Daytime Sleep: Why Children Nap Constantly

Sleep is essential for a child's health, well-being, growth, and learning. However, it is not uncommon for children to feel tired occasionally, and many factors can lead to tiredness. If a child is sleeping constantly throughout the day, it could be a sign that they are not getting enough sleep at night. Other reasons could include a busy schedule, hunger, or an underlying medical condition. In some cases, daytime sleepiness could be a symptom of a sleep disorder such as pediatric hypersomnia or obstructive sleep apnea. If you are concerned about your child's sleep habits or suspect an underlying issue, it is recommended to consult a pediatrician or a sleep specialist for evaluation and guidance.

Sleep disorders

Sleep is a cornerstone of healthy living and development. However, about 25% of children and teens don't sleep well, and this can have a significant impact on their health, well-being, growth, and learning.

There are several reasons why a child may be sleeping constantly throughout the day, and these can be divided into primary and secondary hypersomnia.

Primary Hypersomnia

Primary hypersomnia, also known as idiopathic hypersomnia, has no identifiable cause. It is extremely rare in children, with less than one percent of the population affected, and mostly adolescents and adults.

Secondary Hypersomnia

Secondary hypersomnia is the result of another cause, such as a lack of sleep or a medical problem. This could include sleep apnea, infections, kidney problems, or disorders such as myotonic dystrophy.

Diagnosis

If you suspect your child has a sleep disorder, it is important to consult a doctor. A physical exam will be performed to rule out any medical conditions that may be causing excessive sleepiness. Older children may be asked to keep a sleep diary for a week or more before a sleep test is recommended.

Multiple Sleep Latency Test (MSLT)

This test measures how quickly your child falls into a deep sleep over several two-hour periods. Children with hypersomnia usually fall asleep in less than 10 minutes, making this one of the best ways to detect the disorder.

Sleep Study (Polysomnography)

A sleep study can rule out other sleep disorders that may be causing excessive daytime sleepiness. If no other cause is found, and if the first test is normal, a second polysomnogram may be recommended.

Treatment

The treatment for hypersomnia depends on the type and cause of the disorder.

Primary and Secondary Hypersomnia

Behavioral changes can be effective in treating both types of hypersomnia. This includes a regular sleep schedule, a comfortable bed, pillows, and a quiet room. Avoiding caffeinated drinks before bedtime and using blackout shades can also help.

Secondary Hypersomnia Medications

Medications are most often used to treat secondary hypersomnia. Stimulants such as dextroamphetamine and methylphenidate (Ritalin™) can prevent your child from napping during the day, but they may have harmful side effects such as aggressiveness, dependence, and heart problems.

Wake-Inducing Medications

Medications like modafinil and armodafinil can influence brain chemistry and stimulate wakefulness. They are not stimulants, but they can have side effects such as headaches and potentially life-threatening rashes.

Sodium Oxybate

This drug is taken at bedtime and again during the night to promote deep sleep, which can reduce excessive daytime sleepiness in some patients.

Other Possible Causes of Daytime Sleepiness

Obstructive Sleep Apnea

Obstructive sleep apnea is a common cause of daytime sleepiness in children and teens. It occurs when something blocks the throat and air passages during sleep, causing the child to stop breathing and wake up multiple times during the night. This can lead to difficulty waking up in the mornings and focusing during the school day.

Narcolepsy

Narcolepsy is a chronic sleep disorder that can cause excessive daytime sleepiness. It may be caused by low levels of hypocretin, a brain chemical that regulates sleep and wakefulness. Children with narcolepsy may also experience muscle tone and control loss, known as cataplexy, and may have scary hallucinations.

Medications

Certain medications can cause sleep problems in children. Stimulants prescribed for ADHD, such as amphetamine (Adderall) and methylphenidate (Ritalin), can affect sleep patterns. Antihistamines like diphenhydramine (Benadryl) can also make children drowsy, while newer antihistamines like cetirizine (Zyrtec) and loratadine (Claritin) do not have this effect.

