmacological strategies, especially in typically developing young children. Behavioural therapies for this type of insomnia include extinction, graduated extinction, bedtime fading with positive routines, scheduled awakening, and early intervention/parent education. Several randomised studies showed that behavioural sleep treatments do not lead to later emotional and behavioural problems or negative impacts on the parent-child relationship.
If you are concerned that your child may have behavioural insomnia, it is recommended to contact a healthcare professional for advice and guidance on treatment options.
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Obstructive sleep apnea
The four main features that contribute to OSA are obesity, lymphoid hyperplasia, craniofacial abnormalities, and neuromuscular dysfunction. Obesity can cause fat deposits to form around the upper airway, increasing pressure and leading to collapse. Lymphoid hyperplasia causes tonsillar and adenoid obstruction, which can become more problematic during sleep when muscles relax. Craniofacial abnormalities refer to deviations from typical anatomy that increase the likelihood of airway collapse. Finally, neuromuscular dysfunction can be seen in conditions like Down syndrome, where there is hypotonia or low muscle tone, making the airway more susceptible to collapse.
In children, the most common cause of OSA is enlarged tonsils and adenoids, which can obstruct the airway during sleep. Other causes include low muscle tone associated with conditions like cerebral palsy or Down syndrome. Children with OSA may exhibit certain behaviours and symptoms, such as inattentiveness, irritability, behavioural problems, and morning headaches. They may also snore, sleep with their mouth open, and have frequent throat infections.
Diagnosing OSA involves taking a thorough medical history and conducting a physical examination. Doctors may also recommend a polysomnogram (PSG) or an overnight sleep study, where sensors are used to measure brain activity, heart rate, nasal and oral air movement, blood oxygen levels, and muscle activity. The data collected helps calculate the apnea/hypopnea index (AHI), which quantifies the severity of OSA. An AHI of 1 or greater is considered abnormal in children up to 13 years old.
Treatment options for OSA include surgical removal of enlarged tonsils or adenoids, continuous positive airway pressure (CPAP) therapy, and the use of specialised medical devices during sleep. Mild cases of OSA may be managed with nasal sprays or other medications. It is important to address OSA to prevent potential learning, behavioural, growth, and heart problems that can result from untreated OSA.
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Parasomnias
Sleepwalking, also known as somnambulism, is a type of parasomnia where children get out of bed and walk around or leave the room while asleep. It often occurs during the first half of the night and can be associated with complex behaviours, such as opening the front door and leaving the house. Sleepwalking usually starts during the school years, with a prevalence of 14.5% in children between 2.5 and 6 years old. It tends to improve as children get older, and interventions are generally recommended over treatments.
Sleep talking, or somniloquy, is another common parasomnia that affects more boys than girls. It usually resolves by the early teen years, and treatment is typically not necessary.
Sleep terrors, or night terrors, are considered the most frightening parasomnias for parents and caregivers. They occur when a child suddenly wakes up screaming or crying, appearing scared and confused. Sleep terrors usually happen during the first half of the night and can be accompanied by physical signs such as flushed skin, sweating, dilated pupils, rapid heartbeat, and quick breathing. They are rare, affecting 1-6% of children, and typically peak when a child is one and a half years old. Sleep terrors tend to resolve by the time a child reaches 5 years of age, but if they persist or are severe, behavioural therapies and, in rare cases, medications may be recommended.
Nightmares are also common parasomnias in children. They occur during REM sleep, usually in the second half of the sleep period, and cause the child to wake up suddenly, crying, and seeking comfort. While nightmares are typically not a cause for concern, frequent nightmares can be a sign of anxiety, emotional distress, or traumatism. Interventions such as cognitive behavioural therapy, relaxation techniques, and hypnosis may be beneficial in these cases.
Confusional arousals, or partial arousals, are very common in children, with a prevalence of up to 17% between the ages of 2 and 5 years. Children experiencing confusional arousals may sit up in bed, seem confused, moan, or call out, but they do not appear fully awake. While they are generally harmless, they can sometimes lead to sleepwalking.
Bedwetting, or nocturnal enuresis, is a common problem in childhood, particularly in younger children, and tends to affect boys more than girls. It is often not a cause for concern and can be addressed through behavioural interventions and, in some cases, medication.
While parasomnias in children are typically not indicative of underlying psychiatric or psychological concerns, they can sometimes be triggered by stress, sleep deprivation, certain medications, or medical conditions like sleep apnea. In some cases, parasomnias can be genetic and run in families. If parasomnias are frequent and disruptive to the child or family, treatments such as behavioural therapies and, in rare cases, medications may be recommended.
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Snoring and breathing issues
While occasional snoring in children is often harmless, persistent or loud snoring may signal an underlying health issue. If your child is snoring, it's important to be aware of other symptoms that could indicate a sleep disorder.
Sleep-disordered breathing (SDB) is a general term for breathing difficulties during sleep. SDB can range from frequent loud snoring that disrupts sleep to obstructive sleep apnea (OSA). OSA occurs when the tissues in the throat block the passage of air during sleep, causing frequent, momentary lapses in breathing that disturb nightly sleep. Children with OSA tend to snore with gasp-like pauses in breath, and may exhibit repeated episodes of under-breathing (hypopnea) and/or complete pauses in breathing (apnea). Other signs of OSA include restless sleep, frequent nighttime awakenings, teeth grinding, bed wetting, or unusual sleep positions.
OSA can have serious consequences for a child's health and development. It has been linked to impaired brain development, reduced academic performance, cardiovascular issues such as high blood pressure, altered metabolism, and behavior problems. It is estimated that 1-5% of children experience OSA, and it is of concern when a child's snoring is persistent, loud, or accompanied by abnormal breathing that interrupts their sleep.
If you are concerned about your child's snoring, it is important to consult a pediatrician or a sleep specialist. They can evaluate your child's airway for abnormalities, such as enlarged tonsils or adenoids, and determine if further evaluation or treatment is needed. In some cases, simple home remedies such as steam inhalation, saline nasal sprays, or the use of an air purifier can help alleviate mild snoring caused by congestion or allergies.
It is important to note that not all children who snore have OSA or another sleep disorder. Light, infrequent snoring is common and typically resolves on its own without requiring medical intervention. However, if you notice any signs of breathing difficulties or other symptoms that indicate a sleep disorder, it is always best to seek professional advice to ensure your child is getting the restful, healthy sleep they need.
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Frequently asked questions
Yes, even 1-year-olds can have sleeping disorders. Sleep disorders in children can include insomnia, sleep apnea, parasomnias, and restless legs syndrome.
If your 1-year-old seems to be having a lot of trouble sleeping, it could be a sleep disorder. Some signs to look out for include:
- Your child sleeps for only about 90 minutes at a time, even at night.
- Your child snores loudly.
- Your child resists sleep or takes a long time to fall asleep.
- Your child has frequent nighttime wakings.
If you suspect your 1-year-old may have a sleep disorder, it is important to consult a healthcare professional or a sleep specialist. They will be able to evaluate your child and determine if there is an underlying medical condition that needs to be addressed. You can also try to establish healthy sleeping habits and a bedtime routine for your child.