Infections

Infections, such as the Epstein-Barr virus (EBV) that causes mononucleosis, can lead to extreme tiredness in children. Other symptoms of this infection include a sore throat, fever, swollen lymph nodes, and achy muscles.

Chronic Illnesses

Children with chronic illnesses that are not well-controlled may experience fatigue. For example, asthma can make children short of breath, leading to tiredness during activity. Hypothyroidism, anemia, and juvenile arthritis are other conditions that can cause fatigue in children.

Mental Health Conditions

Mental health conditions like depression and anxiety can cause severe tiredness, lack of interest in activities, and trouble concentrating during the day. Some children with depression may want to sleep all the time, while others may cycle between periods of high activity and exhaustion.

Serious Illnesses

In rare cases, extreme tiredness in children may be caused by serious illnesses such as heart conditions, cancer, or very poor nutrition.

Medical conditions

There are a number of medical conditions that can cause a child to sleep constantly throughout the day. One of the most common is obstructive sleep apnea, a condition in which a blockage in the throat and airways causes the child to stop breathing during sleep. This can result in frequent awakenings throughout the night, leading to excessive daytime sleepiness. Other symptoms of sleep apnea include snoring, gasping for breath, heavy breathing, bedwetting, sleepwalking, and nightmares.

Another possible cause of constant daytime sleepiness in children is narcolepsy, a chronic sleep disorder characterized by an overwhelming urge to sleep during the day. Narcolepsy can cause children to suddenly fall asleep, even in inappropriate situations. It may also be accompanied by cataplexy, or loss of muscle tone, which can lead to symptoms such as drooping eyes, slack jaw, slurred speech, buckling knees, or falling over.

In some cases, constant daytime sleepiness in children can be a sign of more serious underlying medical conditions. These can include heart conditions such as heart failure, cardiomyopathy, congenital heart disease, or heart valve disorders; blood cancers such as leukemia and lymphoma; or bone cancers such as Ewing sarcoma. However, it is important to note that severe fatigue as a symptom of these illnesses is very rare.

Other medical conditions that can cause fatigue and sleepiness in children include asthma, hypothyroidism, anemia, juvenile arthritis, mental health conditions such as depression and anxiety, and infections such as mononucleosis caused by the Epstein-Barr virus.

Poor sleep habits

• Parental assistance and sleep crutches: It's common for parents to unintentionally reinforce poor sleep habits by providing too much assistance during bedtime. This may include staying in the child's room until they fall asleep, singing lullabies, or offering frequent escorted trips to the bathroom. Instead, encourage your child to fall asleep independently by teaching them self-soothing techniques.
• Lack of limits: Children often come up with various reasons why they can't sleep, such as being hungry or uncomfortable. Implement a simple reward system to handle these "curtain calls" or "callbacks." For example, offer a "bedtime pass" that allows your child to make one request and provide a small reward if they don't use the pass.
• Bedroom setup: A good bedroom for sleep is quiet, dark, and unplugged. Keep the room consistent at bedtime and during the night, ensuring the same level of lighting and minimizing disruptions. Remove electronic devices like TVs, computers, and smartphones at least 30 to 60 minutes before bed to reduce stimulation and prevent sleep fragmentation.
• Inconsistent routine: A clear and consistent bedtime routine is essential. This includes a predictable sequence of events, such as a snack, bath, brushing teeth, a final bathroom trip, and reading bedtime stories. By establishing a firm order of events, your child knows what to expect, reducing anxiety and promoting better sleep.
• Homework and screen time: Homework and screen time can impact a child's sleep quality. Ensure that your child has enough time to wind down after finishing homework and avoid having them work in their bedroom. Limit screen time before bed, as it can excite the mind and make it difficult to fall asleep.
• Diet and stimulants: A heavy meal right before bedtime or an empty stomach can disrupt sleep. Find a balanced diet that works for your child. Avoid stimulants like caffeine, which can be found in chocolate, tea, and some soft drinks, as they may cause problems sleeping.

By addressing these poor sleep habits and making necessary adjustments, you can help improve your child's sleep quality and reduce the likelihood of them sleeping constantly throughout the day.

Mental health conditions

Sleep is crucial to a child's health and development, and mental health is a significant factor in sleep patterns. Here are some ways in which mental health conditions can affect a child's sleep:

Anxiety Disorders

Anxiety disorders are the most common childhood psychiatric disorders, affecting up to 20% of children. They are associated with significant impairments in various domains, including academics, family relationships, and social interactions. Research shows that up to 95% of children with anxiety disorders experience sleep problems, including increased nighttime arousals, longer sleep onset latencies, and decreased slow-wave sleep. These sleep difficulties are often underreported by anxious children and may be linked to over-involved parenting and inadequate limit-setting at bedtime.

Depressive Disorders

Depression affects approximately 1% of children and up to 5% of adolescents, with teenage girls being more susceptible. Over 90% of depressed children and adolescents report sleep problems, with the majority experiencing insomnia and/or poor sleep quality resulting in excessive daytime sleepiness. About 10% of these youth also exhibit hypersomnia (excessive sleep). Sleep problems in depressed adolescents often include circadian rhythm disorders, such as delayed sleep phase syndrome, which can lead to difficulties falling asleep and waking up at appropriate times.

Attention Deficit/Hyperactivity Disorder (ADHD)

ADHD occurs in 2–17% of youth and is associated with inattention, impulsivity, and hyperactivity. Sleep disturbances are common in children with ADHD, with up to 50% experiencing sleep issues. These can include difficulty falling asleep, staying asleep, and restless sleep. Co-occurring sleep disorders such as periodic limb movement disorder and sleep-disordered breathing are also more prevalent in children with ADHD, contributing to excessive daytime sleepiness.

Autism Spectrum Disorders (ASD)

ASD is diagnosed in approximately 1 out of 150 children and is associated with deficits in communication, socialization, and repetitive behaviors. Sleep problems are highly prevalent in this population, with rates ranging from 50–80%. Insomnia is the most common complaint, but other issues include irregular sleep-wake patterns, frequent nighttime awakenings, and bedtime resistance. Sleep loss and chronic daytime sleepiness in children with ASD can exacerbate core symptoms, leading to increased aggression, stereotyped behaviors, social skill deficits, and self-injury.

Other Factors

In addition to specific mental health disorders, general mental health issues and stress can impact a child's sleep. Children and teens experiencing mental health challenges are more likely to have sleep problems. Even without a diagnosed condition, stress and anxiety can disrupt sleep patterns and contribute to insomnia or hypersomnia.

Serious illnesses

While it is normal for children to feel tired occasionally, constant sleepiness throughout the day could be a sign of an underlying problem. If a child is consistently sleepy during the day, even when they are getting enough sleep at night, it is a good idea to consult a doctor.

Heart Conditions

Heart conditions such as heart failure, cardiomyopathy, congenital heart disease, or heart valve disorders like aortic stenosis are very rare in children but can cause severe fatigue.

Cancer

Although rare, severe fatigue can be an early symptom of cancer in children and teens, including blood cancers like leukaemia and lymphoma, or bone cancers like Ewing sarcoma.

Chronic Illnesses

Chronic illnesses that are not well controlled can lead to fatigue in children. For example, children with poorly managed asthma may experience shortness of breath, making them feel tired. Other chronic illnesses that can cause fatigue include hypothyroidism, anemia, juvenile arthritis, and mental health conditions such as depression and anxiety.

Sleep Disorders

Sleep disorders such as obstructive sleep apnea and narcolepsy can cause children to feel excessively sleepy during the day. Obstructive sleep apnea is characterised by pauses in breathing during sleep due to blocked throat and air passages. Narcolepsy is a chronic sleep disorder that causes excessive daytime sleepiness and can lead to a loss of muscle tone and control.

Infections

Certain infections, such as the Epstein-Barr virus (EBV), can cause extreme tiredness in children. EBV, which causes mononucleosis, can result in additional symptoms such as a sore throat, fever, swollen lymph nodes, and achy muscles.

Frequently asked questions